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Department of Pharmacy Practice and Science

Poisoning and Toxicology

Emergency room medical teams must be prepared when a patient with an overdose rushes through the doors. Associate Professor Wendy Klein-Schwartz, PharmD, MPH, is dedicated to researching poisoning situations, one-by-one, to improve our understanding of toxicity and to identify treatment modalities with the best clinical outcomes.

Data on overdoses is lacking when new formulations or new drugs are marketed. How does the toxicity of escitalopram (the s-enantiomer) compare to citalopram? How often and when do seizures occur with XL formulation of bupropion? How can we better treat patients with overdoses? Klein-Schwartz’s research aims to answer these questions. Klein-Schwartz is planning a clinical trial comparing the effectiveness of a novel charcoal cookie to the poor tasting activated charcoal slurry considered standard therapy for gastrointestinal decontamination. She is conducting research to elucidate factors that result in failure of the antidote for acetaminophen overdose so that more individualized treatment regimens can be implemented.

Medication errors can result in significant suffering. Klein-Schwartz is using Maryland Poison Center data to also evaluate the frequency and consequences of therapeutic errors in the elderly. Klein-Schwartz points out, “if we can understand why therapeutic errors occur in the elderly, we will be better able to design prevention strategies.” Klein-Schwartz is MPH is coordinator of research & education, as well as the Toxicology Fellowship director.

A sample of our publications in poisoning and toxicology are noted below:

Hayes BD, Klein-Schwartz W, Barrueto F. Polypharmacy and the geriatric patient. Clin Geriatr Med 2007;23:371-90.

Hayes BD, Klein-Schwartz W, Clark RF, Muller AA, Miloradovich JE. Comparison of toxicity of acute overdoses with citalopram and escitalopram. J Emerg Med. Forthcoming 2008.

Hayes BD, Klein-Schwartz W, Doyon S. Frequency of medication errors with intravenous Acetylcysteine for acetaminophen overdose. Ann Pharmacother 2008 Jun;42:766-70.

Hayes BD, Klein-Schwartz W, Doyon S. Toxicity of buprenorphine overdoses in children. Pediatrics 2008;121:e782-6.

Spiller HA, Borys D, Griffith JRK, Klein-Schwartz W, Alegaus A, Sollee D, Anderson DA, Sawyer T. Toxicity from modafinil ingestion. Clin Toxicol. Forthcoming 2008.

Starr P, Klein-Schwartz W, Spiller H, Kern P, Ekleberry SE, Kunkel S. Incidence and onset of delayed seizures following overdoses of extended release (XL) bupropion. Am J Emerg Med. Forthcoming 2008.

Klein-Schwartz W, Lofton AL, Benson BE, Spiller HA, Crouch BI. Prospective observational multi-poison center study of ziprasidone exposures. Clin Toxicol 2007;45(7):782-6.

Klein-Schwartz W. Clinical toxicology case, online. (Accompanies Textbook of therapeutics: drug and disease management. 8th ed.)

Klein-Schwartz W. Toxicologic issues in the geriatric patient. In: Shannon MW, Borron SW, Burns MJ, editors. Clinical management of poisoning and drug overdose. 4th ed. Philadelphia: Saunders Elsevier; 2007.  p. 377-82.