Cardiovascular medication exposures and poisonings in Izmir,Turkey: A 14-year experience

Abstract

Cardiovascular medications (CVMs) are frequently prescribed for cardiovascular diseases. The unconscious use of cardiovascular drugs may lead to severe clinical manifestations, even to death, especially when in overdose. The objective of this study is to clarify the profile of CVM exposures admitted to Department of Emergency Medicine in Dokuz Eylul University Hospital (EMDEU) between 1993 and 2006. Case demographics, type of the medication, route and reason for exposure, clinical effects and outcome were recorded. Related to the CVM exposures, 105 poisoning cases were admitted. Mean age of children and adults were 12.8 ± 1.0 and 30.1 ± 1.8, respectively. Females were dominating (77.1%). Poisoning by accident occurred mainly among children in the 0—6 age group (64.3%) and suicide attempt was predominant in the 19—29 age group (47.8%). The most common ingested CVMs admitted to EMDEU were calcium channel blockers (19.7%), beta-blockers (17.3%), angiotensin converting enzyme inhibitors and diuretics (11.8%). Most of the patients were asymptomatic (59.1%). Frequently observed symptom was altered consciousness (18.6%). Antihypertensive drugs are responsible for the most of the CVM exposures. Prospectively designed multi-centered studies are needed to reflect the epidemiological properties of cardiovascular drug exposures throughout our country and would be very valuable for the determination of preventive measures.

Keywords

cardiovascular medications toxicity Drug and Poison Information Center

References

Lai MW , Klein-Schwartz W. , Rodgers GC , Abrams JY , Haber DA , Bronstein AC , et al. 2005 Annual Report of the American Association of Poison Control Centers’ national poisoning and exposure data. Clin Toxicol 2006; 44: 802-932.

Kalkan S. , Tuncok Y. , Guven H. Poisonings reported to Drug and Poison Control Center. J Dokuz Eylul Univ Shool Med 1998; 12: 275-283.

Cienki JJ , Akhtar J. , Burkhart KK , Donovan JW Cardiovascular parameters in calcium-channel blocker. Acad Emerg Med 1996; 3: 420.

Allin D. , Anderson S. , Brehm J. Intravenous esmolol for the treatment of supraventricular tachycardia: results of a multicenter open label, baseline controlled safety and efficacy study in 160 patients. Am Heart J 1986; 112: 498-505.

Kulling P. , Eleborg L. , Persson H. B-adrenoceptor blocker intoxication: epidemiological data. Prenalterol as an alternative in the treatment of cardiac dysfunction. Hum Toxicol 1983; 2: 175-181.

Ramoska EA , Spiller HA , Winter M. , Borys D. A one-year evaluation of calcium channel blocker overdoses: toxicity and treatment . Ann Emerg Med 1993; 22: 196-200.

Persson HE , Sjöberg GK , Haines JA , Pronczuk de Garbino J. Poisoning severity score. Grading of acute poisoning. J Toxicol Clin Toxicol 1998; 36: 205-213.

Ozkose Z. , Ayoglu F. Etiological and demographical characteristics of acute adult poisoning in Ankara, Turkey. Hum Exp Toxicol 1999; 18: 614-618.

Afshari R. , Majdzadeh R. , Balali-Mood M. Pattern of acute poisoning in Mashhad, Iran 1993-2000. J Toxicol Clin Toxicol 2004; 42: 965-975.

10.

Abaci A. , Kozan O. , Oguz A. , Sahin M. , Deger N. , Senocak H. , et al. Prescribing pattern of antihypertensive drugs in primary care units in Turkey: results from the TURKSAHA study. Eur J Clin Pharmacol 2007; 63: 397-402.

11.

Jepsen P. , Johnsen SP , Sorensen HT Risk of suicide in users of cardiovascular drugs: a review of the epidemiological evidence. Am J Cardiovasc Drugs 2003; 3: 163-167.

12.

Patten SB Propranolol and depression: evidence from the antihypertensive trials . Can J Psychiatry 1990; 35: 257-259.

13.

Hallas J. Evidence of depression provoked by cardiovascular medications: a prescription sequence symmetry analysis. Epidemiology 1996 ; 7: 478-484.

14.

Muldoon MF , Manuck SB , Matthews KA Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials. Br Med J 1990; 301: 309-314.

15.

Lindberg G. , Bingefors K. , Ranstam J. , Råstam L. , Melander A. Use of calcium channel blockers and risk of suicide: ecological findings confirmed in population based cohort study. Br Med J 1998; 7: 741-745.

16.

Sorensen HT , Mellemkajaer L. , Olsen JH Risk of suicide in users of beta-adrenergic blockers, calcium channel blockers and angiotensin converting enzyme inhibitors . Br J Clin Pharmacol 2001; 52: 313-318.

17.

Callreus T. , Andersen UA , Hallas J. , Andersen M. Cardiovascular drugs and risk of suicide: a nested case-control study. Eur J Clin Pharmacol 2007; 63: 591-596.

18.

Andıran N. , Sarikayalar F. Pattern of acute poisonings in childhood in Ankara: what has changes twenty years. Turk J Pediatr 2004; 46: 147-152.

19.

Tufekci IB , Curgunlu A. , Sirin F. Characteristics of acute adult poisoning cases admitted to a university hospital in Istanbul. Hum Exp Toxicol 2004 ; 23: 347-351.

20.

Akbaba M. , Nazlican E. , Demirhindi H. , Sütoluk Z. , Gökel Y. Etiological and demographical characteristics of acute adult poisoning in Adana, Turkey. Hum Exp Toxicol 2007; 26: 401-406.

21.

Hocaoglu N. , Kalkan S. , Akgun A. , Capar S. , Tuncok Y. A retrospective evaluation of analgesic exposures from Izmir, Turkey. Hum Exp Toxicol 2007; 26: 629-636.

22.

Belson MG , Gorman SE , Sullivan K. , Geller RJ Calcium channel blocker ingestions in children. Am J Emerg Med 2000; 18: 581-586.

23.

Ranniger C. , Roche C. Are one or two dangerous? Calcium channel blocker exposure in toddlers. J Emerg Med 2007; 33:145-154.

24.

Onat A. , Şenocak M. , Ornek E. , Gözükara Y. , Şurdum-Avci G. , Karaaslan Y. , et al. Investigations survey on prevalence of cardiac disease and its risk factors in adults in Turkey: 5. Hypertension and smoking. Arch Turk Soc Cardiol 1991; 19: 169-175.

25.

Onat A. , Doğan Y. , Uyarel H. , Ceyhan K. , Uzunlar B. , Yazici M. , et al. Blood pressure levels in Turkish adults: initial trend to improved blood pressure control. Arch Turk Soc Cardiol 2002; 30: 748-757.

26.

Abaci A. , Oguz A. , Kozan O. , Toprak N. , Senocak H. , Deger N. , et al. Treatment and control of hypertension in Turkish population: a survey on high blood pressure in primary care (the TURKSAHA study). J Hum Hypertens 2006; 20: 355-361.