Research Article
6 August 2026
Saudi Toxicology Journal (STJ) is the official journal of the Saudi Toxicology Society (STS) and hosted by digital commons of Elsevier. STJ is a peer-reviewed, multidisciplinary, open-access journal dedicated to advancing research across all areas of toxicological sciences. The journal operates a continuous publication model, ensuring rapid dissemination of high-quality research. STJ provides an international platform for scientific contributions addressing toxic agents, drugs/natural products safety and efficacy, underlying mechanisms, analytical approaches, and the prevention and management of toxic exposures and their impact on human health.
The readership of STJ includes researchers, clinicians, toxicologists, pharmacists, forensic scientists, and professionals working in academic, healthcare, industrial, environmental, and regulatory settings worldwide, as well as postgraduate trainees and advanced undergraduate students with an interest in toxicological sciences.
Current Issue
Volume 3, Issue 2 (2026)View issue
Featured Content
- Case Report3 August 2026
Accidental Transdermal Buprenorphine Patch Overdose in an Older Adult: A Case Report
Background: Buprenorphine is an opioid that is generally used for chronic pain and opioid dependence. Its pharmacological ceiling effect on respiratory depression gives it a comparatively favorable safety profile relative to other opioids. Despite its safety profile, inappropriate use can still result in clinically significant opioid poisoning. This case report highlights a case of accidental buprenorphine overdose in an aged patient. It illustrates the clinical presentation and preventive considerations associated with this uncommon but critical event. Case presentation: A 65-year-old woman with recent left total knee replacement was brought to the Emergency Department (ED) after being found drowsy and unresponsive at home. Initial clinical presentations showed a somnolence patient with hypoxia. A comprehensive physical examination and investigations showed no clear evidence of a respiratory etiology nor intracranial pathology. Detailed history revealed the use of buprenorphine transdermal patches that were mistaken for wound dressings. Three transdermal patches of (Butrans\textregistered ), 10 mcg/hour were used simultaneously. Intervention/Outcome: The patient was treated for suspected opioid toxicity with naloxone 0.4 mg intravenously followed by an additional 0.8 mg intravenously resulting in a rapid improvement in consciousness and resolution of hypoxia. Eventually the patient was admitted for observation for 24 hours and was discharged the next day with no complications. Conclusion: This case highlights that buprenorphine transdermal patches can cause life-threatening opioid toxicity when misused. Elderly patients are particularly vulnerable due to medication errors and age-related physiological changes. Careful counseling, clear labeling and appropriate prescribing practices are essential to prevent similar adverse events.
Current Articles
Most Popular Articles
- Review Article3 August 2026
Hematological, Inflammatory, and Oxidative Stress Biomarker Profiles in Substance Abuse Combinations: A Comprehensive Evidence-Based Review
A potential risk of polysubstance use in relation to substance abuse can involve the development of intricate pharmacological interactions affecting the immune system and oxidative stress responses of the body. The current review aims to present a synthesis of the existing literature about hematologic, inflammatory, and oxidative stress markers associated with three patterns of polysubstance use: (1) stimulants and cannabis, (2) stimulants/depressants and CNS depressants, and (3) multi-drug complex usage. This review explores markers such as a neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), eosinophil-to-lymphocyte ratio (ELR), total oxidant status (TOS), total antioxidant status (TAS), as well as C-reactive protein, interleukin-6, and tumor necrosis factor-alpha. Available evidence suggests that stimulant-cannabis combinations are associated with elevated neutrophil-driven inflammatory indices while maintaining aberrant thiol/disulfide homeostasis. Stimulant-depressant combinations appear to be associated with greater oxidative stress while simultaneously suppressing lymphocyte-mediated immunity. Polydrug use has been associated with more pronounced oxidative imbalance compared with single-substance use, with markedly elevated TOS and oxidative stress indices compared to single-drug abuse. These findings suggest that biomarker panels may serve as clinically valuable adjuncts for assessing addiction severity, monitoring treatment engagement, and identifying immunological complications in patients with substance use disorders; however, their clinical utility requires prospective validation. - Review Article13 February 2025
Pharmacogenomics Implications of Tamoxifen in Breast Cancer Treatment: Clinical Relevance and Future Directions
Tamoxifen is a cornerstone therapy for estrogen receptor-positive (ER+) breast cancer, improving survival and reducing recurrence. Its efficacy and toxicity, however, vary due to genetic polymorphisms influencing metabolism and transport. Key genes, such as CYP2D6, CYP3A4, and ATP-binding cassette transporters (ABCB1, ABCC2), are crucial in forming and distributing active metabolites like endoxifen. This review explores tamoxifen pharmacogenetics through an analysis of literature from PubMed, Scopus, Google Scholar, and PharmaGKB. Genetic variations like CYP2D6*10 in Asians and CYP2D6*17/29 in Africans impact therapeutic outcomes. Barriers to personalized tamoxifen therapy include inconsistent guidelines, limited access to genetic testing, and underrepresentation of ethnic groups in research.The findings highlight the need for multidisciplinary approaches integrating genetic, clinical, and environmental factors to optimize therapy. Large-scale, diverse, population-specific studies are essential to establish universal pharmacogenetic guidelines. - Review Article24 January 2026
SGLT2 Inhibitors in Diabetes Management: Mechanisms, Clinical Benefits, and Expanding Therapeutic Frontiers
