Nicolas Simon

• MD, PhD
• Professor (Full) at Aix-Marseille University

Objective: In some regions of the globe, accidental food confusion regarding plants can cause severe poisoning events and deaths. The aim of this study was to report on those confusions from the Marseille Poison Control Centre’s (PCC) experience from 2002 to 2023. Results: Over 22 years, 2197 food confusion events were managed with 321 different sp...

Introduction High variability in vancomycin exposure in neonates requires advanced individualized dosing regimens. Achieving steady-state trough concentration (C0) and steady-state area-under-curve (AUC0-24) targets are important to optimize treatment. The objective was to evaluate whether machine learning (ML) can be used in clinical practice to p...

Bed bugs are pervasive global pests that have reemerged in the last 20 years as a significant public health concern, especially in densely populated urban areas. Beyond financial losses, expenses, inconvenience, and psychological distress, bed bug infestations often necessitate chemical management, posing poisoning risks to those with an infestatio...

Aims: We propose using glomerular filtration rate (GFR) as the physiological basis for distinguishing components of renal clearance. Methods: Gentamicin, amikacin and vancomycin are thought to be predominantly excreted by the kidneys. A mixed effects joint model of the pharmacokinetics of these drugs was developed, with a wide dispersion of weight...

Introduction: In a few regions of the globe, deliberate botanical intoxication may induce significant rates of toxicity and fatality. The objective of this report was to describe plant self-intoxication using the experiences of the southeastern France poison control center (PCC) between 2002 and 2021. Results: During those 20 years, 262 deliberate...

Aims To study the effect of inhaled cannabis on self-assessed predicted driving ability and its relation to reaction times and driving ability on a driving simulator. Participants and methods 30 healthy male volunteers aged 18–34: 15 chronic (1–2 joints /day) and 15 occasional (1–2 joints/week) consumers. Self-assessed driving confidence (visual a...

Background and objective: High variability in vancomycin exposure in neonates requires advanced individualized dosing regimens. Achieving steady-state trough concentration (C0) and steady-state area-under-curve (AUC0-24) targets is important to optimize treatment. The objective was to evaluate whether machine learning (ML) can be used to predict t...

Background Although poisonings due to a toxic substance being decanted into a secondary container are often reported to poison centers, we were unable to locate prior European data about their circumstances, incidence and consequences. We sought to describe the circumstances and outcomes of this behavior. Materials and method We conducted a prospe...

Aims The estimated effect of sodium oxybate (SMO) in the treatment of alcohol dependence is heterogeneous. Population severity and treatment duration have been identified as potential effect modifiers. Population severity distinguishes heavy drinking patients with <14 days of abstinence before treatment initiation (high-severity population) from ot...

Le scombrotoxisme est une intoxication observée après ingestion de chair de poisson mal conservée, le plus souvent de la famille des scombridés, d’où le nom du toxidrome. La chair de poissons habituellement comestibles comme les thons ou les maquereaux, peut, dans certaines conditions, contenir d’importantes quantités d’histamine générant un tablea...

Tramadol overdose is frequently associated with the onset of seizures, usually considered as serotonin syndrome manifestations. Recently, the serotoninergic mechanism of tramadol-attributed seizures has been questioned. This study’s aim was to identify the mechanisms involved in tramadol-induced seizures in overdose in rats. The investigations incl...

Concerns have been raised about early vs. later impacts of the COVID-19 pandemic on suicidal behavior. However, data remain sparse to date. We investigated all calls for intentional drug or other toxic ingestions to the eight Poison Control Centers in France between 1st January 2018 and 31st May 2022. Data were extracted from the French National Da...

Introduction The effects of antipsychotic drugs are dose-dependent, which is particularly true for their efficacy, each antipsychotic having a specific dose-response curve. This may justify individualizing doses for these agents. Areas covered We review the pharmacokinetic profiles of seven oral antipsychotics: haloperidol, risperidone, olanzapine...

In this study, we aimed to identify the factors related to esophageal impaction following button battery (BB) ingestion in children. PilBouTox, a prospective multicentric observational cohort study, was conducted from French Poison Control Centers between June 1, 2016 and May 31, 2018. Children (0-12 years old) with BB ingestion were included. Afte...

