Journal of Medical Toxicology

, Volume 15, Issue 4, pp 262–270 | Cite as

Adverse Drug Events and Reactions Managed by Medical Toxicologists: an Analysis of the Toxicology Investigators Consortium (ToxIC) Registry, 2010–2016

  • Gillian A. BeauchampEmail author
  • Alexandra Amaducci
  • Marna Rayl Greenberg
  • Matthew Meyers
  • Matthew Cook
  • Robert D. Cannon
  • Kenneth D. Katz
  • Yaron Finkelstein
  • On behalf of the Toxicology Investigators Consortium (ToxIC)
Original Article



Adverse drug events/reactions (ADE/ADRs) cost more than $30 billion annually and are among the leading causes of death in the USA. Little is known about patients treated at the bedside for ADE/ADR by medical toxicologists.


We conducted a retrospective study of ADE/ADR cases reported to the Toxicology Investigators Consortium (ToxIC) registry between January 1, 2010, and December 31, 2016. Clinical and demographic data were collected including age, sex, circumstances surrounding exposure, suspected offending substance, clinical manifestations, treatment, disposition, and outcome.


Among 51,440 ToxIC cases during this time period, 673 ADE/ADR cases were reported (337 females). By age, ADE/ADRs were seen most commonly among adults age 19–65 years (442/673, 65.7% of ADE/ADR) and older adults age 65–89 years (134/673, 19.9% of ADE/ADR). 222/673 (33%) of consults for ADE/ADR were seen in the emergency department (ED); 181/673 (26.9%) were seen in the hospital ward; and 160/673 (23.8%) were seen in the intensive care unit (ICU). The most commonly reported sign for ADE/ADR was tachycardia: 51/673 (7.6%), followed by bradycardia: 49/673 (7.3%). Most commonly reported agents associated with ADE/ADR were as follows: 97/673 (14.4%) due to cardiovascular medications; 76/673 (11.3%) due to antipsychotic medications; and 61/673 (9.1%) due to antidepressants. 429/673 (63.7%) of ADE/ADR were reported as due to a single agent, and 212/673 (31.5%) were reported as due to multiple agents.


4.2% of cases managed at the bedside by a consulting toxicologist and reported to the ToxIC registry between 2010 and 2016 had ADE/ADR as the reason for consultation. Agents most commonly involved in ADE/ADRs included cardiovascular medications, antipsychotic medications, and antidepressants.


Adverse drug reaction Adverse drug event Poisoning Drug safety 



We acknowledge Stephen W. Dusza, DrPH, and Hope Kincaid, MPH, CPH, for their help with the statistical analysis. We thank Anita Kurt, PhD, RN, for managing all resources and operations related to this project. We thank the study team involved in ToxIC research at our institution: Rita M. Pechulis, MD; Richard Mazzaccaro, MD, PhD; Manuel F. Colon, BS; Amy Wier, DO; Gregory Makar, DO; Briana Tully, DO; Brittany Ely, DO; and Emily Pollack, MD.

Sources of Funding

This project was supported in part by an institutional Dorothy Rider Pool Trust for Health Research and Education Community Foundation Grant.

Compliance with Ethical Standards

ToxIC works under the approval of the Western Institutional Review Board (IRB) and participating sites obtain approval from their respective local IRB. This study was deemed non-human subjects research due to the characteristics of the data source and was therefore not subject to IRB review and approval.

