1. PACKAGING OF MEDICINES AND CHILDREN SAFETY Accident data from Belgium Dr Martine MOSTIN

2. NATIONAL POISON CENTRE ~ 50.000 calls year 75% calls from public 80% accidental exposure 50% children

3. NATIONAL POISON CENTRE Availability of product Perceived risk (hypnotics, thyroid hormones, contraceptives …) Need for information ( medical professionnals) : new drugs Calls reflect exposure rather than poisoning

6. ACCIDENT DATA 2003 Children exposure (0-14 y): 19.872 calls Pharmaceutical exposure: 6.808 calls Pharmaceutical exposure 1- 5 y: 4.836 calls

8. ACCIDENT DATA 2003 Child 1- 5 year Pharmaceutical exposure Referred to hospital by PC OR Call received from hospital

9. 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

10. ACCIDENT DATA 2003 One death 3 y old Therapeutic error Percutaneous administration of monochloroacetic acid

14. HYPNOTICS SEDATIVES Total (1-5 y) HospH/T Benzodiaz.27413650% Zopiclone, Zolpidem 341338% Barbiturates3267% Hydroxyzine3133% Clomethiazole22100%

15. HYPNOTICS and SEDATIVES Benzodiazepines Liquid forms : 2% < 8 tablets : 60% >8 tablets : 8% Unspecified : 30 %

16. 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

17. 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

18. HYPNOTICS and SEDATIVES Clomethiazole 192 mg tablets Limited data on overdosage in children 1 –2 tablets = significant exposure Symptoms : coma, risk cardiorespiratory arrest

20. ANTIDEPRESSANTS Total (1-5 y) HospH/T SSRI552545% Tricyclics272385% Trazodone201575% Venlafaxine5360% Lithium4250% Mirtazapine4375% Reboxetine3267%

21. ANTIDEPRESSANTS Tricyclic Antidepressants All <8 tablets (19) or unknown (4) Less 8 tablets = significant exposure Cardiovascular toxicity, convulsions Life threatening intoxication possible medical attention mandatory !!

22. ANTIDEPRESSANTS SSRI Wider safety margin than T3AD Symptoms : Hyperthermia, agitation, hallucinations, convulsions Less 8 tablets = significant exposure Life threatening poisoning not expected

23. 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

24. ANTIDEPRESSANTS Trazodone Less 8 tablets = significant exposure Life threatening poisoning not expected

26. NEUROLEPTICSTotal (1-5 y) HospH/T Phenothiazines201995% Risperidone141286% Buyrophenone12650% Olanzapine5480% Other10660%

27. PHENOTHIAZINES All <8 tablets or unknown CNS depression, dysrythmia, hypotension Medical attention almost needed

28. 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

29. OLANZAPINE Symptoms reported with 10 mg 5 -7,5 -10 mg tablets CNS depression, tachycardia, hpotension, extrapyramidal syndrome

31. DRUGS EXTERNAL USE Ethanol based antiseptics Hydrogen peroxide Quaternary ammonium antiseptics Keratolytic preparations Pediculosis & scabies treatment ….

33. ANALGESICS ANTIPYRETICS ANTIINFLAMMATORY Total (1-5 y) HospH/T NSAID3756517% PARACETAMOL1734727% ASSOCIATIONS45716% SALICYLATES431433% NARCOTIC ANALG.403383% DRUG USED GOUT8450% PYRAZOLON7457% MISCELLANEOUS4250%

34. NARCOTIC ANALGESICS Dextropropoxyphene : 150 mg tablet toxic: 10mg /kg lethal: 20mg/kg Coma, respiratory depression, arrythmia, cardiac arrest

35. NARCOTIC ANALGESICS Methadone Lethal ~10 mg child Syrup 50 -100 mg tablets Underestimation danger by addicts

37. DRUGS RESPIR. DISEASE Total (1-5 y) HospH/T Antitussives42313632% Drug used in bronchospasm 2235424% Drugs rhinitis, sinusitis2378235%

38. MEDICAL ATTENTION Narrow safety margin (chloroquine, buflomedil, dextropropoxyphene…) Life threatening symptoms reported in overdose Safety in children not established Limited data on overdosage

39. 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