Background Sodium oxybate (SMO) has been shown to be effective in the maintenance of abstinence (MoA) in alcohol-dependent patients in a series of small randomized controlled trials (RCTs). These results needed to be confirmed by a large trial investigating the treatment effect and its sustainability after medication discontinuation. Aims To confi...

Introduction: In recent years, the number of patients managed by poison control centres (PCCs) has increased without a proportional increase in the number of physicians. To improve efficiency without neglecting patient follow-up, some PCCs have begun using text messages. We evaluated the difference in response rates between text messaging and trad...

We develop a population pharmacokinetic model for hydroxychloroquine (HCQ) and three of its metabolites (desethylhydroxychloroquine, Des HCQ; desethylchloroquine, DesCQ; and didesethylchloroquine, didesCQ) in COVID-19 patients in order to determine whether a pharmacokinetic (PK)/pharmacodynamic (PD) relationship was present. The population PK of HC...

On the French island of Corsica, a 57-y-old woman without significant medical history was stung on the left thumb while she was taking care of an ornamental Ficus benjamina plant. Immediately, she felt intense pain in her hand. She saw a strange caterpillar, later identified by the local poison center as Acharia stimulea. The pain in her hand was e...

Objectifs La strychnine est un alcaloïde toxique utilisé depuis le 15e siècle comme rodenticide ; son utilisation est interdite en France depuis 1999 [1], [2]. Cependant, des cas souvent mortels sont toujours signalés, notamment aux centres antipoison. En janvier 2020, le centre antipoison était contacté pour un cas de suicide avec 5 g d’une poudre...

Objectifs La pervenche française (Vinca minor) est une plante grimpante de la famille des apocynacées. Les tiges sont fines, les feuilles sont opposées, ovales ou oblongues, et les fleurs, très souvent violettes, ont cinq pétales. La floraison a lieu pendant les mois de mars à juin et les fruits, qui se trouvent au milieu de la fleur contiennent 7-...

Objectifs Les violets de roche du genre Microcosmus sont des fruits de mer consommés crus en périodes festives en Provence. Ce sont des animaux marins sessiles de la classe des ascidies. À partir de 2011, le centre antipoison de Marseille (CAPM) a été consulté pour plusieurs intoxications après consommation de violets avec un tableau clinique n’évo...

Background There is considerable unexplained variability in alcohol abstinence rates (AR) in the placebo groups of randomized controlled trials (RCTs) for alcohol dependence (AD). This is of particular interest because placebo responses correlate negatively with treatment effect size. Recent evidence suggests that the placebo response is lower in v...

In the world, the impact of environmental conditions on the number of scorpion events was evaluated in North Africa,Middle East, and the Amazonian region but not in Europe. In mainland France, scorpion species described are Buthus occitanus (Amoreux, 1789), Belisarius xambeui (Simon, 1879) and 4 Euscorpiidae: Euscorpius concinnus (Koch, 1837), Eusc...

Concentrated ammonia solutions are strong mineral bases that can induce severe lesions of the upper gastrointestinal tract when ingested. Little is known about the circumstances of poisoning with these solutions. The aim of this study was to compare ammonia exposure between patients who were drug users or abusers with non-user patients. A retrospec...

Background Population pharmacokinetic evaluations have been widely used in neonatal pharmacokinetic studies, while machine learning has become a popular approach to solving complex problems in the current era of big data.Objective The aim of this proof-of-concept study was to evaluate whether combining population pharmacokinetic and machine learnin...

Objective To develop a population pharmacokinetic model for lopinavir boosted by ritonavir in coronavirus disease 2019 (Covid-19) patients. Methods Concentrations of lopinavir/ritonavir were assayed by an accredited LC-MS/MS method. The population pharmacokinetics of lopinavir was described using non-linear mixed-effects modeling (NONMEM version 7...

