Search Our Scientific Publications & Authors

J Med Virol 2020 May 27. Epub 2020 May 27.

Attending Physician, SUNY Upstate Medical University, Department of Medicine, 750 East Adams Street, Syracuse, NY, USA, 3154645540.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), first identified in December 2019 in Wuhan, China, is the virus responsible for the current pandemic known as COVID-19. We report the case of a patient with past medical history of substance abuse who presented with suspected drug overdose. He was agitated and altered in the emergency room and he was treated with benzodiazepines for his agitation. Read More

Br J Pharmacol 2020 May 15. Epub 2020 May 15.

Centre for Health Economics and Medicines Evaluation, Bangor University, UK.

Background And Purpose: Resurgence in the use of chloroquine as a putative treatment for COVID-19 has seen recent cases of fatal toxicity due to unintentional overdoses. Protocols for the management of poisoning recommend diazepam, although there are uncertainties in its pharmacology and efficacy in this context. The aim was to assess the effects of diazepam in experimental models of chloroquine cardiotoxicity. Read More

Physiol Behav 2020 May 12;222:112935. Epub 2020 May 12.

Institute of Forensic Sciences and Criminology, Panjab University, Chandigarh-160014, India. Electronic address:

Background: In the previous decade, abuse of several types of prescription drugs, particularly anxiolytics, opioid analgesics, and stimulants has increased significantly worldwide. Methylphenidate (MPH) and Alprazolam (ALZ) are extensively used drugs for the treatment of attention deficit hyperactivity disorder (ADHD) and anxiety disorders, respectively. However, these drugs have a high risk of being misused or abused alone, and their combination in some peculiar cases has shown their deleterious effects. Read More

Br J Clin Pharmacol 2020 May 6. Epub 2020 May 6.

Clinical Toxicology Research Group, University of Newcastle, Newcastle, New South Wales, Australia.

Introduction: With rising use worldwide, pregabalin is increasingly implicated in poisoning deaths. We aimed to investigate the clinical effects and complications of pregabalin poisoning.

Methods: This is a retrospective review of patients presenting with pregabalin poisoning to two tertiary toxicology units from 1 July 2014 to 30 June 2019. Read More

An Acad Bras Cienc 2020 17;92(1):e20180595. Epub 2020 Apr 17.

Instituto de Ciências do Mar/LABOMAR, Universidade Federal do Ceará, Av. da Abolição 3207, Bairro Meireles, 60165-081 Fortaleza, CE, Brazil.

Pharmaceuticals occur in the environment due to their excessive consumption and the inefficiency of treatment plants to degrade, inactivate or remove them. Diazepam (DZP) stands out as the most consumed benzodiazepine, and induces sedative effects and reduces anxiety. Considering its potential appearance in several environmental compartments, the aim of the present study was to determine the effects of DZP under acute and chronic exposures on the mysid Mysidopsis juniae. Read More

Drug Alcohol Rev 2020 May 3;39(4):330-336. Epub 2020 Apr 3.

School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.

Issues: Etizolam is a thienodiazepine derivative, with high affinity for the benzodiazepine site of GABA receptors. It is often referred to as a new (or novel) psychoactive substance, a 'designer' benzodiazepine or a 'street benzodiazepine'. Increasing reports of non-medical use, identification of etizolam as an ingredient in counterfeit medications and the common identification of etizolam in drug-related deaths, highlight the need for a greater understanding of etizolam. Read More

Biochem Biophys Res Commun 2020 May 30;526(2):505-511. Epub 2020 Mar 30.

Universidade Estadual do Ceará, Centro de Ciências e Tecnologia, Programa de Pós-Graduação Ciências Naturais, Laboratório de Química de Produtos Naturais, Fortaleza, Ceará, Brazil; Universidade Regional do Cariri, Departamento de Química Biológica, Crato, Ceará, Brazil; Universidade Estadual Vale do Acaraú, Curso de Química, Sobral, Ceará, Brazil. Electronic address:

The action of anxiolytic compounds that act on selective serotonin receptors (SSRIs) have been scarcely evaluated. Serotonergic drugs have been shown to be effective in treating anxiety without presenting adverse effects as benzodiazepines. However, the anxiolytic effects take days to occur. Read More

J Emerg Med 2020 Mar 20. Epub 2020 Mar 20.