Conflicts of Interest



  1. 1.
    World Health Organization. International drug monitoring: the role of national centres. Geneva: World Health Organization; 1972. (Technical Report Series No. 498)Google Scholar
  2. 2.
    Davies EC, Green CF, Taylor S, Williamson PR, Mottram DR, Pirmohamed M. Adverse drug reactions in hospital in-patients: a prospective analysis of 3695 patient-episodes. PLoS One. 2009;4(2):e4439.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998;279:1200–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. 2004;329(7456):15–9.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Wester K, Jönsson AK, Spigset O, Druid H, Hägg S. Incidence of fatal adverse drug reactions: a population based study. Br J Clin Pharmacol. 2008;65(4):573–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Sultana J, Cutroneo P, Trifiro G. Clinical and economic burden of adverse drug reactions. J Pharmacol Pharmacother. 2013;4(Suppl 1):S73–7.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Alhawassi TM, Krass I, Bajorek BV, Pont LG. A systematic review of the prevalence and risk factors for adverse drug reactions in the elderly in the acute care setting. Clin Interv Aging. 2014;9:2079–86.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Carleton BC, Smith MA, Gelin MN, Heathcote SC. Paediatric adverse drug reaction reporting: understanding and future directions. Can J Clin Pharmacol. 2007;14(1):e45–57.PubMedGoogle Scholar
  9. 9.
    Carey JL, Nader N, Chai PR, Carreiro S, Griswold MK, Boyle KL. Drugs and medical devices: adverse events and the impact on women’s health. Clin Ther. 2017;39(1):10–22.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Farrugia LA, Rhyee SH, Calello DP, Campleman SL, Riederer AM, Malashock HR, et al. The Toxicology Investigators Consortium case registry-the 2016 experience. J Med Toxicol. 2017;13(3):203–26.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Stausberg J. International prevalence of adverse drug events in hospitals: an analysis of routine data from England, Germany, and the USA. BMC Health Serv Res. 2014;14:125.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Hohl CM, Kuramoto L, Yu E, Rogula B, Stausberg J, Sobolev B. Evaluating adverse drug event reporting in administrative data from emergency departments: a validation study. BMC Health Serv Res. 2013;13:473.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Shehab N, Lovegrove MC, Geller AI, Rose KO, Weidle NJ, Budnitz DS. US emergency department visits for outpatient adverse drug events, 2013-2014. JAMA. 2016;16(20):2115–25.CrossRefGoogle Scholar
  14. 14.
    Nickel CH, Ruedinger JM, Messmer AS, Maile S, Peng A, Bodmer M, et al. Drug-related emergency department visits by elderly patients presenting with non-specific complaints. Scan J Trauma Resusc Emerg Med. 2013;21:15.CrossRefGoogle Scholar
  15. 15.
    Mohebbi N, Shalviri G, Salarifar M, Salamzadeh J, Gholami K. Adverse drug reactions induced by cardiovascular drugs in cardiovascular care unit patients. Pharmacoepidemiol Drug Saf. 2010;19(9):889–94.CrossRefPubMedGoogle Scholar
  16. 16.
    Perucca E, Meador KJ. Adverse effects of antiepileptic drugs. Acta Neurol Scand Suppl. 2005;181:30–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Hale GM, Kane-Gill SL, Groetzinger L, Smithburger PL. An evaluation of adverse drug reactions associated with antipsychotic use for the treatment of delirium in the intensive care unit. J Pharm Pract. 2016;29(4):355–60.CrossRefPubMedGoogle Scholar
  18. 18.
    Tangiisuran B, Gozzoli MP, Davies JG, Rajkumar C. Adverse drug reactions in older people. Rev Clin Gerontol. 2010;20:246–59.CrossRefGoogle Scholar
  19. 19.
    Stöllberger C. Drug interactions with new oral anticoagulants in elderly patients. Expert Rev Clin Pharmacol. 2017;10(11):1191–202.CrossRefPubMedGoogle Scholar
  20. 20.
    Napoleone E. Children and ADRs (adverse drug reactions). Ital J Pediatr. 2010;36:4.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Priyadharsini R, Surendiran A, Adithan C, Sreenivasan S, Sahoo FK. A study of adverse drug reactions in pediatric patients. J Pharmacol Pharmacother. 2011;2(4):277–80.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Kurian J, Mathew J, Sowjanya K, Chaitanya KRK, Ramesh M, Sebastian J, et al. Adverse drug reactions in hospitalized pediatric patients: a prospective observational study. Indian J Pediatr. 2016;83(5):414–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Khajehpiri Z, Mahmoudi-Gharaei J, Faghihi T, Karimzadeh I, Khalili H, Mohammadi M. Adverse reactions of methylphenidate in children with attention deficit-hyperactivity disorder: report from a referral center. J Res Pharm Pract. 2014;3(4):130–6.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    McGregor AJ, Beauchamp GA, Wira CR 3rd, Perman SM, Safdar B. Sex as a biological variable in emergency medicine research and clinical practice: a brief narrative review. West J Emerg Med. 2017;18(6):1079–90.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239–45.CrossRefGoogle Scholar
  26. 26.
    Belhekar MN, Taur SR, Munshi RP. A study of agreement between the Naranjo algorithm and WHO-UMC criteria for causality assessment of adverse drug reactions. Indian J Pharmacol. 2014;46(1):117–20.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Seger D, Barker K, McNaughton C. Misuse of the Naranjo Adverse Drug Reaction Probability Scale in toxicology. Clin Toxicol. 2013;51(6):461–6.CrossRefGoogle Scholar

Copyright information

© American College of Medical Toxicology 2019

Authors and Affiliations

  • Gillian A. Beauchamp
    • 1
    • 2
    Email author
  • Alexandra Amaducci
    • 1
  • Marna Rayl Greenberg
    • 1
  • Matthew Meyers
    • 3
  • Matthew Cook
    • 1
    • 2
  • Robert D. Cannon
    • 1
    • 2
  • Kenneth D. Katz
    • 1
    • 2
  • Yaron Finkelstein
    • 4
    • 5
  • On behalf of the Toxicology Investigators Consortium (ToxIC)
  1. 1.Department of Emergency and Hospital Medicine/USF Morsani College of MedicineLehigh Valley Health NetworkAllentownUSA
  2. 2.Department of Emergency and Hospital Medicine, Section of Medical ToxicologyLehigh Valley Health NetworkAllentownUSA
  3. 3.Philadelphia College of Osteopathic MedicinePhiladelphiaUSA
  4. 4.Department of Paediatrics, Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
  5. 5.Department of Pharmacology and ToxicologyUniversity of TorontoTorontoCanada

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