Introduction Peganum harmala, aussi appelé rue sauvage, est une plante herbacée vivace, à l’origine rencontrée dans les milieux semi-arides du bassin méditerranéen et en Asie centrale mais répandue aujourd’hui en Afrique, Amérique du Sud et Australie. Graines, feuilles et fleurs sont utilisées pendant des rites, pour leurs effets médicaux, comme dr...

Objectif Explorer l’exploitabilité des appels à la Réponse Téléphonique d’Urgence (RTU) pour suivre la pathologie psychiatrique d’un patient et l’efficacité de sa prise en charge. Historique du cas Mme F contacte à partir de mi-2015 de plus en plus fréquemment la RTU du CAP de Marseille (CAPM). Ses premiers appels sont assez agités, voire agressif...

Objectif La solution d’ammoniaque a de nombreux usages tant domestiques que professionnels. Les usagers de cocaïne connaissent également ses propriétés basiques qui permettent la synthèse de crack (ou free base) [1]. Les cas d’ingestion accidentels ou volontaires de ce produit caustique sont rares mais potentiellement graves. L’objectif de cette ét...

The coronavirus disease 2019 (COVID-19) pandemic has made alcohol-based hand sanitizers (ABHS) widely available in public places. This may warrant determining whether cases of unintentional ocular exposure are increasing, especially in children.

Aims To develop a population pharmacokinetic (PP) model of delta‐9‐tetrahydrocannabinol (THC) and its metabolites in blood and to determine the relationship between blood THC pharmacokinetics and results of on‐site oral fluid (OF) testing in chronic (CC) and occasional (OC) cannabis users. Methods Fifteen CC (1–2 joints/day) and 15 OC (1–2 joints/...

Since the accidental introduction of the yellow-legged hornet (Vespa velutina nigrithorax) in France in 2004, there have been reports of this insect unexpectedly projecting a liquid toward the human face, but ocular morbidity associated with this is unknown, to our knowledge.

Buprenorphine has been used in pain and opioid addiction management for nearly 25 years. Compared to methadone, buprenorphine is thought to exhibit less side effects and respiratory depression in case of accidental or suicidal overdose. The aim was to describe the characteristics of exposures reported to a French Poison Control Center (PCC). We con...

Introduction: Antipsychotic polypharmacy (APP), defined as the use of more than one antipsychotic, is common in schizophrenia. However, current guidelines consider that the level of evidence to support APP is weak and mostly recommend monotherapy. Areas covered: Meta-analyses of randomized controlled trials (RCTs) on the efficacy and tolerabilit...

In European countries, vitamin A toxicity is most often the result of an excessive intake of vitamin supplements and rarely the consequence of the ingestion of a large carnivorous fish liver. We report 3 cases of vitamin A poisoning after fish liver ingestion in mainland and overseas France. The patients were a 12-y-old girl, a 36-y-old pregnant wo...

Introduction Ciguatera fish poisoning (CFP) is a common Poisoning in the tropical countries. France is directly concerned with French tourists in endemic area and with French citizens living in the French overseas territories. Method Retrospective, descriptive study of CFP cases handled by the French Poison Control Centre Network from 2012 through...

Chronic cannabis use can be associated with uncontrollable vomiting and abdominal pain. Diagnostic criteria for cannabinoid hyperemesis syndrome (CHS) were defined in 2012 by Simonetto et al. The objectives of this study were to describe the prevalence of CHS, the patients’ epidemiological characteristics and to show the difficulties encountered in...

Introduction: For many years, applications for baclofen have widened in the treatment of substance abuse disorder (SUD), mainly alcohol use disorder, with a growing rate of off-label prescriptions in Europe, particularly in France. Clinical effects seem to be both a decrease of craving and anxiety, leading to a decrease of drug or alcohol consumpti...

Résumé Objectif: la relation pharmacocinétique/pharmacodynamique (PK/PD) après une prise fumée de cannabis et l’aptitude à conduire est peu documentée. Méthodes: le tétrahydrocannabinol (THC) et ses deux principaux métabolites ont été mesurés dans le sang de 15 consommateurs chroniques (CC, 1-2 joints/jour) et de 15 consommateurs occasionnels (CO,...

