This week on The Tox Lab, we’re taking a closer look at bupropion and its distinctive toxicity profile in overdose.

We explore a case of bupropion overdose to examine the often complex clinical presentation, including seizures and cardiovascular complications, as well as the challenges of management and potential longer-term consequences. We then unpack the mechanism underlying bupropion-associated seizures and how these differ from other antidepressants.

We also turn our attention to the cardiac effects seen in overdose, focusing on QRS widening, why traditional treatments such as sodium bicarbonate may be ineffective, and what current evidence suggests about the underlying mechanism.

Join us as we examine how bupropion behaves in overdose, what makes its toxicology unique, and what this means for clinical management and interpretation.

Hope you enjoy!

Links to the papers we discussed:

https://pmc.ncbi.nlm.nih.gov/articles/PMC12735355/

https://pmc.ncbi.nlm.nih.gov/articles/PMC12281246/

https://www.tandfonline.com/doi/full/10.1080/15563650.2023.2218029

https://pmc.ncbi.nlm.nih.gov/articles/PMC4294106/pdf/bph0171-4808.pdf

Disclaimer: All opinions are our own.

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This week on The Tox Lab, we’re taking a closer look at quaaludes and their modern analogues.

Once synonymous with a particular era of drug use, quaaludes have largely disappeared from the illicit market. But have they really gone away? We explore the history of methaqualone, how and why it fell out of use, and what has appeared in its place.

We then dive into a review examining a wide range of methaqualone analogues, focusing on how these substances are described by users, the variability in their effects, and what this means for interpretation.

Join us as we unpack the legacy of quaaludes, the chemistry behind their analogues, and what user experiences can tell us about substances that are often poorly characterised.

This episode is very kindly sponsored by Cayman Chemical. Check them out here: https://www.caymanchem.com/

Hope you enjoy!

Links to the paper we discussed:

https://ejournals.eu/en/journal/amsik/article/review-of-the-experiences-of-users-of-methaqualone-and-methaqualone-derivatives-an-analysis-of-online-forums

Disclaimer: All opinions are our own.

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This week on The Tox Lab, we’re exploring naloxone and its effectiveness in the context of novel synthetic opioid overdoses.

Naloxone remains a cornerstone of opioid overdose management, but the emergence of highly potent synthetic opioids has raised important questions about whether standard approaches are still sufficient. We discuss clinical nitazene exposure data from Australia, examining the concentrations detected in patients and how naloxone was used in these cases.

We also review a striking case of occupational carfentanil exposure in a veterinarian, where reversal was achieved with naltrexone.

To tie this together, we dive into the pharmacology, exploring what may be happening at the receptor level.

Join us as we unpack the clinical data, receptor dynamics, and real-world challenges of managing overdoses in an ever-evolving synthetic opioid landscape.

Hope you enjoy!

Links to the papers we discussed:

https://onlinelibrary.wiley.com/doi/epdf/10.1111/dar.13998

https://www.sciencedirect.com/science/article/abs/pii/S0735675710001178?via%3Dihub

https://pmc.ncbi.nlm.nih.gov/articles/PMC10912486/

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]

This week on The Tox Lab, we’re exploring early warning systems and their growing role in toxicology and public health.

We break down the core principles that underpin early warning systems, before focusing on how these frameworks are applied to drug early warning systems aimed at identifying emerging substances and harms. We then discuss a recent paper examining the value of incorporating experiential reports from people who use drugs, and how these insights might strengthen surveillance and response efforts.

Join us as we unpack how early warning systems are built, what makes them effective, and how listening to lived experience could help detect and prevent harm sooner.

Hope you enjoy!

Links to the papers we discussed:

https://www.sciencedirect.com/science/article/pii/S0955395925002427

https://www.sciencedirect.com/science/article/pii/S0955395925003949

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]

Welcome back to The Tox Lab! We are kicking off 2026 by exploring drugs that disrupt metabolism and the consequences that can follow.

In this episode, we focus on compounds that alter glucose metabolism and the interplay between toxicology and biochemistry. We discuss a fatal case of metformin toxicity and the analytical and interpretive challenges involved in recognising this diagnosis.

We then turn to amphetamine-like weight loss drugs, examining the risks they pose to individuals with diabetes and the evidence linking methamphetamine use to an increased risk of fatal diabetic ketoacidosis. Finally, we explore a case involving SGLT2 inhibitor therapy and unexpected positive urine ethanol results, highlighting the importance of pre-analytical factors and careful interpretation in toxicology.

Join us as we unpack how drugs can interfere with metabolic pathways, why these effects matter clinically, and what toxicologists need to consider when metabolism goes wrong.

Hope you enjoy!

Links to the papers we discussed:

https://www.sciencedirect.com/science/article/pii/S037907382500324X

https://onlinelibrary.wiley.com/doi/10.1155/2015/917869

https://journals.sagepub.com/doi/10.1177/00258024211020936?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

https://www.nejm.org/doi/full/10.1056/NEJMc2313463

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]

This week on The Tox Lab, we’re closing out the year with a festive twist as we explore the link between marzipan, bitter almonds, and cyanide.