The kidneys play a vital role in renal glucose reabsorption, with the sodium-glucose cotransporter-2 (SGLT2) in the proximal renal tubules performing a crucial function in reabsorbing glucose into the bloodstream. SGLT2-selective inhibitors are a new class of oral antidiabetic drugs that enhance glycemic control in diabetic patients by blocking glucose reabsorption. These drugs are primarily developed to treat type 2 diabetes mellitus (T2DM). This review summarizes the latest preclinical and clinical trials on SGLT2 inhibitors. These new oral antidiabetic agents effectively and selectively block SGLT2, leading to a reduction in blood glucose levels and HbA1c in both diabetic animal models and T2DM patients. SGLT2 inhibitors provide several advantages over other oral hypoglycemic agents, including consistent glucose control by avoiding major risks such as hypoglycemia, β-cell dysfunction, and insulin resistance, due to their insulin-independent mechanism. They have also shown promising results in lowering body weight and blood pressure. Preclinical and clinical trials have demonstrated their safety and tolerability, as well as the potential to be combined with other antidiabetic drugs for successful and long-term glycemic management. However, the long-term safety of these medications still requires thorough investigation. - Case Report3 August 2026
Accidental Transdermal Buprenorphine Patch Overdose in an Older Adult: A Case Report
Background: Buprenorphine is an opioid that is generally used for chronic pain and opioid dependence. Its pharmacological ceiling effect on respiratory depression gives it a comparatively favorable safety profile relative to other opioids. Despite its safety profile, inappropriate use can still result in clinically significant opioid poisoning. This case report highlights a case of accidental buprenorphine overdose in an aged patient. It illustrates the clinical presentation and preventive considerations associated with this uncommon but critical event. Case presentation: A 65-year-old woman with recent left total knee replacement was brought to the Emergency Department (ED) after being found drowsy and unresponsive at home. Initial clinical presentations showed a somnolence patient with hypoxia. A comprehensive physical examination and investigations showed no clear evidence of a respiratory etiology nor intracranial pathology. Detailed history revealed the use of buprenorphine transdermal patches that were mistaken for wound dressings. Three transdermal patches of (Butrans\textregistered ), 10 mcg/hour were used simultaneously. Intervention/Outcome: The patient was treated for suspected opioid toxicity with naloxone 0.4 mg intravenously followed by an additional 0.8 mg intravenously resulting in a rapid improvement in consciousness and resolution of hypoxia. Eventually the patient was admitted for observation for 24 hours and was discharged the next day with no complications. Conclusion: This case highlights that buprenorphine transdermal patches can cause life-threatening opioid toxicity when misused. Elderly patients are particularly vulnerable due to medication errors and age-related physiological changes. Careful counseling, clear labeling and appropriate prescribing practices are essential to prevent similar adverse events. - Research Article6 August 2026
Assessment of Parents' Informational Needs before Pediatric Day Care Surgery in Makkah City, Saudi Arabia
Introduction Pediatric surgical procedures can be highly stressful for children and their parents due to factors such as limited understanding, lack of control, and anxiety. The study aims to assess the informational needs of parents of children scheduled to undergo day care surgery in Makkah City, Saudi Arabia. Methodology A cross-sectional study was conducted over six months. The study included parents or caregivers of children scheduled for day care surgery in Makkah City, Saudi Arabia.A convenient sampling techniques was used for participant selection. Data were analyzed using SPSS software. Results The study included 380 participants and assessed parental informational needs prior to day care surgery. More than 80% of the participants considered most preoperative information categories essential, particularly regarding the necessity of surgery and pain management. Nearly all participants (99.5%) preferred to receive information from doctors, especially through oral communication (73.9%). Surgeons were the favored information source (92.9%), and the received information was considered useful by the majority (95.0%). Females and participants with higher education levels reported significantly higher informational needs. Preferences regarding the method and timing of information delivery were also significantly associated with informational needs scores. Conclusion Clear and structured communication from surgeons, aligned with parental preference and preferably delivered orally prior to surgery, may help improve parental understanding of pediatric day care surgery. These findings may support the development of patient-centered preoperative communication strategies. - Research Article3 May 2026
Prevalence, Determinants, and Objective Risk of Unintentional Therapeutic Duplication Among Adults in Saudi Arabia
Background: Unintentional therapeutic duplication represents an underrecognized yet preventable contributor to medication-related harm, particularly in settings characterized by widespread over-the-counter (OTC) medicine use and self-medication practices. Objective: To estimate the prevalence of unintentional therapeutic duplication among adults in Saudi Arabia and identify sociodemographic and behavioral predictors associated with increased therapeutic duplication risk. Methods: A national crosssectional study was conducted between February 10 and April 28, 2025, using a structured, self-administered online questionnaire distributed via social media platforms. The survey assessed sociodemographic characteristics, medication-use behaviors, active-ingredient literacy, and duplication risk using both self-reported measures and scenario-based assessments. Multivariable logistic regression was performed to identify independent predictors of elevated therapeutic duplication risk. Results: A total of 700 participants were included (mean age 34.2 ± 10.5 years; 58% female). The prevalence of self-reported therapeutic duplication within the preceding 90 days was 43.0%. Paracetamol-containing products were the most commonly implicated (32.0%), followed by nonsteroidal antiinflammatory drugs (24.0%) and antihistamines (15.0%). The mean ingredient-literacy score was 5.1 ± 2.3 (out of 10), with only 48% correctly identifying duplication scenarios. In adjusted analysis, poor ingredient literacy (AOR 3.12, 95% CI 2.29–4.25), frequent OTC use (AOR 2.41, 95% CI 1.78–3.26), and lower educational attainment (AOR 1.89, 95% CI 1.32– 2.71) were independently associated with increased duplication risk ( p < 0.001). Conclusion: Unintentional therapeutic duplication is common among adults in Saudi Arabia and is strongly associated with limited activeingredient literacy. Targeted interventions focusing on patient education, improved labeling, and pharmacist-led counseling are warranted to mitigate preventable medication harm.