Malgré des avancées thérapeutiques majeures, avec notamment l’apport de la clozapine, les stratégies de prise en charge et les recommandations publiées, beaucoup de patients continuent de présenter des formes sévères de la maladie. Face à ce constat, est-il possible aujourd’hui de dégager des modèles neurobiologiques de la résistance qui permettrai...

Buprenorphine is a µ‐partial agonist and k‐antagonist acting on central opioid receptors. Patented for analgesia in 1968, buprenorphine has been used as opioid substitutive therapy since the 1990s, as well as methadone. The aim was to document pediatric poisoning, to discover the severity and to evaluate the treatment with naloxone. All pediatric p...

En raison de ses différents risques sanitaires, le cannabis est interdit en France avec une législation sévère pour les usagers. Malgré cela, les niveaux d'usage de cannabis en France sont les plus élevés d'Europe. En outre, la prohibition empêche la mise en place de mesure de régulation et de prévention. Pour ces raisons, la possibilité de faire é...

Résumé La ciguatéra est une intoxication fréquente en zone tropicale. Depuis 1993, le Centre Antipoison de Marseille travaille sur le sujet de la Toxinologie marine et des intoxications par produits de la mer. Les auteurs rapportent l’expérience de ce service sur la ciguatéra de 1993 à 2017. Quarante-neuf intoxications ont été étudiées concernant 1...

Purpose: Off-label use of vemurafenib (VMF) to treat BRAFV600E mutation-positive, refractory, childhood Langerhans cell histiocytosis (LCH) was evaluated. Patients and methods: Fifty-four patients from 12 countries took VMF 20 mg/kg/d. They were classified according to risk organ involvement: liver, spleen, and/or blood cytopenia. The main evalu...

PURPOSE Off-label use of vemurafenib (VMF) to treat BRAF V600E mutation-positive, refractory, childhood Langerhans cell histiocytosis (LCH) was evaluated. PATIENTS AND METHODS Fifty-four patients from 12 countries took VMF 20 mg/kg/d. They were classified according to risk organ involvement: liver, spleen, and/or blood cytopenia. The main evaluatio...

Methadone has been prescribed in France as opioid substitution therapy as a syrup formulation since 1995 and as capsules since 2008. Following two publications showing on a national scale the high risk of methadone poisoning in children and the lack of difference in poisoning severity between both methadone formulations, French health authorities c...

Nutmeg is one of the most used spice all over the world and has been for many centuries. When ingested in large quantities, it has been reported to have toxic effects and described in literature for long time. Fatal case was described at the beginning of the 20th Century and a more recent in 2001. Method : Our study was based on calls compiled by t...

Bipolar disorder is a chronic, disabling, and costly illness with frequent relapses and recurrences, high rates of co-morbid conditions, and poor adherence to treatment. Mood stabilizers and antipsychotics are the cornerstones of treatment. Dopamine receptor partial agonists are a novel class of antipsychotic agents with original pharmacodynamic pr...

Introduction: Since the 1990s, opioid maintenance treatments (OMTs), i.e., mostly methadone and buprenorphine, have represented the therapeutic cornerstone of opioid dependence. In France, the public health strategy on opioid dependence, identified here as the “French model”, has consisted of offering a facilitated access to buprenorphine, to reach...

Background In the absence of consensus, the present meta-analysis was performed to determine an optimal dosing regimen of vancomycin for neonates. Methods A ‘meta-model’ using NONMEM with 4894 concentrations from 1631 neonates was built and Monte Carlo simulations were performed to design an optimal intermittent infusion, aiming at reaching a targ...

Objectives: In the absence of consensus, the present meta-analysis was performed to determine an optimal dosing regimen of vancomycin for neonates. Methods: A ‘meta-model’ with 4894 concentrations from 1631 neonates was built using NONMEM, and Monte Carlo simulations were performed to design an optimal intermittent infusion, aiming to reach a targe...

Objectives: In the absence of consensus, the present meta-analysis was performed to determine an optimal dosing regimen of vancomycin for neonates. Methods: A 'meta-model' with 4894 concentrations from 1631 neonates was built using NONMEM, and Monte Carlo simulations were performed to design an optimal intermittent infusion, aiming to reach a ta...

