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PACKAGING  OF MEDICINES AND CHILDREN SAFETY. Accident data from Belgium Dr Martine MOSTIN. NATIONAL POISON CENTRE . ~ 50.000 calls year 75% calls from public 80% accidental exposure 50% children . NATIONAL POISON CENTRE. Calls reflect exposure rather than poisoning .

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packaging of medicines and children safety

PACKAGING  OF MEDICINES AND CHILDREN SAFETY

Accident data from Belgium

Dr Martine MOSTIN

national poison centre
NATIONAL POISON CENTRE
  • ~ 50.000 calls year
  • 75% calls from public
  • 80% accidental exposure
  • 50% children
national poison centre3
NATIONAL POISON CENTRE

Calls reflect exposure rather than poisoning

  • Availability of product
  • Perceived risk (hypnotics, thyroid hormones, contraceptives …)
  • Need for information ( medical professionnals) : new drugs
accident data 2003
ACCIDENT DATA 2003
  • Children exposure (0-14 y): 19.872 calls
  • Pharmaceutical exposure: 6.808 calls
  • Pharmaceutical exposure 1- 5 y: 4.836 calls
accident data 20038
ACCIDENT DATA 2003
  • Child 1- 5 year
  • Pharmaceutical exposure

Referred to hospital by PC

OR

Call received from hospital

accident data 20039
ACCIDENT DATA 2003
  • 1385 significant exposure (28.5%)
    • 1247 single drug exposure
    • 1293 accidents
    • 67 therapeutic error
    • 19 adverse drug reactions
    • 6 circonstances n.sp
accident data 200310
ACCIDENT DATA 2003
  • One death
  • 3 y old
  • Therapeutic error
  • Percutaneous administration of monochloroacetic acid
hypnotics and sedatives benzodiazepines
HYPNOTICS and SEDATIVES Benzodiazepines
  • Liquid forms : 2%
  • < 8 tablets : 60%

>8 tablets : 8%

Unspecified : 30 %

hypnotics en sedatives benzodiazepines
HYPNOTICS EN SEDATIVES Benzodiazepines

Symptoms: 46 %

ataxia, vertigo, drunkeness, vomiting, agitation, sedation, coma, hypotonia

  • Less than 8 tablets = significant exposure

Life threatening intoxication unlikely with medical attention

hypnotics and sedatives zopiclone zolpidem
HYPNOTICS and SEDATIVES Zopiclone - Zolpidem
  • No therapeutic dosage for children
  • 1 tablet = usual hypnotic dose adult
  • Less 8 tablets = significant exposure
  • Life threatening intoxication unlikely with medical attention
hypnotics and sedatives clomethiazole
HYPNOTICS and SEDATIVES Clomethiazole
  • 192 mg tablets
  • Limited data on overdosage in children
  • 1 –2 tablets = significant exposure
  • Symptoms :
    • coma, risk cardiorespiratory arrest
antidepressants tricyclic antidepressants
ANTIDEPRESSANTSTricyclic Antidepressants
  • All <8 tablets (19) or unknown (4)
  • Less 8 tablets = significant exposure
    • Cardiovascular toxicity, convulsions
  • Life threatening intoxication possible
    • medical attention mandatory !!
antidepressants ssri
ANTIDEPRESSANTS SSRI
  • Wider safety margin than T3AD
  • Symptoms :
  • Hyperthermia, agitation, hallucinations, convulsions
  • Less 8 tablets = significant exposure
  • Life threatening poisoning not expected
antidepressants trazodone
ANTIDEPRESSANTS Trazodone
  • All <8 tablets (8) or unknown (7)
  • Limited data in children
  • Not recommended <6 y
    • 1-2 x 100mg, 19 month : somnolence, ataxia, hypotonia, bradypnea, bradycardia
antidepressants trazodone24
ANTIDEPRESSANTS Trazodone
  • Less 8 tablets = significant exposure
  • Life threatening poisoning not expected
phenothiazines
PHENOTHIAZINES
  • All <8 tablets or unknown
  • CNS depression, dysrythmia, hypotension
  • Medical attention almost needed
risperidone
RISPERIDONE
  • Liquid formulation (30 mg & 100 mg)
  • tablets 1-2-3 mg
  • Safety in children not established
    • Autism: 0,5 -3mg/ day
  • Limited data on overdosage
  • CNS depression/ cardiovascular symptoms /extrapyramidal effects
olanzapine
OLANZAPINE
  • Symptoms reported with 10 mg
  • 5 -7,5 -10 mg tablets
  • CNS depression, tachycardia, hpotension, extrapyramidal syndrome
drugs external use
DRUGS EXTERNAL USE
  • Ethanol based antiseptics
  • Hydrogen peroxide
  • Quaternary ammonium antiseptics
  • Keratolytic preparations
  • Pediculosis & scabies treatment
  • ….
narcotic analgesics
NARCOTIC ANALGESICS
  • Dextropropoxyphene : 150 mg tablet
    • toxic: 10mg /kg
    • lethal: 20mg/kg
  • Coma, respiratory depression, arrythmia, cardiac arrest
narcotic analgesics35
NARCOTIC ANALGESICS
  • Methadone
  • Lethal ~10 mg child
  • Syrup
  • 50 -100 mg tablets
  • Underestimation danger by addicts
medical attention
MEDICAL ATTENTION
  • Narrow safety margin
    • (chloroquine, buflomedil, dextropropoxyphene…)
  • Life threatening symptoms reported in overdose
  • Safety in children not established
  • Limited data on overdosage
children accidents
CHILDREN ACCIDENTS
  • Dose taken often unknown
  • Ingestion < 8 units common
  • If > 8 units frequently reported, look at drug presentation
  • Therapeutic error : look at drug presentation