1. Overlæge, dr.med. Kim Dalhoff Giftlinjen & Klinisk Farmakologisk Afd Bispebjerg Hospital Netværk for Forebyggelse af Medicineringsfejl – 10.11.2010 Oplæg om … Forgiftninger pga. medicineringsfejl Methylphenidat

2. 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

3. Medication Errors – Tools

4. 53 cases in all Medication Errors – Results

5. Medication Errors – Results (adjusted for total enquiries per months)

6. 25/53 (47%) Medication Errors – Results

7. Medication Errors – Results (age groups)

8. Medication Errors – Results (no of drugs involved)

9. Medication Errors – Results (no of drugs involved – single dose or multiple doses)

10. Medication Errors – Results (cause)

11. Medication Errors – Results (where did the ME take place?)

12. Medication Errors – Results (symptoms)

13. Medication Errors – Results (risk assessment!)

14. 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

15. Medication Errors – Results (where did the ME take place?)

16. Medication Errors – Results (nursing (psychiatric) home) 16/23 (70%)

17. Medication Errors – Results (the entire ME population) 18/53 (34%)

18. All enquiries to Giftlinjen (antipsychotics and antidepressants) 689/4406 (16%)

19. 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

21. Methylphenidate (MPH) and its use as a drug of abuse Kim Dalhoff Giftlinjen (DPIC) & Department of Clinical Pharmacology Bispebjerg Hospital Denmark

22. 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

23. 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

24. Results

34. 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

35. 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?