The cost of maintaining adequate antidote supplies
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* David Juurlink
* Donald Redelmeier

We thank Benoit Bailey and Jean-François Bussières for their thoughtful comments on the costs of maintaining appropriate supplies of antidotes. The actual cost of an adequate inventory is influenced by variables other than acquisition cost, including the drug's shelf life and the manufacturer's policy on issuance of credit for outdated product.1 For example, a course of treatment with digoxin immune Fab antibody fragments may cost up to $8000. This sticker shock, coupled with the infrequency of use, may lead some hospitals to purposefully not stock the drug. Consider, however, that the manufacturer will credit hospitals for outdated product, and the cost becomes a justifiable one-time expense.

How much of each antidote should a hospital stock? There is no right answer, but suggestions have been published.2,3,4,5 For some toxins, such as acetaminophen, methanol and ethylene glycol, a hospital should be prepared for the simultaneous treatment of more than one patient. Clearly, every hospital should keep at least enough of each antidote in the emergency department to be able to initiate treatment immediately.

Our survey6 generated substantial media attention, and this may have helped to mitigate the problem of inadequate antidote stocking at some hospitals. In addition, the simple act of completing our questionnaire may also have led hospitals to recognize and address the deficiencies in their antidote supplies. We were pleased to receive calls from 4 different hospitals in the days after publication asking if they could announce that they were the one hospital in the province with all 10 antidotes on hand. Such corrective actions are encouraging. 

## References

1.  1. Sivilotti M, Lee J, Peterson R. A pharmacoeconomic model of annual costs required to maintain an antidote stock [abstr]. J Toxicol Clin Toxicol 2001;39(5):537-8.
    
    

2.  2. Dart RC, Goldfrank LR, Chyka PA Lotzer D, Woolf AD, McNally J, et al. Combined evidence-based literature analysis and consensus guidelines for stocking of emergency antidotes in the United States. Ann Emerg Med 2000;36 (2): 126-32.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1067/mem.2000.108182&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=10918103&link_type=MED&atom=%2Fcmaj%2F165%2F11%2F1467.2.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=000088584700006&link_type=ISI) 

3.  3. Bussières JF, Bailey B. Insufficient stocking of antidotes in hospital pharmacies: problem, causes, and solution. Can J Hosp Pharm 2000; 53 (5):325-37.
    
    

4.  4. Olson KR, Anderson B, Benowitz NL, Blanc PD, Clark RF, Kearney TE, et al. Therapeutic drugs and antidotes. In: *Poisoning and drug overdose*. 3rd ed. New York: Appleton and Lange; 1999. p. 333-410.
    
    

5.  5. Burda AM. Poison antidotes: issues of inadequate stocking with review of uses of 24 common antidotal agents. In: Leikin JB, Paloucek FP, editors. *Poisoning and toxicology compendium*. 2nd ed. Cleveland: Lexicomp; 1998. p. 1017-26.
    
    

6.  6. Juurlink DN, McGuigan MA, Paton TW, Redelmeier DA. Availability of antidotes at acute care hospitals in Ontario. CMAJ 2001;165(1):27-30.
    
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