San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio-Fort Sam Houston, Texas.

Background: Intrathecal Baclofen (ITB) has become an increasingly common treatment for severe muscle spasticity associated with conditions such as cerebral palsy and spinal cord injury. Classically, withdrawal symptoms mimic symptoms of serotonin syndrome with hypertension, increased spasticity, clonus, hyperthermia, tachycardia, and possibly acute psychosis. Hypotension, muscle flaccidity, and respiratory depression are generally considered symptoms of toxicity or overdose. Read More

Forensic Sci Int 2020 May 6;310:110237. Epub 2020 Mar 6.

Department of Toxicology, Poznan University of Medical Sciences, Poznan, Poland.

Background: Recently the number of new psychoactive substances have significantly increased, becoming popular among experienced users of designer drugs. A significant group includes benzodiazepine derivatives, which have not been introduced as medications but are abused by people experimenting with new and classical psychoactive substances.

Case Presentation: The aim of this paper was to present the case of a clonazolam ingestion by a person who was not habituated to benzodiazepines. Read More

Int J Obstet Anesth 2020 May 23;42:109-111. Epub 2019 Dec 23.

Division of Obstetric, Gynecologic, and Fetal Anesthesia, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, USA. Electronic address:

A 32-year-old G2P1 woman presented for induction of labor at term. Her past medical history included polysubstance use disorder and methadone maintenance, scant prenatal care, morbid obesity, and intimate partner violence. Her induction was progressing smoothly until the acute onset of altered mental status near to the time of delivery, several minutes after a clinician-administered epidural local anesthetic bolus for significant pain. Read More

Molecules 2020 Feb 5;25(3). Epub 2020 Feb 5.

Departamento de Farmacia, Facultad de Química, Universidad Nacional Autónoma de México, Ciudad Universitaria 04510, Mexico.

Cav. (Asteraceae) is an ancient medicinal plant commonly used to alleviate pain. Nevertheless, scientific studies validating this property are lacking in the literature. Read More

Ann N Y Acad Sci 2020 Feb 6. Epub 2020 Feb 6.

US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland.

Chemical warfare nerve agent exposure leads to status epilepticus that may progress to epileptogenesis and severe brain pathology when benzodiazepine treatment is delayed. We evaluated the dose-response effects of delayed midazolam (MDZ) on toxicity induced by soman (GD) in the plasma carboxylesterase knockout (Es1 ) mouse, which, similar to humans, lacks plasma carboxylesterase. Initially, we compared the median lethal dose (LD ) of GD exposure in female Es1 mice across estrous with male mice and observed a greater LD during estrus compared with proestrus or with males. Read More

Am J Emerg Med 2020 Jan 8. Epub 2020 Jan 8.

Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh School of Medicine, USA; Pittsburgh Poison Center, Pittsburgh, PA, USA.

Background: Local anesthetic systemic toxicity characteristically occurs after inadvertent intravascular injection of local anesthetics; however, it is unclear if similar symptoms arise after intrathecal adminstration. Intrathecal use of local anesthetics for chronic pain is increasing and carries a potential risk of toxicity. Experience with the presenting symptoms and appropriate treatment for intrathecal local anesthetic toxicity is limited. Read More

Curr Neuropharmacol 2020 Jan 10. Epub 2020 Jan 10.

Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, AL10 9AB, Herts. 0.

Background: NPS belonging to the benzodiazepine (BZD) class, e.g., 'legal/designer BZDs'/'research chemicals', have recently emerged on the drug (mainly online/virtual) market. Read More

BMJ Case Rep 2020 Jan 12;13(1). Epub 2020 Jan 12.

Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

A previously healthy 11-month-old infant presented to the emergency department in status epilepticus. There was no clear trigger of her seizure activity which resolved with benzodiazepines and fosphenytoin. On further review, her parents disclosed that she had been prescribed topical 4% lidocaine cream for a groin rash and was ultimately diagnosed with lidocaine toxicity in the emergency department. Read More

Clin Toxicol (Phila) 2020 Jan 8:1-6. Epub 2020 Jan 8.

Maryland Poison Center, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA.

Pediatric ingestions of amphetamines used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) are on the rise. Little data provide an amphetamine dose at which to refer pediatric unintentional ingestions to a healthcare facility for monitoring. We studied the dose at which unintentional ingestions of amphetamines develop symptoms and receive benzodiazepines. Read More

Malar J 2019 Dec 30;18(1):447. Epub 2019 Dec 30.

Sao Carlos Institute of Physics, University of Sao Paulo, Av. Joao Dagnone, 1100 Jardim Santa Angelina, São Carlos, SP, 13563-120, Brazil.

Background: Artemisinin-based combination therapy (ACT) is used as the first-line treatment of uncomplicated malaria caused by the Plasmodium falciparum parasite and chloroquine-resistant Plasmodium vivax parasites. Evidence of resistance to ACT has been reported in Cambodia, and without new and effective anti-malarial agents, malaria burden and mortality will rise.

Methods: The used MolPrint 2D fingerprints and the Tanimoto similarity index were used to perform a structural similarity search within the Malaria Box collection to select diverse molecular scaffolds that are different from artesunate. Read More

Toxicol Sci 2020 Mar;174(1):124-132

Battelle Memorial Institute, Columbus, OH 43201, Ohio.

Organophosphorus (OP) compounds, which include insecticides and chemical warfare nerve agents (CWNAs) such as sarin (GB) and VX, continue to be a global threat to both civilian and military populations. It is widely accepted that cholinesterase inhibition is the primary mechanism for acute OP toxicity. Disruption of cholinergic function through the inhibition of acetylcholinesterase (AChE) leads to the accumulation of the neurotransmitter acetylcholine. Read More

J Med Toxicol 2020 Jan 10;16(1):12-16. Epub 2019 Dec 10.

Emory University School of Medicine, Atlanta, GA, USA.

Introduction: Bupropion is the only Food and Drug Administration-approved synthetic cathinone. It increases the release of norepinephrine in the locus coeruleus and dorsal raphe nucleus, causing an increase in the frequency of serotonergic neuron firing. The diagnosis of serotonin toxicity (ST) from bupropion poisoning is controversial due to the lack of direct serotonergic activity. Read More

Prehosp Disaster Med 2020 Feb 6;35(1):41-45. Epub 2019 Dec 6.

Edith Cowan University, School of Medical and Health Sciences, Joondalup, Western Australia, Australia.

Introduction: Serotonin and sympathomimetic toxicity (SST) after ingestion of amphetamine-based drugs can lead to severe morbidity and death. There have been evaluations of the safety and efficacy of on-site treatment protocols for SST at music festivals.

Problem: The study aimed to examine the safety and efficacy of treating patients with SST on-site at a music festival using a protocol adapted from hospital-based treatment of SST. Read More

Przegl Epidemiol 2019 ;73(3):337-347

Medical University of Bialystok, Department of Psychiatry

Introduction: In Poland, an increasing number of psychoactive substances are becoming prohibited by law as psychotropic or narcotic substances, or as new psychoactive substances (NPSs). Owing to the enormous technological possibilities offered by today’s science, synthesis of new derivatives of prohibited compounds is no longer a problem. The moment a dangerous substance is outlawed, new designer drugs (in Poland known as ‘dopalacze’) appear on the market. Read More

Drug Saf 2020 03;43(3):223-232

Best Practice Advocacy Centre New Zealand, Level 8, 10 George Street, Dunedin, 9016, New Zealand.

Introduction: The fatal toxicity index (FTI) is a measure for assessing the relative risks of death due to the medicines prescribed in a population. This knowledge is useful for prescribers and informs medicine safety initiatives. This study aimed to calculate FTIs for the New Zealand population using three methodologies. Read More

Sci Total Environ 2020 Feb 2;702:134780. Epub 2019 Nov 2.

