Netværk for Forebyggelse af
Medicineringsfejl – 10.11.2010
Oplæg om …
•Forgiftninger pga. medicineringsfejl
•Methylphenidat
Overlæge, dr.med. Kim Dalhoff
Giftlinjen & Klinisk Farmakologisk Afd
Bispebjerg Hospital
Medication errors – experience
from the Danish Poison
Information Service
Netværk for Forebyggelse af
Medicineringsfejl – 10.11.2010
Overlæge, dr.med. Kim Dalhoff
Giftlinjen & Klinisk Farmakologisk Afd
Bispebjerg Hospital
Medication Errors – Tools
Medication Errors – Results
30
25
Antal
20
53 cases in all
15
10
5
0
2006
2007
2008
2009
Medication Errors – Results
(adjusted for total enquiries per months)
(error/all/month) (x10-3)
3,00
2,50
2,00
1,50
1,00
0,50
0,00
2006
2007
2008
2009
Medication Errors – Results
8
7
6
Antal
5
4
3
2
1
0
jan
feb
mar apr maj
2006
jun jul aug sep
25/53 (47%)
2007
2008
2009
okt
nov dec
Medication Errors – Results
(age groups)
20
18
16
14
No
12
10
8
6
4
2
0
0-5
6-10
11-40
Age Group
41-70
>71
Medication Errors – Results
(no of drugs involved)
30
Antal henvendelser
25
20
15
10
5
0
1
2
3
Antal lægemidler
4
5
Medication Errors – Results
(no of drugs involved – single dose or
multiple doses)
53
Alle medicineringsfejl
24
Forgiftning med et
enkelt lægemiddel
14
Paracetamol
(58%)
10
Andre lægemidler
(9 forskellige)
29
Blandingsforgiftninger
5
Paracetamol
(17%)
24
Andre lægemidler
Medication Errors – Results
(cause)
Årsag
Uheld
4%
Forveksling
19%
Fejldosering
77%
Medication Errors – Results
Sted
(where did the ME take place?)
Hjem / have
34%
Anden institution
45%
Sygehus
21%
Medication Errors – Results
(symptoms)
1
3
1
8
40
Ingen
CNS
Hjerte/kredsløb
Mave-tarm
Andet
Medication Errors – Results
(risk assessment!)
2 3 0
26
20
2
Ingen risiko
Forbigående effekt
Behandlingskrævende
Livstruende
Uafklaret
Ikke angivet
Medication Errors – Results
(risk assessment - life threatening)
68-year old male (fejldosering)
• 25 mg haloperidol
• 100 mg topiramat
• 300 mg clozapin
• 2 mg clonazepam
• 8 mg biperiden
88-year old female (fejldosering)
• 200 mg labetalol
83-year old male (beh krævende, forveksling) 
•
•
•
•
60 mg diltiazem
125 mg levodopa
20 mg citalopram
100 mg mandolgin
Medication Errors – Results
Sted
(where did the ME take place?)
Hjem / have
34%
Anden institution
45%
Sygehus
21%
Alle medicineringsfejl
plejehjem
Medication
Errors – på
Results
(nursing (psychiatric) home)
7
16
16/23 (70%)
resten
anti-psyk + anti-dep
Alle medicineringsfejl
Medication
Errors – Results
(the entire ME population)
18
35
18/53 (34%)
resten
anti-psyk + anti-dep
All enquiries
Giftlinjen
Alle to
henvendelser
(antipsychotics and antidepressants)
371
318
3717
689/4406 (16%)
resten
anti-psyk
anti-dep
Medication Errors
Conclusion
• Number of enquiries to GL about ME’s increases
• About 50% comes from nursing homes during
summertime and the majority are related to the use of
antipsychotic and antidepressant drugs
• The majority of ME’s are asymptomatic and only a few
are categorised as life-threatening
• Half of the ME’s are single-dose incidences and half
multiple-dose incidences
• Paracetamol is the major single agent leading to an ME
Methylphenidate (MPH) and its
use as a drug of abuse
Kim Dalhoff
Giftlinjen (DPIC) & Department of Clinical
Pharmacology
Bispebjerg Hospital
Denmark
Methylphenidate
• d,l-threo-methylphenidate (racemate)
• Approved for the treatment of ADHD
and narcolepsy (1 DDD = 30 mg)
• MOA involves increasing dopamine via
blockade of dopamin transporters
• MPH toxicity resembles the toxic
effects of typical sympathomimetic
drugs – including varying degrees of
psychiatric and neurological effects
Amphetamin
Methods
• Extraction of data from
Giftlinjen = DPIC since 1.1.2006
(for 52 weeks)
• Search profile =
methylphenidate or
corresponding trade names
registered in Denmark
• Categorization according to
causes of MPH intake
Results
Ratio between all MPH / all DPIC
enquiries (from 1.1.2006)
Ratio (0/00)
15
10
5
0
0
12
24
Weeks
36
48
Ratio between misuse MPH / all DPIC
enquiries (from 1.1.2006)
6
Ratio (0/00)
5
4
3
2
1
0
0
12
24
Weeks
36
48
Ratio between misuse / all enquiries
about MPH (from 1.1.2006)
60
Ratio (%)
50
40
30
20
10
0
0
12
24
Weeks
36
48
Age and gender of all
misuse MPH enquiries
Female
Male
20
15
10
5
0
11
-1
5
16
-2
0
21
-2
5
26
-3
0
31
-3
5
36
-4
0
41
-4
5
46
-7
0
010
No of enquiries
25
Age
All misuse MPH and other
concomitant factors
No of enquiries
100
All misuse MPH
+ additional MPH Tx
+ alcohol
+ mixed abuse
75
50
25
0
2006
2007
2008
Year
2009
MPH dose
10000
Dose (mg)
1000
180 mg
100
360 mg*
10
1
All MPH enq
All misuse MPH enq
Time from MPH overdose
to calling the DPIC
100
Time (hrs)
10
6.0 hrs*
1.9 hrs
1
0.1
0.01
All MPH enq
All misuse MPH enq
Pct
Risk assessment
100
90
80
70
60
50
40
30
20
10
0
No risk
Transient risk
Require treatment
Life-threatening
Unresolved
All MPH
All misuse MPH
Conclusion
• Over a 4-year period, the number of MPH
enquiries is increasing in Denmark (adjusted for ↑
total DPIC inquiries)
• The number of enquiries related to abuse users of
MPH is increasing - relative to the total number of
MPH enquires
• The abusers of MPH take larger doses and call
later!
• The second largest group of abusers are in the age
group 11 – 15 yrs
• A large number use other substances of abuse in
addition to MPH
Perspectives
• A rapid development of a new and serious
healthcare problem as a consequence of the
increased use of a treatment of another
healthcare problem!
• Healthcare Authorities need to know
• The treating psychiatrists need to know
• Our (DPIC) risk assessment may have to be
adjusted in cases in which the patients has abused
MPH
• Interventions are needed – more warnings, change
in prescription patterns, early and more frequent
monitoring of treated patients?