Archive for the ‘Best of TPR’ Category

W-18, a synthetic opiate 100 times more potent than fentanyl

February 4, 2016, 2:01 pm



Last August, Canadian police seized 110 illegal fentanyl pills at a home in Alberta province. Yesterday, Global News reported that some of the pills have tested positive for an extremely potent opioid called W-18.

This is certainly a disturbing development, since W-18 is a μ-receptor agonist 100 times more potent than fentanyl. According to B.C. Centre for Disease

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Must-read: review of single-dose activated charcoal

November 17, 2015, 12:25 am


Activated charcoal for acute overdose: a reappraisal. Juurlink D. Br J Clin Pharmacol 2015 Sep 26 [Epub ahead of print]


The British Journal of Clinical Pharmacology seems to be publishing a series of articles on basic management of the poisoned patient. Several weeks ago we reviewed (and highly recommended) Marco Sivilotti’s excellent discussion of flumazenil, naloxone and the

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Use of flumazenil and naloxone in poisoned patients

November 2, 2015, 11:08 pm


Flumazenil, naloxone and the ‘coma cocktail’ Sivilotti MLA Br J Clin Pharmacol 2015 Aug 7 [Epub ahead of print]


This very smart paper reviews factors affecting the clinical use of two antidotes that reliably reverse  coma caused by two major classes of poisons: flumazenil for benzodiazepines, and naloxone for opiates.

Both these antidotes are specific, rapid-acting, short-lived, and titratable. …

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The first 100 “Tox Tunes”

August 30, 2015, 9:15 pm

On January 3, 2010, TPR launched “Tox Tunes,” a series of clips of songs about drug, toxins, and poisons starting with Keith Richards’ version of Reverent Gary Davis’s “Cocaine Blues.” Last week, we featured our one-hundredth tune, Amy Winehouse’s classic — and tragically ironic — song “Rehab.” To celebrate the 100-tunes milestone, we are listing all …

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Early metabolic acidosis and coma in massive acetaminophen overdose

August 7, 2015, 1:33 pm


Coma and Severe Acidosis: Remember to Consider Acetaminophen. Villano JH et al. J Med Toxicol 2015 July 8 [Epub ahead of print]


This paper, from UC-San Diego, contains an excellent case discussion that makes numerous important points about a patient who presents with decreased mental status and high-anion-gap metabolic acidosis.

The patient was a 28-year-old male who was …

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ED sedation with droperidol is relatively safe and effective

May 19, 2015, 7:57 pm


The Safety and Effectiveness of Droperidol for Sedation of Acute Behavioral Disturbance in the Emergency Department. Calver L et al. Ann Emerg Med 2015 Apr 11 [Epub ahead of print]


Before the Food and Drug Administration issued a black box warning in 2001 regarding the relationship between droperidol and risk of QTc prolongation, the drug had been used for …

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27 fatalities from laboratory-confirmed exposure to PMMA (“Dr. Death”)

April 18, 2015, 2:22 pm


Deaths from exposure to paramethoxymethamphetamine in Alberta and British Columbia, Canada: a case series. Nicol JJE et al. CMAJ Open. 2015 Jan 13;3(1):E83-9

Full Text

From June 2011 through April 2012, 27 deaths in the Canadian provinces of Albert and British Columbia were attributed to the hallucinogenic stimulant para-methoxy-N-methylamphetamine (PMMA) as the primary toxic agent based …

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There is no real evidence on treating calcium channel blocker overdose

November 6, 2014, 8:06 pm


Treatment of calcium channel blocker poisoning: A systematic review. St-Onge M et al. Clin Toxicol 2014 Nov;52:926-944.


This systematic review is massive, thorough, intimidating, and all but unreadable.

As a prelude to establishing a clinical guideline for treatment of calcium channel blocker (CCB) overdose, the 14 Canadian authors systematically searched and evaluated relevant literature. They initially identified 15,577(!) citations, …

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Must-read: marketing vs. medicine in the case of Pradaxa (dabigatran)

July 27, 2014, 8:01 pm


Dabigatran: how the drug company withheld important analyses. Cohen D. BMJ 2014 Jul 23;349:g4670. doi: 10.1136/bmj.g4670.

Full Text

As TPR has reported before, there has long been reason to doubt the claim that the anticoagulant dabigatran (Pradaxa) can be safely and effectively used for prevention of strokes in patients with non-valvular atrial fibrillation without laboratory monitoring.

This must-read investigative …

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