Department of Chemistry, Umeå University, SE-90187 Umeå, Sweden.

We studied the adverse effects of four benzodiazepines frequently measured in European surface waters. We evaluated bioaccumulation potential of oxazepam, bromazepam, temazepam, and clobazam in freshwater fish species - perch (Perca fluviatilis) and we conducted a series of behavioral trials to assess their potential to alter boldness, activity, and social behavior. All selected endpoints were studied individually for each target benzodiazepine and as a mixture of all tested compounds to assess possible combinatory effects. Read More

Bioorg Chem 2020 Jan 12;94:103334. Epub 2019 Oct 12.

N. D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, 47 Leninsky prosp., 119991 Moscow, Russia. Electronic address:

Structure-activity relationship studies were conducted in the search for 1,3-thiazole isosteric analogs of imidazopyridine drugs (Zolpidem, Alpidem). Three series of novel γ-aminobutyric acid receptor (GABAR) ligands belonging to imidazo[2,1-b]thiazoles, imidazo[2,1-b][1,3,4]thiadiazoles, and benzo[d]imidazo[2,1-b]thiazoles were synthesized and characterized as active agents against GABAR benzodiazepine-binding site. In each of these series, potent compounds were discovered using a radioligand competition binding assay. Read More

Life Sci 2019 Dec 4;239:117033. Epub 2019 Nov 4.

State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing Institute of Pharmacology and Toxicology, Beijing, China. Electronic address:

Aims: Benzodiazepines (BZDs) produce various pharmacological actions by binding to and allosterically regulating GABA receptors. Several in vitro studies have demonstrated diazepam, the prototypic BZD, produces a high-dose action that cannot be countered with the classical BZD-binding site antagonist flumazenil. Here, we investigate the existence and behavioral relevance of non-classical BZD binding sites in zebrafish larvae. Read More

J Clin Psychopharmacol 2019 Nov/Dec;39(6):628-633

Oregon Poison Center.

Background: Serotonin toxicity is a common cause of drug-induced altered mental status. However, data on the causes of serotonin toxicity, symptomatology, complications, and rate of antidotal treatment are limited.

Methods: This study evaluated cases of serotonin toxicity in the ToxIC registry, an international database of prospectively collected cases seen by medical toxicologists. Read More

Addict Behav 2020 02 15;101:106142. Epub 2019 Oct 15.

Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, USA.

Introduction: Polysubstance use and misuse can increase risks for nonfatal and fatal drug overdose. To categorize drugs used in combination in nonfatal overdoses, we analyzed data from emergency department (ED) overdose-related visits in 18 states funded by CDC's Enhanced State Opioid Overdose Surveillance (ESOOS) program.

Methods: From 2017 to 2018, 120,706 ED visits included at least one hospital discharge code indicating acute drug poisoning for opioids, stimulants, hallucinogens, cannabis, anti-depressants, sedatives, alcohol, benzodiazepines, or other psychotropic drugs. Read More

J Vet Emerg Crit Care (San Antonio) 2019 Nov 21;29(6):680-685. Epub 2019 Oct 21.

Unité Urgences et soins intensifs, Ecole Nationale Vétérinaire de Toulouse, Toulouse Cedex 03, France.

Objective: To describe a case of mannitol overdose associated with acute kidney injury (AKI), hypertonic hyponatremia, and neurologic abnormalities in a dog.

Case Summary: A 10-year-old intact male Shiba Inu dog was referred to the emergency service of a veterinary teaching hospital for inappetence and acute onset of seizures. The dog had received 2 IV boluses of 3 g/kg of mannitol in less than 24 hours for a glaucoma crisis. Read More

Epilepsy Behav 2019 12 18;101(Pt B):106367. Epub 2019 Oct 18.

Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Epilepsy Research Laboratory (151), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. Electronic address:

The transition from single seizures to status epilepticus (SE) is associated with malaptive trafficking of synaptic gamma-aminobutyric acid (GABA) and glutamate receptors. The receptor trafficking hypothesis proposes that these changes are key events in the development of pharmacoresistance to antiepileptic drugs (AEDs) during SE, and that blocking their expression will help control drug-refractory SE (RSE). We tested this hypothesis in a model of SE induced by very high-dose lithium and pilocarpine (RSE), and in a model of SE induced by sc soman. Read More

IET Nanobiotechnol 2019 Sep;13(7):703-711

Department of Tissue Engineering & Regenerative Medicine, Iran University of Medical Sciences, Tehran, Iran.

The forefront horizon of biomedical investigations in recent decades is parcelling-up and delivery of drugs to achieve controlled/targeted release. In this regard, developing green-based delivery systems for a spatiotemporal controlling therapeutic agent have drawn a lot of attention. A facile route based on cyclic carbonate ring-opening reaction has been utilised to synthesise a bio-based polyol-containing urethane bond [polyol-urethane (POU)] as a nanoparticulate drug delivery system of olanzapine in order to enhance its bioavailability. Read More

Chem Biol Interact 2019 Dec 26;314:108823. Epub 2019 Sep 26.

Department of Pharmacology, Faculty of Pharmacy, Erciyes University, Kayseri, Turkey. Electronic address:

Schizophrenia cannot be treated sufficiently with existing antipsychotic drugs. Taken into account that increased Glycogen Synthase Kinase 3 Beta (GSK-3β) activity is associated with schizophrenia pathophysiology and certain antipsychotics can be able to decrease GSK3β activity, inhibition of GSK-3β activity could be a novel approach for the treatment of schizophrenia. In the present study MK-801, a widely used chemical for the in vivo/in vitro modeling of schizophrenia was selected to evoke a detrimental effect on cellular survival via GSK3β and related proteins. Read More

Heliyon 2019 Sep 9;5(9):e02446. Epub 2019 Sep 9.

MCNS Laboratory, Faculty of Science, Moulay Ismail University, Meknes, Morocco.

In this study, we have selected a series of a new family of molecules bearing Triazolo-benzodiazepines, an eleven membered heterocyclic ring has been studied for antidepression activity. Docking studies suggested that all the eleven ligands interacted well within active site of Drosophila melanogaster dopamine transporter (dDAT) (PDB ID: 4M48). Most ligands formed H-bond with amino acid Phe43, Asp46, Asp475, Tyr123, Ser421 and/or Gln316 and also exhibited Pi and Pi-Pi interactions with amino acid residues Tyr124, Phe319, Phe43, Phe325, Ala479 and Val120. Read More

J Med Toxicol 2020 Jan 3;16(1):67-70. Epub 2019 Sep 3.

Guys and St Thomas' NHS Foundation, Faculty of Life Sciences and Medicine, King's College London, London, UK.

Introduction: 3-Hydroxyphencyclidine (3-HO-PCP) is a new psychoactive substance (NPS) and a hydroxy derivative of phencyclidine (PCP), and N-ethylhexedrone (Hexen) is a synthetic cathinone. We describe an analytically confirmed case of acute toxicity related to the use of both 3-hydroxyphencyclidine and N-ethylhexedrone.

Case Report: A 56-year-old male was brought to the Emergency Department by ambulance with hyperthermia (39. Read More

Neurobiol Dis 2020 01 24;133:104537. Epub 2019 Aug 24.

Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Epilepsy Research Laboratory (151), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA., USA. Electronic address:

The initiation and maintenance phases of cholinergic status epilepticus (SE) are associated with maladaptive trafficking of synaptic GABA and glutamate receptors. The resulting pharmacoresistance reflects a decrease in synaptic GABA receptors and increase in NMDA and AMPA receptors, which tilt the balance between inhibition and excitation in favor of the latter. If these changes are important to the pathophysiology of SE, both should be treated, and blocking their consequences should have therapeutic potential. Read More

Toxicol Lett 2019 Nov 19;316:183-193. Epub 2019 Aug 19.

