Clinical Toxicology

Clinical Toxicology

Published by Taylor & Francis

Online ISSN: 1556-9519

·

Print ISSN: 1556-3650

Journal websiteAuthor guidelines

Top-read articles

47 reads in the past 30 days

Figure 1. Plasma paracetamol concentrations (log scale) in 30 poisoned patients who did not receive antidotal treatment. Patients without liver damage (dashed lines) and with liver damage (continuous lines). Redrawn from Prescott et al. 1971 [7] with permission.
Figure 2. Rumack-Matthew nomogram (dashed line) and the United States Food and Drug Administration approved United States National Multicenter Study treatment line (solid) utilized since 1976 [8]. Used with permission.
Fifty years of paracetamol (acetaminophen) poisoning: the development of risk assessment and treatment 1973-2023 with particular focus on contributions published from Edinburgh and Denver

January 2024

·

500 Reads

·

12 Citations

·

·

James W Dear

·

[...]

·

Download

24 reads in the past 30 days

Characterizing pharmacobezoar formation: a descriptive analysis from VigiBase

May 2025

·

24 Reads

Introduction: Pharmacobezoars are concretions of drugs that can persist within the gastrointestinal tract and can lead to mechanical obstruction and pharmacological toxicity. We aimed to provide a descriptive analysis of reported cases of pharmacobezoar in VigiBase, the World Health Organization global database of adverse event reports for medicines and vaccines. Methods: We conducted a descriptive analysis of all de-duplicated individual case safety reports related to pharmacobezoars recorded in VigiBase, from its inception in 1968 to March 2, 2025. In a subgroup analysis, we selected reports containing at least one Preferred Term related to drug overdose, misuse, or suicidal behavior to identify potential cases of acute intoxication. Results: A total of 632 individual case safety reports related to pharmacobezoars were analyzed. These primarily involved male patients (n = 318; 50.3%), with a median age of 60.0 years (IQR 43.0-71.0 years). Overall, 432 reports (68.4%) described serious adverse drug reactions. The most frequently involved drugs were carbidopa/levodopa (n = 148; 23.4%), quetiapine (n = 63; 10.0%), sucralfate (n = 46; 7.3%), nifedipine (n = 41; 6.5%), and acetylsalicylic acid (n = 40; 6.3%). The subgroup analysis included 158 reports related to acute intoxications, mostly involving female patients (n = 103; 65.2%), with a median age of 43.0 years (IQR 24.0-54.0 years). Almost all were serious (n = 156; 98.7%), with quetiapine, venlafaxine, ibuprofen, acetylsalicylic acid, paracetamol, and lorazepam most frequently reported. Discussion: The findings highlight the clinical severity and heterogeneous presentation of pharmacobezoars. Carbidopa/levodopa was frequently reported, possibly reflecting underlying conditions such as Parkinson disease with delayed gastric motility. The high prevalence of psychotropics underscores the need for targeted prevention in at-risk populations, particularly those with psychiatric comorbidities. Conclusions: While pharmacobezoars are rare, their association with serious and potentially fatal outcomes warrants increased clinical awareness. Early recognition and appropriate management may be particularly important in cases involving high-risk drugs.

Aims and scope


Clinical Toxicology is an international journal publishing research on the various aspects of clinical toxicology including the diagnosis and treatment of poisoning.

  • Clinical Toxicology is a subscription-based journal that publishes peer-reviewed scientific research and clinical advances in clinical toxicology.
  • The journal reflects the professional concerns and best scientific judgment of its sponsors, the American Academy of Clinical Toxicology, the European Association of Poisons Centres and Clinical Toxicologists, America's Poison Centres and the Asia Pacific Association of Medical Toxicology and, as such, is the leading international journal in the specialty.
  • Clinical Toxicology aims to be the journal of primary interest to practicing clinical toxicologists, whether in hospitals, poison centres, academia, government or industry.

For a full list of the subject areas this journal covers, please visit the journal website.

