Minder accidentele overdoseringen en intoxicaties met Thyrax bij kleine kinderen door wijziging van flacon naar blisterverpakicing

OBJECTIVE In December 2013, the largest manufacturer of levo-thyroxlne for the Dutch market (brand Thyrax) started packaging their product from glass bottles into blisters to protect it from environmental influences. We investigated whether this change in the primary packaging influenced the frequency and severity of accidental levothyroxine overdose in young children. DESIGN AND METHODS Telephone inquiries to our Dutch Poisons Information Center concerning children under seven years of age exposed to Thyrax were registered between January 2010 and December 2015. The ingested amount of levothyroxine In mg/kg body weight was recorded and the severity of the overdoses was estimated. An unknown dose or an ingested dose of more than 0.05 mg/kg of levothyroxine was defined as a toxic dose. Information about the actual manner of packaging was collected in 20U and 2015. The number of telephone inquiries before and after the change in the primary packaging were compared using interrupted time series analyses. The decrease in proportions of cases exposed to a toxic dose were compared using a Z-test. RESULTS The monthly average number of Thyrax overdose cases decreased from 12.1 per month before the change in the primary packaging to 6A after (P = 0.0). Furthermore, this decrease was proportionally larger among children exposed to a toxic dose than among children exposed to a non-toxic dose:-66% versus-38%, respectively IP = 0.002). However, in 2015 still 21% of the children with an overdose took these Thyrax tablets out of a bottle. CONCLUSION Blister packaging has significantly reduced the number and severity of accidental intake of Thyrax by young children. However, this preventive effect is hampered by parents removing the medication from the blister well before use.