Institute of Pharmaceutical Analysis and Drug Metabolism, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China. Electronic address:

Olanzapine, a representative of antipsychotics, is a first-line drug for treatment of schizophrenia. However, olanzapine-induced liver steatosis limits its clinical utilization. This study is to explore the mechanism of liver steatosis induced by olanzapine based on the regulation of transporters involved in uptake and oxidation of fatty acids. Read More

J Investig Med High Impact Case Rep 2019 Jan-Dec;7:2324709619868266

1 Louisiana State University Health Sciences Center, New Orleans, LA, USA.

Toxic leukoencephalopathy (TL) is characterized by white matter disease on magnetic resonance imaging (MRI) and evidence of exposure to a neurotoxic agent. We describe a case of cocaine-induced TL in which extensive white matter disease did not preclude full recovery. A 57-year-old man with substance abuse disorder presented with a 5-day history of strange behavior. Read More

Ann Saudi Med 2019 Jul-Aug;39(4):279-282. Epub 2019 Aug 5.

From the Department of Surgery, Division of Otorhinolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

A 28-month-old boy mistakenly received intranasal atropine sulfate instead of Otrivin (xylometazoline hydrochloride) for the treatment of adenoid hypertrophy. Later on, he came to the emergency department with anticholinergic manifestations after the administration of multiple drops. The child presented with a tonic-clonic seizure lasting for a few minutes, followed by a brief loss of consciousness, vomiting, agitation, and irritability, all of which were stabilized by a dose of intravenous lorazepam. Read More

Neurotoxicology 2019 09 27;74:203-208. Epub 2019 Jul 27.

Neuroscience Branch, US Army Medical Research Institute of Chemical Defense, 8350 Ricketts Point Road, Aberdeen Proving Ground, MD, 21010, USA.

Risk exists for civilian exposure to nerve agents (NA), and exposure can produce prolonged seizures. Pediatric populations are at greater risk for injury or death due to the central nervous system effects of NAs. To address the need to evaluate the effectiveness of anticonvulsants, pediatric and adult animal models were established to test the effectiveness of anticonvulsant drugs for treating NA-induced seizures in pediatric populations. Read More

Am J Addict 2019 09 26;28(5):413-415. Epub 2019 Jul 26.

Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska.

Background And Objectives: Carbon monoxide is one of the most common causes of fatal intoxications in the United States, and multiple previous studies have demonstrated that cigarette smokers have higher levels of carbon monoxide in their blood. However, the potential negative effects due to acute carbon monoxide poisoning from excessive cigarette smoking have not been well established.

Methods: This is a single patient case report. Read More

Swiss Med Wkly 2019 Jul 24;149:w20056. Epub 2019 Jul 24.

Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland / Institute of Pharmacology, University of Bern, Switzerland.

Aims Of The Study: To analyse emergency department (ED) presentations related to acute medical problems after recreational use of prescription/over-the-counter (OTC) drugs in two major Swiss hospitals in order to identify the prevalence of specific drugs, vulnerable groups, time trends and local differences which could have major public health implications.

Methods: Retrospective analysis of cases presenting with signs/symptoms consistent with acute toxicity due to recreational use of prescription/OTC drugs from May 2012 to August 2017 at the ED of the University Hospital of Bern and from October 2013 to July 2017 at the ED of the University Hospital Basel. We investigated time trends, sex differences, patient characteristics and consumption patterns within three age groups (≥16 to <36 years; ≥36 to <56 years; ≥56 years). Read More

Alcohol 2020 02 18;82:23-27. Epub 2019 Jul 18.

Cleveland Clinic, Cleveland, OH, United States.

A symptom-triggered lorazepam regimen is the standard for treating alcohol withdrawal syndrome (AWS) in an inpatient setting. However, in severe AWS, lorazepam requirements can reach significant amounts and lead to risk of delirium and propylene glycol toxicity. Phenobarbital has been shown to be an effective adjunctive therapy for AWS, reducing benzodiazepine use, in the emergency department. Read More

Regul Toxicol Pharmacol 2019 Oct 17;107:104429. Epub 2019 Jul 17.