Recent articles


Acute oral toxic ingestion of lidocaine 4
  • Article

June 2025

Kayla Leathem

·

Molly Chang

·

Katherine Weigartz















Characterizing pharmacobezoar formation: a descriptive analysis from VigiBase

May 2025

·

24 Reads

Introduction: Pharmacobezoars are concretions of drugs that can persist within the gastrointestinal tract and can lead to mechanical obstruction and pharmacological toxicity. We aimed to provide a descriptive analysis of reported cases of pharmacobezoar in VigiBase, the World Health Organization global database of adverse event reports for medicines and vaccines. Methods: We conducted a descriptive analysis of all de-duplicated individual case safety reports related to pharmacobezoars recorded in VigiBase, from its inception in 1968 to March 2, 2025. In a subgroup analysis, we selected reports containing at least one Preferred Term related to drug overdose, misuse, or suicidal behavior to identify potential cases of acute intoxication. Results: A total of 632 individual case safety reports related to pharmacobezoars were analyzed. These primarily involved male patients (n = 318; 50.3%), with a median age of 60.0 years (IQR 43.0-71.0 years). Overall, 432 reports (68.4%) described serious adverse drug reactions. The most frequently involved drugs were carbidopa/levodopa (n = 148; 23.4%), quetiapine (n = 63; 10.0%), sucralfate (n = 46; 7.3%), nifedipine (n = 41; 6.5%), and acetylsalicylic acid (n = 40; 6.3%). The subgroup analysis included 158 reports related to acute intoxications, mostly involving female patients (n = 103; 65.2%), with a median age of 43.0 years (IQR 24.0-54.0 years). Almost all were serious (n = 156; 98.7%), with quetiapine, venlafaxine, ibuprofen, acetylsalicylic acid, paracetamol, and lorazepam most frequently reported. Discussion: The findings highlight the clinical severity and heterogeneous presentation of pharmacobezoars. Carbidopa/levodopa was frequently reported, possibly reflecting underlying conditions such as Parkinson disease with delayed gastric motility. The high prevalence of psychotropics underscores the need for targeted prevention in at-risk populations, particularly those with psychiatric comorbidities. Conclusions: While pharmacobezoars are rare, their association with serious and potentially fatal outcomes warrants increased clinical awareness. Early recognition and appropriate management may be particularly important in cases involving high-risk drugs.







Occult bromazolam exposure in patients presenting with opioid or stimulant overdose

May 2025

·

10 Reads

Introduction: Bromazolam is a benzodiazepine, not approved for use in any North American or European jurisdiction that has emerged as an adulterant in the United States illicit drug supply. Methods: This is a case series of seven patients treated for an acute overdose and found to have bromazolam in their blood despite no self-reported exposure. Patients were enrolled from June 2023 to January 2024 as part of the Drug Overdose Toxico-Surveillance Reporting Program, a multi-center, prospective project including patients aged 13 years and older with a suspected life-threatening opioid and/or stimulant overdose. This case series is drawn from a single emergency department from that project. Patients were interviewed on their drug use, and clinical data were collected from electronic medical records. Whole blood was obtained and tested qualitatively for over 1,200 psychoactive substances using liquid chromatography quadrupole time-of-flight mass spectrometry and quantitative measurements using liquid chromatography-tandem quadrupole mass spectrometry. Results: Patients presented with acute signs of excessive sedation (six of seven) or agitation (one of seven). The median blood bromazolam concentration was 29 µg/L (range <5-84 µg/L). Three patients were admitted to hospital or observed for more than 24 h in the emergency department. The reasons for admission/observation were advanced pregnancy, prolonged sedation, and the need for social services. No patients were placed in a critical care unit and all patients survived. During the structured interview, none of the patients reported bromazolam use. Discussion: This case series demonstrated no poor clinical outcomes in patients with acute overdose who had detectable bromazolam concentrations despite no reported bromazolam use. In all cases of sedation, patients responded to naloxone (in all cases the patients admitted to taking opioids, which was confirmed analytically), and there was no ongoing sedation attributed to the detected bromazolam. Conclusions: Substances unknown to patients are present in the drug supply. Toxico-surveillance programs are essential to obtaining information about community patterns of drug use that cannot be obtained from patient history or from medical charts.






Journal metrics


3.0 (2023)

Journal Impact Factor™


27%

Acceptance rate


5.7 (2023)

CiteScore™


4 days

Submission to first decision


1.294 (2023)

SNIP


0.956 (2023)

SJR

Editors