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TOXBASE and its use in collecting data on new and uncommon products of interest

Author/s Adams RD, Good AM, Thomas SHL, Thompson JP, Vale JA, Eddleston M
Year 2015
Type of publication Conference proceeding

Objective: To describe reports submitted to TOXBASE ® relating to new, uncommon and other products of interest. Methods: From 2000 a link to an optional electronic questionnaire was added for completion by healthcare professionals accessing new TOXBASE ® entries of interest. This included new products (e.g. black triangle drugs), uncommon agents and novel treatments such as the use of intravenous lipid emulsion. Reports were collated and entered into Microsoft Access. Results: From July 2000 to April 2014 1,246 product questionnaires were received, relating to pharmaceuticals (855, 68.6%), novel psychoactive substances (NPS) (153), household products (143), drugs of abuse (34), other (22), unlicensed pharmaceuticals (10), water proofers (9), weight loss agents (5), plants (5), unknown (4), antidotes (3) and veterinary products (3). Of 143 household products 132 were detergent capsules. Of these 16 patients were asymptomatic (12.1%). Symptomatic patients reported eye pain (64, 48.5%), of which 10 (15.6%) reported corneal damage, gastrointestinal symptoms (25), CNS depression (7), skin damage (5) and reduced respiratory rate (1). The fi rst report about an NPS (“Bolts Extra Strength”) was received in 2006. The patient was tachycardic and agitated. Between 2007 and 2009 6 reports related to benzylpiperazine. Since 2009 there have been 78 reports related to mephedrone and a further 69 reports about 30 other NPS. Two deaths (from cardiac arrest) have been reported (benzo fury, 5,6- methylenedioxy-2-aminoindane [MDAI]). Only 3 reports involved asymptomatic patients. Symptoms reported were cardiac features (78, 51%), agitation (42, 27.5%), hallucination (33), gastrointestinal symptoms (27), convulsions (14) and acute psychotic episode (5). Additional features were reported in 135 (88.2%) cases. Unlicensed pharmaceuticals were melanotan (7), “ melanotan 2 ” (2) and flupirtine (1). All patients exposed to melanotan reported gastrointestinal symptoms (nausea, vomiting, abdominal pain). Other symptoms included dizziness (3), flushing (2) and chest discomfort (2). Across Europe in 2003 a sharp increase in respiratory symptoms (cough, dyspnoea, alveolitis and pulmonary oedema) was reported after the use of some water-repellent aerosols. Subsequent to this, 9 reports of adverse features were collected following exposure to waterproofing sprays reported via TOXBASE, 8 between 2004 and 2009 and the most recent in 2013. Symptoms reported included persistent cough (7), dyspnoea (6) and rigors (2). Reports were received on 128 pharmaceutical products, most frequently montelukast (85), bupropion (61), orlistat (54), quetiapine (48), paracetamol (48), pregabalin (36), sildenafi l (33), melatonin (31), levetiracetam (29) and escitalopram (28). Conclusion: In addition to alerting, TOXBASE ® provides a useful route to collect user generated data on products of interest. This data can be used to monitor exposure prevalence over time and to gather symptom profile data on agents of concern.

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