ANALYSIS OF ANTIDOTE RECOMMENDATIONS FOR DRUG POISONING IN BRAZIL

Resumo

INTRODUCTION: Drug intoxications are a significant public health issue in Brazil, often requiring the use of antidotes for patient treatment. However, the country still lacks a consolidated National Antidote Policy, and understanding the regional toxicological profile is essential for developing an effective policy. OBJECTIVE: To assess cases of drug exposure handled by the Toxicological Information Center of Rio Grande do Sul (CIT/RS) between 2020 and 2022, and to conduct a comparative analysis of antidote usage recommendations for drug poisonings across different Brazilian states. MATERIAL AND METHODS: Data on drug exposures recorded by CIT/RS from 2020 to 2022 were analyzed. The focus was on medications with antidotes listed in the document "Recommendations on Indications, Use, and Stock of Antidotes", excluding drug classes and medications with no reported cases. A comparison of antidote usage guidelines among Brazilian states was also conducted, based on official documents found in publicly accessible online sources. RESULTS AND CONCLUSION: During the studied period, CIT/RS recorded 75,691 cases of human exposure to toxic agents, with 26,126 being caused by medications. The main pharmacological classes involved were antidepressants, benzodiazepines, analgesics, neuroleptics, and anticonvulsants. Antidote usage recommendations were found for seven states: PR, CE, MS, MG, BA, SC, and SP; however, only the last four were analyzed. Among these, only three antidotes were consistently recommended for the same toxic agent: flumazenil (benzodiazepines), naloxone (hypnoanalgesics), and N-acetylcysteine (acetaminophen). Furthermore, the protocols varied in terms of the information provided (antidote, indication, dosage, mechanism of action, minimum stock, costs and availability) and the content itself. Among the documents analyzed, São Paulo's was the most comprehensive. Rio Grande do Sul uses the Toxbase® platform as a reference, as it does not have its own guideline. Therefore, in RS, drug intoxications primarily involved psychotropic medications. Although some states have antidotes and related recommendations, discrepancies in the information persist. Thus, establishing a standardized and unified document concerning antidote usage is essential to cement a National Antidote Policy and improve the emergency management of drug intoxication cases in Brazil.