We take a closer look at the chemistry linking cyanide to almonds and discuss a case of intentional bitter almond ingestion. We then turn to National Poisons Information Service data to examine patterns of cyanide exposure, clinical outcomes, and the antidotes used in management.

To round off the episode, we dip into the archives with a historical case report describing thallium poisoning linked to contaminated marzipan, reminding us that even festive treats can carry hidden toxicological risks.

Join us for a seasonal deep dive into poisons, cases, and chemistry as we wrap up the year on a sweet but slightly sinister note.

Hope you enjoy!

We're taking a little break over the festive season but will be back with a brand new episode on the 5th January!

Links to the papers we discussed:

https://onlinelibrary.wiley.com/doi/10.1002/ccr3.8418

https://www.tandfonline.com/doi/full/10.1080/15563650.2022.2080074

https://www.tandfonline.com/doi/abs/10.3109/15563659409017979

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]

This week on The Tox Lab, we’re taking a closer look at serotonin and its intriguing role in both depression and epilepsy.

We review recent data examining the seizure risk associated with different classes of antidepressants and what this means for clinical decision making. We then explore a case report in which sertraline, an SSRI, appeared to have an anti-seizure effect, challenging some long-held assumptions. Finally, we discuss emerging evidence on the potential use of serotonergic therapies in epilepsy management and even in reducing the risk of SUDEP.

Join us as we unravel the complex relationship between serotonin, antidepressants, and seizure disorders, and what this evolving evidence could mean for patient care.

Hope you enjoy!

Links to the papers we discussed:

https://www.sciencedirect.com/science/article/pii/S0165032725005853?via%3Dihub

https://www.seizure-journal.com/article/S1059-1311(20)30145-X/fulltext

https://pmc.ncbi.nlm.nih.gov/articles/PMC8478129/

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]

This week on The Tox Lab, we are examining the growing evidence around cannabis and cardiovascular risk.

We start with a recent systematic review and meta-analysis that explores whether cannabis use is linked to higher rates of cardiovascular disease. We break down the strength of the data and discuss what the current evidence can and cannot tell us.

We then move onto research investigating how THC and its metabolites affect cardiac myocyte structure and function. These findings offer a possible mechanistic explanation for cardiac dysregulation and may help connect population-level associations with cellular effects.

Join us as we unpack the toxicology, the uncertainties, and what this emerging research means for clinicians, researchers, and anyone interested in the evolving science of cannabis and heart health.

Hope you enjoy!

Links to the papers we discussed:

https://heart.bmj.com/content/111/22/1047.long

https://www.ahajournals.org/doi/10.1161/JAHA.123.030178

https://pmc.ncbi.nlm.nih.gov/articles/PMC8835806/pdf/ijms-23-01401.pdf

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]

This week on The Tox Lab, we’re diving into the emerging world of “space oil”, the anesthetic drug etomidate, which has begun appearing in the recreational drug supply across parts of Asia and beyond.

We explore several cases involving etomidate vaping, where repeated exposure led to adrenal insufficiency due to its potent inhibition of 11β-hydroxylase. We also discuss a fatal ingestion case, highlighting just how dangerous this drug can become when used outside controlled medical settings.

Etomidate’s presence isn’t limited to Asia: it has recently been detected alongside fentanyl in Philadelphia and identified in a handful of UK seizures, raising important questions about its evolving role in the illicit drug market. With emerging analogues starting to surface, the landscape may become even more complex.

Join us as we unpack the pharmacology, the clinical consequences, and why etomidate is now a substance toxicologists are watching closely.

Hope you enjoy!

Links to the papers we discussed:

https://www.hkmj.org/system/files/hkmj2412244.pdf

https://link.springer.com/article/10.1007/s12024-024-00813-8

https://hip.phila.gov/document/4686/PDPH-HAN-429U-Etomidate-08.12.2024-1.pdf/

https://www.gov.uk/government/publications/acmd-review-of-the-evidence-on-the-use-and-harms-of-etomidate

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

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This week on The Tox Lab, we’re taking a closer look at organophosphates, a diverse group of compounds used everywhere from agriculture to chemical warfare.

We walk through two real-world poisoning cases: an accidental exposure from a head lice treatment and an intentional ingestion of phorate, illustrating just how wide the spectrum of organophosphate toxicity can be. Along the way, we break down their mechanism of action, why their effects can be so severe, and the key treatment approaches clinicians depend on.

We also revisit the Salisbury poisonings, exploring the devastating impact of organophosphate nerve agents and the wider implications for public health and emergency response.

Join us as we unpack the chemistry, the clinical realities, and the far-reaching consequences of these powerful compounds.

Hope you enjoy!

Links to the papers we discussed:

https://academic.oup.com/jat/advance-article-abstract/doi/10.1093/jat/bkaf096/8300174?redirectedFrom=fulltext

https://www.frontiersin.org/journals/toxicology/articles/10.3389/ftox.2025.1581362/full

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]