Use and cost of antidotes in 2 hospital emergency departments

Aguilar Salmerón R, Soy Muner D, Nogué Xarau S

Background and objectives: Antidotes are basic resources among the options available

for treating certain types of acute intoxication. The aim of this study was to describe the

use of antidotes in the emergency departments of 2 hospitals and to determine the cost

of using these drugs in the context of the overall treatment of patients who have been

poisoned.

Material and methods: Prospective descriptive study of the use and cost of antidotes

administered in the emergency departments of 2 university teaching hospitals. Data

were collected from March through November 2006. Variables assessed were the use,

suitability, and efficacy of each antidote, and the total expenditure on drugs (antidotes

plus other medications).

Results: Antidotes were administered 228 times to 184 patients (8.7% of acute

intoxications attended during the study period). Use of the antidote was considered

justified in the attempt to reverse the effect of poisoning in 85.3% of the cases,

corresponding to 10 of the 14 antidotes used. The expected reversal was achieved in

73.9% of the cases. Use was inappropriate in 16% of the administrations of flumazenil

and 4% of the administrations of naloxone. Adverse events were recorded in 6.5% of the

cases in which antidotes were used. Expenditure on antidotes accounted for 81.97% of

the total amount spent on the pharmacologic treatment of poisoned patients and 1.1%

of the amount spent on all drugs used in emergency department care during the study

period.

Conclusions: The use of antidotes in the emergency department is largely appropriate

but not free of side effects. Flumazenil and naloxone were used too often. Expenditure

on antidotes is very low.

Aguilar Salmerón R, Nogué Xarau S, Soy Muner D