We read with interest the recent article regarding amlodipine toxicity in children (
1). Although we agree that amlodipine poisoning poses significant risks in children, we are weary of some of the assumptions made by the authors. The limitations of the poison center data system have been well recognized for many years and published elsewhere (
- Benson B.E.
- Spyker D.A.
- Troutman W.G.
- Watson W.A.
- Bakhireva L.N.
Amlodipine toxicity in children less than 6 years of age: a dose-response analysis using national poison data system data.
J Emerg Med. 2010; 39: 186-193
2). Without reiterating all of its inequities, we must remember that data collected reflect “exposures,” which are unreliable when no attempt is made to confirm “ingestions” by either qualitative or quantitative testing. This confusion is carried throughout the article, beginning with the title that should read “Amlodipine Exposure” not “Amlodipine Toxicity.” Similarly, when the discussion states that the study comprises the largest cohort of pediatric amlodipine ingestions reported to date, the authors clearly overstep their bounds because, with the exception of the symptomatic children, it is quite possible that no other child has even ingested any amlodipine. Exposures do not equal ingestions.
- Hoffman R.S.
Understanding the limitations of retrospective analyses of poison center data.
Clin Toxicol (Phila). 2007; 45: 943-945
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- Amlodipine toxicity in children less than 6 years of age: a dose-response analysis using national poison data system data.J Emerg Med. 2010; 39: 186-193
- Understanding the limitations of retrospective analyses of poison center data.Clin Toxicol (Phila). 2007; 45: 943-945
Published online: June 21, 2010
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Amlodipine Toxicity in Children Less Than 6 Years of Age: A Dose-Response Analysis Using National Poison Data System DataJournal of Emergency MedicineVol. 39Issue 2
- PreviewBackground: Amlodipine is a long-acting calcium channel blocker capable of producing hypotension and dysrhythmia in overdose. The toxic doses of amlodipine in children are unclear. Objectives: The purposes of this study were to describe amlodipine poisoning in children and to determine whether a dose-response relationship could be detected in this population using standardized call data from United States (US) poison centers. Patients and Methods: 1251 amlodipine-only ingestions in children < 6 years of age were reviewed.