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

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.