US Food and Drug Administration, Center for Drug Evaluation and Research, Office of Hematology and Oncology Products, 10903 New Hampshire Ave, Silver Spring, MD, 20903, United States.

With a new generation of antibody-drug conjugates (ADCs) that contain a drug-to-antibody ratio (DAR) of 2, the question remains whether advances in technology have resulted in more stable and tumor-specific ADCs. These ADCs are anticipated to cause minimal systemic exposures of payloads, with toxicities being evident mainly at tumor sites. We examined 15 ADCs with PBD-dimer payloads and a DAR of 2 and concluded that dose limiting toxicities in animals and in humans are generally related to the payload. Read More

Drug Test Anal 2019 Sep 9;11(9):1460-1464. Epub 2019 Jul 9.

Institut de médecine légale, Strasbourg, France.

The stability of compounds in formalin solution is an important factor for drug analysis in a toxicological investigation. In this article, the authors report a complex medico-legal case involving midazolam and oxycodone. The complexity of this case comes from the fact that the body was embalmed with formalin solution before the autopsy. Read More

Acad Forensic Pathol 2018 Sep 31;8(3):729-737. Epub 2018 Aug 31.

Over a three-month period in early 2017, the Hennepin County Medical Examiner's Office investigated nine apparent opioid toxicity deaths that occurred in three separate urban, suburban, and rural counties in our jurisdiction. All decedents were known substance abusers and had reportedly recently used heroin; most were found with drug paraphernalia. Complete autopsies variably showed classic stigmata of opioid overdose with no significant injury or natural disease to explain death. Read More

Breastfeed Med 2019 09 18;14(7):508-512. Epub 2019 Jun 18.

Department of Emergency Medicine/Oregon, Alaska and Guam Poison Center, Oregon Health and Science University, Portland, Oregon.

We described calls to U.S. poison centers (PCs) related to potential exposure to substances through breast milk. Read More

Expert Opin Drug Saf 2019 Aug 14;18(8):753-758. Epub 2019 Jun 14.

c Department of Internal Medicine and Gastroenterology, Catholic University of Rome , Rome , Italy.

: Z-Drugs (ZDs) have been developed to limit benzodiazepines (BZDs) abuse for sleep disorders. Data on the liver toxicity of zolpidem (ZLM) are lacking or anecdotal. The authors evaluated the presence of drug-induced liver injury (DILI) among a cohort of high-dose ZLM abusers. Read More

Br J Clin Pharmacol 2019 09 17;85(9):2098-2107. Epub 2019 Jul 17.

Translational Australian Clinical Toxicology Program, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia.

Aims: We aim to calculate 2 metrics of relative lethal toxicity; the fatal toxicity index (FTI; number of deaths per year of a daily dose) and the case fatality (CF; number of deaths per overdose) with a focus on opioids, antidepressants, antipsychotics, benzodiazepines and illicit drugs.

Methods: This descriptive cohort study used the Australian National Coronial Information System (NCIS) to identify a population of individuals with drug-associated deaths in the Greater Newcastle Hunter Area between January 2002 and December 2016. This was combined with Australian medicine dispensing data and corresponding data from the Hunter Area Toxicology Service to calculate FTI and CF. Read More

Circ Res 2019 08 3;125(4):449-466. Epub 2019 Jun 3.

From the Pulmonary Hypertension Research Group of the Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Canada (B.R., V.N., A.B., S.P., E.T., J.O., N.C., R.A-A., L.T., A.D., S.B.-B., P.P., R.P., O.B., S.B., F.P.).

Rationale: Pulmonary hypertension (PH) due to left heart disease (LHD), or group 2 PH, is the most prevalent form of PH worldwide. PH due to LHD is often associated with metabolic syndrome (MetS). In 12% to 13% of cases, patients with PH due to LHD display vascular remodeling of pulmonary arteries (PAs) associated with poor prognosis. Read More