Abstract
Objective: Many antidotes are relatively rare-use, indication-specific medicines with a variable evidence base. In Aotearoa New Zealand, there are no national statistics available on their use. This study aimed to characterize the numbers of cases and advice provided by the Aotearoa New Zealand National Poisons Centre (NZNPC) on the use of true antidotes and antidote-adjacent medicines to treat poisonings from 2020 to 2025.
Methods: The numbers of NZNPC medical/clinical toxicologist consultations advising on the use of antidotes and antidote-adjacent medicines were determined and data categorized by health region, the caller type of healthcare provider and the numbers of cases advising for and against the use of specific medicines.
Results: Consultations occurred in 2952 exposure incidents with hospital-based clinicians comprising 2800 (95%); covered all regions; and consisted of advising on use of individual antidotes/adjacent medicines 3408 times. N-acetylcysteine (1371; 40%) and charcoal (775; 23%) were most frequently discussed. Of relatively high-cost antidotes, NZNPC advised against use of fomepizole in 22/58 (38%) and digoxin-binding antibody in 36/74 (49%) cases. Of labour-intensive interventions, NZNPC advised against use of high-dose insulin euglycemic therapy in 52/89 (58%) and whole bowel irrigation in 68/135 (50%) cases.
Conclusions: There was use of the NZNPC consultation service across all regions, and the recommendations provided for each antidote ranged from mostly in favour of use to mostly against use based on the patient presentation. Utilizing a specialist medical/clinical toxicologist consultation service may assist in rationalizing care and optimizing use of healthcare resources.