Deadly Single Dose Agents

In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.


Although the basics of evaluating and treating most unknown ingestants are well known, many overdoses require very specific treatment if the patient is to have any chance of survival. Countless studies have been published supporting Dr. Gideon Koren's 1993 landmark article "Medications Which Can Kill a Toddler with One Tablet or Teaspoonful" in the Journal of Toxicology. while each has its own merits, most focus solely on pediatric overdoses, and relatively few of them provide an exhaustive list or act as a "quick-reference" when dealing with real-time ingestions.

Despite widespread public education, childproof containers, and other safety measures, accidental overdoses continue to occur. In the United States, poison control centers receive over 2.2 million calls each year, 47% of which concern children less than six years of age. Most pediatric accidental ingestions involve cosmetics and personal care products, followed by cleaning products, and then analgesics and prescription medications. Adult overdoses usually are due to the intentional ingestion of analgesics and sedative-hypnotics.

Following are the list of toxic drugs (in decreasing severity/difficulty of treatment) included in this summary:

  1. Alpha-2 adrenergic agonists - clonidine, naphazoline, oxymetazoline, tetrahydrozoline

  2. Sulfonylureas - chlorpropamide, glyburide, glipizide, glimepiride

  3. Calcium channel blockers - nifedipine, verapamil, diltiazem, amlodipine, nicardipine

  4. Beta-blockers - metoprolol, labetalol

  5. Tricyclic antidepressants - imipramine, desipramine, amitriptyline, nortriptyline

  6. Opioids - codeine, hydrocodone, methadone, morphine, heroin

  7. Anti-diarrheals - diphenoxylate + atropine, loperamide

  8. Salicylates/Methyl salicylates - wintergreen oil, bismuth subsalicylate, mentholated balms

  9. Antipsychotics - loxapine, thioridazine, chlorpromazine

  10. Antimalarials - chloroquine, hydroxychloroquine, quinine

  11. Antiarrhythmics - quinidine, disopyramide, procainamide, flecainide

  12. Terpenoid (camphor) - analgesic, anti-itch, and cooling gels, ointments, and balms

  13. Non-alkaloid toxic lignan - podophyllin, podofilox

  14. Plant toxin/secondary metabolite - colchicine

  15. Oral acetylcholinesterase inhibitors - rivastigmine, donepezil, galantamine

  16. Methylxanthine - theophylline: 1,3-dimethylxanthine

  17. Partial opioid agonist/synthetics - buprenorphine/fentanyl

  18. Toxic alcohols - methanol, ethylene glycol

  19. Caustics /household products - acidic or alkaline household products, hydrofluoric acid, selenious acid, ammonia fluoride, methacrylic acid (cosmetic glue), naphthalene (mothballs)

Publication types

  • Study Guide