Introduction La survenue d’une méthémoglobinémie est une situation pathologique rare chez l’enfant. Les étiologies sont congénitales par déficit en cytochrome b5 réductase (hémoglobinose M) ou acquises. De nombreux xénobiotiques et substances oxydantes peuvent entraîner une méthémoglobinémie toxique. Le but de ce travail est de décrire les agents m...

Objective Description of a fatal case of aconite poisoning after ingestion of leaves of Aconitum napellus, documented by the dosages of 3 aconite alkaloids on various matrices in a deceased patient. Case history After accidental ingestion of aconite plant as a Couscouil salad, a 78-years-old man with non-insulin-dependent diabetes mellitus, and hi...

Background: The pharmacokinetic-pharmacodynamic relationship between whole blood δ-9-tetrahydrocannabinol (THC) and driving risk is poorly understood. Methods: Fifteen chronic cannabis consumers (1-2 joints/day; CC) and 15 occasional cannabis consumers (1-2 joints/week; OC) of 18 to 34 years of age were included. A pharmacokinetic study was cond...

Zusammenfassung Palytoxine, die in Korallen vorkommen und unter anderem durch Dinoflagellaten synthetisiert werden, wirken bei Exponierten über einen Eingriff in die Natrium-Kalium-Pumpe und führen somit zu einer Änderung des Konzentrationsgradienten zwischen intra- und extrazellulärem Raum. Die Symptomatik kann aus Atemnot, Übelkeit und Erbrechen,...

Résumé L’aripiprazole peut être considéré comme le prototype des antipsychotiques de troisième génération. Ce concept repose sur la notion d’agonisme partiel des récepteurs dopaminergiques de type D2, alors que les molécules des générations précédentes étaient des antagonistes D2. Après un rappel des notions pharmacologiques de base sur lesquelles...

Several clinical randomized trials have evaluated the interest of baclofen in patients with alcohol use disorder. Depending on the study design and the inclusion criteria, the results vary from enthusiastic to pessimistic. However, all researchers and practitioners agree that they observe a wide variability in the therapeutic responses. If some pat...

Background: Antipsychotics produce electroencephalogram (EEG) modifications and increase the risk of epileptic seizure. These modifications remain sparsely studied specifically for atypical antipsychotics. In this context, our study focuses on EEG modifications associated with atypical strict antipsychotic monotherapies. Methods: Electroencephal...

Specialists in addiction medicine continue to debate whether baclofen is still indicated to treat alcohol use disorders in view of conflicting results as to its efficacy. This review summarizes current knowledge on self-poisoning with baclofen focusing of alcohol-use disorder in order to provide an overview of the reliable scientific knowledge on m...

Objectif Rapporter un cas de piqûre par Isometrus maculatus sur l’atoll de rangiroa en polynésie française. Description du cas Il s’agit d’une femme de 55 ans, sans antécédents, qui est piquée au niveau de l’index à son domicile, sur l’atoll de rangiroa, en polynésie française. Elle consulte son médecin traitant 1h30 plus tard qui constate un œdèm...

Objectif Rapporter un cas d’intoxication humaine par Mercurialis annua lors d’une erreur d’identification. Description du cas Une femme de 46 ans, sans antécédents, récolte dans son jardin ce qu’elle pense être du chénopode blanc (Chenopodium album), plus connu sous le nom d’épinard sauvage. Elle en consomme, après cuisson, une pleine assiette au...

Objectif Rapporter le cas d’un homme, sans antécédent personnel ou familial de convulsions, ayant présenté des vomissements puis des crises convulsives itératives après un repas de Verpes de Bohème (Verpa bohemica). Description du cas Fin mars, un homme de 24 ans, aux antécédents de toxicomanie cannabinique, décide de cuisiner environ 60 g de cham...

