[Antidotes and medicines used to treat poisoning in Brazil: needs, availability and opportunities].

Antidotes and certain other drugs are essential for treating some types of poisoning. Failures in their supply can jeopardize the population's health and safety. The current study aimed to assess the availability of antidotes and other drugs used in the treatment of poisonings in Brazil. International guidelines were used as the basis for selecting 41 antidotes for analysis, none of which currently protected by patents. Of these, 27 are registered in Brazil, but 11 of these are available in inadequate forms for treating poisoning, leaving 16 commercially available antidotes. Only one-third of the drugs needed for treating poisoning are included in the country's list of essential drugs. The article also presents a proposal for supplying the demand for one of the antidotes, anti-digoxin antibody, considering Brazil's domestic capacity for manufacturing immunobiologicals. The study's results show the limitations to adequate treatment for poison victims in Brazil and reinforce the urgent need to strengthen public policies in this area.

[1]  Edgar Hernández-Leiva Epidemiología del síndrome coronario agudo y la insuficiencia cardiaca en Latinoamérica , 2011 .

[2]  D. Spyker,et al.  2010 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 28th Annual Report , 2011, Clinical toxicology.

[3]  Carlos Alberto Silva,et al.  Impact of a poison control center on the length of hospital stay of poisoned patients: retrospective cohort. , 2011, Sao Paulo medical journal = Revista paulista de medicina.

[4]  C. Smollin Toxicology: pearls and pitfalls in the use of antidotes. , 2010, Emergency medicine clinics of North America.

[5]  G. C. Rodgers,et al.  Antidotes and Treatments for Chemical Warfare/Terrorism Agents: An Evidence‐Based Review , 2010, Clinical pharmacology and therapeutics.

[6]  K. Kehe,et al.  Development of antidotes: problems and strategies. , 2007, Toxicology.

[7]  J. Bussières,et al.  Antidote availability in Quebec hospital pharmacies: impact of N-acetylcysteine and naloxone consumption. , 2000, The Canadian journal of clinical pharmacology = Journal canadien de pharmacologie clinique.

[8]  D. Bouros,et al.  Availability of antidotes in hospital pharmacies in Greece. , 2001, Veterinary and human toxicology.

[9]  S. Walton,et al.  Analysis of the Use of Digoxin Immune Fab for the Treatment of Non-Life-Threatening Digoxin Toxicity , 2000, Journal of cardiovascular pharmacology and therapeutics.

[10]  J. Bussières,et al.  Availability of antidotes in Quebec hospitals before and after dissemination of guidelines. , 2003, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[11]  C. Morillo,et al.  Congestive heart failure in Latin America: the next epidemic. , 2004, American heart journal.

[12]  A. Woolf,et al.  Combined evidence-based literature analysis and consensus guidelines for stocking of emergency antidotes in the United States. , 2000, Annals of emergency medicine.

[13]  J. Brubacher,et al.  Adequacy of antidote stocking in British Columbia hospitals: the 2005 Antidote Stocking Study. , 2006, CJEM.

[14]  D. Jacobsen,et al.  A one-year observational study of all hospitalized acute poisonings in Oslo: complications, treatment and sequelae , 2012, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.

[15]  Nara Azevedo,et al.  Inovao em vacinas no Brasil: experincia recente e constrangimentos estruturais , 2003 .

[16]  J. Feussner,et al.  Reassessing the efficacy of digitalis: from routine treatment to evidence-based medicine. , 2010, The American journal of the medical sciences.

[17]  Viviane Midori Murata Produção e caracterização da porção Fab do anticorpo anti-digoxina utilizando a tecnologia de phage display , 2012 .

[18]  C. Steffen The dilemma of approving antidotes. , 2007, Toxicology.

[19]  V. Abbott,et al.  Access in New Zealand to antidotes for accidental and intentional drug poisonings. , 2012, Journal of primary health care.

[20]  P. Hauptman,et al.  Digoxin use and digoxin toxicity in the post-DIG trial era. , 2006, Journal of cardiac failure.

[21]  T. Wenger,et al.  Cost-effectiveness analysis of the use of digoxin immune Fab (ovine) for treatment of digoxin toxicity. , 1991, The American journal of cardiology.

[22]  K. Wong,et al.  Availability of antidotes for the treatment of acute poisoning in Queensland public hospitals. , 2010, The Australian journal of rural health.

[23]  R. D. Mello AGÊNCIA NACIONAL DE VIGILÂNCIA SANITÁRIA , 2002 .

[24]  M. Silva,et al.  ECONOMIC EVALUATION OF POISON CENTERS: A SYSTEMATIC REVIEW , 2012, International Journal of Technology Assessment in Health Care.

[25]  J. Kalil,et al.  Anti-Digoxin Fab Variants Generated by Phage Display , 2013, Molecular Biotechnology.

[26]  James A. Swenberg,et al.  Toxicology and Epidemiology: Improving the Science with a Framework for Combining Toxicological and Epidemiological Evidence to Establish Causal Inference , 2011, Toxicological sciences : an official journal of the Society of Toxicology.

[27]  Daniel Marques Mota,et al.  Perfil da mortalidade por intoxicação com medicamentos no Brasil, 1996-2005: retrato de uma década , 2012 .

[28]  Amy F Wolkin,et al.  Using poison center data for national public health surveillance for chemical and poison exposure and associated illness. , 2012, Annals of emergency medicine.

[29]  Silas W Smith Drugs and pharmaceuticals: management of intoxication and antidotes , 2010, EXS.

[30]  R. Gair Antidote program in British Columbia. , 2012, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[31]  Fundação Nacional de Saúde Manual de diagnóstico e tratamento de acidentes por animais peçonhentos , 1998 .

[32]  A. Pankratov [Cardiac glycosides]. , 1978, Meditsinskaia sestra.

[33]  N. Buckley,et al.  Oximes for acute organophosphate pesticide poisoning. , 2005, The Cochrane database of systematic reviews.

[34]  S. Lowenstein,et al.  Insufficient stocking of poisoning antidotes in hospital pharmacies. , 1996, JAMA.

[35]  K. Luomanmäki,et al.  [Calcium channel blocker poisoning]. , 1993, Duodecim; laaketieteellinen aikakauskirja.

[36]  J. Brubacher,et al.  Antidote stocking in British Columbia hospitals. , 2003, CJEM.

[37]  V. Cohen,et al.  Antidotes for toxicological emergencies: a practical review. , 2012, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[38]  T. Galvão,et al.  Padronização das informações toxicológicas no Brasil , 2011 .