Drugs that harm toddlers

Clin Drug Investig. 2018 Nov 15. doi: 10.1007/s40261-018-0726-1. [Epub ahead of print]

Drugs that Can Kill a Toddler with One Tablet or Teaspoonful: A 2018 Updated List.


Koren G, Nachmani A.


Abstract

BACKGROUND AND OBJECTIVE:

Young children may be accidentally exposed to adult dose forms of medications, some of which can be fatal, even with a single dose. As numerous new medications have been introduced, we herein update a 2004 list of potentially toxic drugs that can be lethal for toddlers when taking one adult dose unit.

METHODS:

We reviewed all medications available in North America and identified their reported fatal doses per kilogram in children, or in adults if no pediatric data were available. For each drug we identified the largest dose unit available on the market and calculated how many dose units would be fatal to a 10 kg toddler.

RESULTS:

Since 2004, the list of potentially fatal drugs for toddlers has doubled and now includes new anticoagulants, a phosphodiesterase-5 inhibitor, new antiepileptic drugs, antidiabetic medications, drugs for multiple sclerosis, and second-generation antipsychotic drugs, among others.

CONCLUSION:

With the development of potent new medications, an increasing number of drugs are dangerous upon accidental exposure to toddlers and young children. The present 2018 list of documented fatal drugs has doubled compared with 2004, and special labeling of these medications is urgently needed to avoid such calamities.



The list of potentially fatal drugs for toddlers is shockingly large and in-fact according to this article the number has doubled over the past 14 years. The rate of accidental poisoning is 8% among one year olds, compared with 0.35% among adults. 

Medicines prepared for adults takes into consideration that a single does unit based on dose per kilogram upon accidental exposure does not result in poisoning. But toddlers are small, and for a 10kg toddler, one or two dose units may prove fatal.

The MS drug armamentarium is not simply the disease-modifying drugs, but also includes the tricyclic antidepressants, antipsychotics and opioids. Tablets, understandably, having the appearance of smarties and owing to their ease of ingestion pose the greatest risk. The MS drugs list, from this publication are dalfampridine and fingolimod. Amitryptyline, venlafaxine, codeine, morphine, tramadol. buprenorphine, oxycodone, fentanyl, gabapentin, pregablin, lamotrigine, sildenafil are also on the list (see Table 1 below).

 Special labeling of pill bottles may help, but remember, although your own home maybe child proof, where you take them might not be!
Table 1
An updated list of medications that can kill a 10 kg toddler when using the largest available tablet or teaspoonful
Drug
Minimal potential fatal dose per kilogram of body weight (mg)
Maximal available unit dose (mg)
No. of tablets/teaspoons that can cause fatality in toddlers
Antidepressants
Amitriptylinea
15
100
1–2
Imipraminea
15
150
1
Desipraminea
15
75
1–2
Venlafaxine
6.4
225
1
Antipsychotics
Loxapinea
30
50
1–2
Thioridazine
15
200
1
Chlorpromazine
25
200
1–2
Ziprasidone
3
40
1
Clozapinea
2.5
20
1
Antimalarials
Chloroquinea
20
500
1
Hydroxychloroquinea
20
200
1
Quinine
80
650
1–2
Antiarrhythmics
Quinidine
15
324
1
Disopiramide
15
150
1
Procainamide
70
1000
1
Flecainidea
25
150
1–2
Ivabradinea
0.14
5
1
Propafenonea
40
300
1–2
Calcium channel blockers
Nifedipinea
15
90
1–2
Verapamil
15
360
1
Diltiazem
15
360
1
Opioids
Codeinea
7
60
1–2
Hydrocodonea
1.5
60 mg/5 ml
1
Methadonea
1
40
1
Morphine
0.7
200
1
Tramadol
11.6
200
1
Oxycodone
1.7
80
1
Fentanyl
10 µg
800 µg
1
Buprenorphine
0.8
8
1–2
Oral antihyperglycemics
Chlorpropamide
27
250
2
Glyburidea
0.1
5
1
Glipizidea
0.1
10
1
Repaglidine
0.2
2
1
Glimepiride
0.1
4
1
Sitagliptin
0.3
25
1
Antiplatelets/NOACs
Ticagrelor
10
90
1–2
Prasugrel
0.7
10
1
Clopidogrel
10
75
1–2
Rivaroxaban
3
20
1–2
Dabigatran
4
150
1–2
Antiepileptics
Gabapentin
130
800
1–2
Pregabalin
50
300
1–2
Lamotrigine
50
300
1–2
Multiple sclerosis drugs
Dalfampridine
0.6
10
1
Fingolimod
0.03
0.5
1
Miscellaneous
Imidazolineb
50 µg/kg
0.05%
1 teaspoon
Theophylline
8.4
500
1
Sildenafil
8
100
1
Camphora
100
1 g/5 ml
1
Methyl salicylatea
200
1.4 g/ml
1
Podophyllina
15
1.25 g/5 ml
1

NOACs noval oral anticoagulants
aDrugs that were reported to cause death in toddlers < 2 years of age; for all other drugs, the lethal dose for a 10 kg toddler was extrapolated from adult fatalities
bTetrazoline, oxymetazoline, naphazoline

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