Objectif Présenter un cas peu commun d’intoxication par les violets (Microcosmus sp.), découvert au cours d’un interrogatoire sémiologique avisé. Description du cas Le jour du réveillon de Noël, une marseillaise âgée de 56 ans, aux antécédents de communication inter-auriculaire, consulte le centre antipoison de Marseille (CAPTVM) car elle présente...

Introduction: Alcohol use disorder (AUD) is a major public health concern worldwide. In France, only 10% of people with AUD (PWAUD) receive medical care. General practitioners (GP) are one of the main entry points for AUD care. The present ongoing study, entitled ASIA (Access to Care and Indifference toward Alcohol, Accès aux Soins et Indifference...

Baclofen a gamma amino-butyric acid type B (GABA-B) receptor agonist, which has raised some interest for the treatment of alcohol use disorder (AUD), occasionally at dose up to 300 mg/d. We conducted the first full-profile pharmacokinetic study on baclofen in AUD subjects, up to the oral daily dose of 300 mg. Sixty subjects treated for AUD with mar...

Since the early 2000s, the gamma-aminobutyric acid type B (GABA-B) receptor agonist baclofen has been extensively used for treating alcohol use disorder (AUD). In some countries, like France, Australia, or Germany, baclofen has been used at patient-tailored dose regimens, which can reach 300 mgpd or even more in some patients. The GABA-B-related ph...

Medication development for alcohol relapse prevention or reduction of consumption is highly challenging due to methodological issues of pharmacotherapy trials. Existing approved medications are only modestly effective with many patients failing to benefit from these therapies. Therefore, there is a pressing need for other effective treatments with...

Aripiprazole may be viewed as the prototype of third-generation antipsychotics. This concept is based on the notion of D2 partial agonism, whereas all molecules of first-and second generation were D2 antagonists. After reviewing the basic pharmacological notions linked to such concepts, the mechanisms of action of these molecules are addressed, wit...

Harmonizing clinical pharmacology and therapeutics (CPT) education in Europe is necessary to ensure that the prescribing competency of future doctors is of an uniform high standard. As there are currently no uniform requirements, our aim was to achieve consensus on key learning outcomes for undergraduate CPT education in Europe. We used a modified...

Individuals with a history of injecting drugs have a high prevalence of chronic hepatitis C (HCV) infection. Many have a history of opioid use disorder (OUD). Despite novel treatments with improved efficacy and tolerability, treatment is limited in the group. A faculty of experts shared insights from clinical practice to develop an HCV care-readine...

Le baclofène est un agoniste des récepteurs de l'acide gamma-aminobutyrique de type B (GABA-B) qui possède depuis les années 1970 une autorisation de mise sur le marché (AMM) dans les états de spasticité neurologique, à la dose maximale de 120 mg/j. Depuis les années 2000, le baclofène fait l'objet d'essais cliniques à faibles doses (le plus souven...

Background: Little is known about the sequence of onsets in patients affected by comorbid alcohol use and bipolar disorder. This study examines the risk factors associated with their co-occurrence and order of onset. Method: The demographic, clinical, and temperament characteristics as well as the course of illness were analyzed within our sampl...

Objectif Rapporter un cas d’intoxication aiguë avec une dose potentiellement létale d’isoniazide suite à une erreur thérapeutique chez un nourrisson de 21 mois. Description Un enfant de 21 mois, pesant 13 kg, aux antécédents d’asthme avec bronchiolites à répétition, dont le père est atteint de tuberculose pulmonaire, se voit prescrire un traitemen...

Objectif Rapporter deux cas d’intoxication par palytoxines, dont un collectif, survenus lors de la manipulation de coraux mous ornementaux issus d’aquariums. Description Cas no 1 : Monsieur D, 45 ans, sans antécédent médical, décide de nettoyer son aquarium domestique. Il sort les coraux mous (Palythoa heliodiscus) sans protection, les brosse puis...

Objectif Recenser les cas de ciguatera rapportés au CAP de Marseille de 2010 à 2016 afin d’évaluer l’ampleur de cette intoxication en termes de nouveaux cas, de gravité et de résurgence des symptômes. Description La ciguatera est une intoxication fréquente des régions tropicales, décrite après ingestion de chair de poissons contaminés par les cigu...