Deaths due to absence of an affordable antitoxin for plant poisoning

  title={Deaths due to absence of an affordable antitoxin for plant poisoning},
  author={Michael Eddleston and Lalith Senarathna and Fahim Mohamed and Nick A. Buckley and Edmund Juszczak and M H Rezvi Sheriff and Ariaranee Ariaratnam and Senaka Rajapakse and David A Warrell and K Rajakanthan},
  journal={The Lancet},
There is a severe shortage of affordable antivenoms and antitoxins in the developing world. An anti-digoxin antitoxin for oleander poisoning was introduced in Sri Lanka in July, 2001, but because of its cost, stocks ran out in July, 2002. We looked at the effect of its introduction and withdrawal on case fatality, and determined its cost-effectiveness. The antitoxin strikingly reduced the case fatality; its absence resulted in a three-fold rise in deaths. At the present price of US2650 dollars… Expand
Antidotes for acute cardenolide (cardiac glycoside) poisoning.
There is some evidence to suggest that MDAC and anti-digoxin Fab antitoxin may be effective treatments for yellow oleander poisoning, but the efficacy and indications of these interventions for the treatment of acute digitalis poisoning is uncertain due to the lack of good quality controlled clinical trials. Expand
Efficacy of activated charcoal in yellow oleander poisoning.
The treatment of yellow oleander poisoning in Sri Lankan hospitals includes gastric lavage, administration of activated charcoal (AC), and intravenous atropine or isoprenaline, or both, for bradyarrhythmias, and temporary cardiac pacing is done if patients develop life-threatening bradyarrythmias. Expand
Fructose-1, 6-diphosphate (FDP) as a novel antidote for yellow oleander-induced cardiac toxicity: A randomized controlled double blind study
If FDP is effective in cardiac glycoside toxicity, it would provide substantial benefit to the patients in rural Asia and the drug is inexpensive and thus could be made available at primary care hospitals if proven to be effective. Expand
Applied clinical pharmacology and public health in rural Asia – preventing deaths from organophosphorus pesticide and yellow oleander poisoning
  • M. Eddleston
  • Medicine
  • British journal of clinical pharmacology
  • 2013
This review shows the evolution of the clinical toxicology and pharmacology group's research from a clinical pharmacology approach to one that studies possible interventions at multiple levels, including the patient, the community and government legislation. Expand
Researching nature's venoms and poisons.
  • D. Warrell
  • Medicine
  • Transactions of the Royal Society of Tropical Medicine and Hygiene
  • 2009
A randomised placebo-controlled trial proved that this treatment effectively reversed kaneru cardiotoxicity and there are strong scientific grounds for the use of activated charcoal, but encouraging results with multiple-dose activated charcoal were not confirmed by a recent more powerful study. Expand
Management of yellow oleander poisoning
Digoxin-specific antibody fragments remain the only proven therapy for yellow oleander poisoning and are effective in reverting life-threatening cardiac arrhythmias in patients with severe poisoning. Expand
Deliberate Self-poisoning due to Plant Toxins: Verdant Footprints of the Past into the Present
Oleander and oduvanthalai were most commonly used for DSP and the seasonal pattern was found to peak in the month of April, which sheds light on the spectrum of local plants consumed for D SP. Expand
protocolFructose-1 , 6-diphosphate ( FDP ) as a novel antidote for yellow oleander-induced cardiac toxicity : A randomized controlled double blind study
Background: Cardiac toxicity due to ingestion of oleander plant seeds in Sri Lanka and some other South Asian countries is very common. At present symptomatic oleander seed poisoning carries aExpand
Rapid Detection of Oleander Poisoning Using Digoxin Immunoassays: Comparison of Five Assays
It is concluded that FPIA is most sensitive to detect the presence of oleander in serum, and should be used for monitoring digoxin in a patient receiving digoxin and self-medicated with a herbal remedy containing oleandrin. Expand
The hazards of gastric lavage for intentional self-poisoning in a resource poor location
It is believed that lavage should be considered for few patients – in those who have recently taken a potentially fatal dose of a poison, and who either give their verbal consent for the procedure or are sedated and intubated. Expand


Acute Plant Poisoning and Antitoxin Antibodies
Antitoxins developed against colchicine and cardiac glycosides would be useful for plant poisonings but their great cost limits their use in the developing world where they would make a major difference in patient management. Expand
Epidemic of self‐poisoning with seeds of the yellow oleander tree (Thevetia peruviana) in northern Sri Lanka
There is an urgent need for an intervention which could be used in rural hospitals, thus preventing the hazardous and expensive emergency transfer of patients to the capital. Expand
Anti-digoxin Fab fragments in cardiotoxicity induced by ingestion of yellow oleander: a randomised controlled trial
Anti-digoxin Fab fragments are a safe and effective treatment for serious cardiac arrhythmias induced by yellow oleander and their use in small rural hospitals in Sri Lanka should minimise costly transfer of patients and reduce the numbers of deaths. Expand
Report of a WHO workshop on the standardization and control of antivenoms.
There was much room for improving the production, quality control and safety profile of antivenoms and that lessons could be learnt from the experience gained with the preparation of human immunoglobulins, but international standards and reference materials were not appropriate in the antivenom field. Expand
Drug development for neglected diseases: a deficient market and a public-health policy failure
It is found that, of 1393 new chemical entities marketed between 1975 and 1999, only 16 were for tropical diseases and tuberculosis, and there is a 13-fold greater chance of a drug being brought to market for central-nervous-system disorders or cancer than for a neglected disease. Expand
Acute digitalis intoxication--is pacing still appropriate?
During digitalis intoxication, the pacemaker has limited preventive and curative effects, is difficult to handle, and exposes patients to severe iatrogenic accidents, while Fab fragments act as a powerful antidote and are safer and much easier to use than pacing. Expand
Acute yellow oleander (Thevetia peruviana) poisoning: cardiac arrhythmias, electrolyte disturbances, and serum cardiac glycoside concentrations on presentation to hospital
The cardiac arrhythmias, electrolyte disturbances, and serum cardiac glycoside levels seen in patients presenting to hospital with acute yellow oleander poisoning and to compare these with published reports of digitalis poisoning are described. Expand
Differential pricing of drugs: a role for cost-effectiveness analysis?
A method whereby differential prices for essential drugs could be derived in countries of variable national wealth, and, using angiotensin-converting enzyme inhibitors, an example of how the process might work is described. Expand