Clinical Pharmacology & Toxicology
The division focuses on clinical issues of children’s medications, diagnoses and treatment of adverse effects and toxicities of drugs, overdoses and poisoning, and early-life exposures to drugs and environmental toxins. Our clinical programs span wide areas ranging from the consultation service and clinic, to the Ontario, Manitoba & Nunavut Poison Centres.
Recently, we have introduced an individual-specific approach of “pharmacogenomics” to identify individuals at an elevated risk of drug toxicity or ineffectiveness. As one of the areas of precision medicine, this approach is to decipher a patient’s genes important for the breakdown of, or responses to, drugs, so that we can adjust the doses of the drug or suggest other drugs.
Poisoning is also an important child health problem. Over the last few years, the Poison Center has provided medical information and advice to more than 120,000 patients and health professionals, serving both the provinces of Ontario and Manitoba, and Nunavut territory. Both the clinical service of the Clinical Pharmacology program and the Poison Center provide a training platform for the Royal College-accredited Clinical Pharmacology/Toxicology Residency program of the University of Toronto.
Our research programs also focus on a wide range of clinically important drug-related issues: drug safety in children, drug metabolizing enzymes and their development, drug transporters, mammary gland drug transport and metabolism, and reproductive toxicology and teratology. As the discipline of clinical pharmacology is growing in its scope, our current research methodologies include not only molecular-level pharmacology such as pharmacogenetics but also population-level pharmacology using clinical epidemiology approaches.
What we do
Diagnoses and treatment of adverse drug reactions in children are complex. Some children are susceptible to them, while others are resistant. Although they are mostly rare events, certain age groups are clearly at risk.
For example, neonates and infants are often prone to drug toxicity, while gene-based individual differences to drug responses become more evident in older children. Our focus on drug safety also includes drug exposures through the mother during pregnancy and breastfeeding. In addition to these medication-related problems, children and infants are susceptible to environmental toxins such as lead and mercury, but how to diagnose and treat them is not so simple as it seems.
Our expertise lies in this broad range of medication- and toxin-related problems, which are often different from those seen in adults. In our clinics, we combine key pediatrics knowledge and skills with specialized approaches in sciences of drugs and toxins.
We use important technology such as drug level measurements and pharmacogenetics, which extracts information on individual susceptibility to drug toxicity from their genes. We interpret the results, taking into account other drugs children take and their underlying diseases. Our goal is to share clear understanding of the possible causes of their drug- and toxin-related problems, management plans and prevention strategies with the patients and their families.
- Drug hypersensitivity reactions (except for immediate type reactions)
- Environmental toxin exposures (for example, lead and mercury)
- Early-Life Exposures (such as safe use of drugs in pregnancy and breastfeeding)
- Poisoning follow-up
- Pharmacogenetics test service, interpretation and therapy recommendation
Note that this clinic is a joint activity between our division and Allergy/Immunology. Referrals may be redirected to Allergy/Immunology if diagnoses of immediate type allergic reactions are required.
A telephone service that provides expert poison advice 24 hours a day to the public and healthcare professionals in Ontario, Manitoba & Nunavut (health care professionals only). Assistance is provided to people of all ages for a wide variety of exposures. Examples include:
- A child who was found with an open household chemical
- A child who ate a plant
- A teenager who has been experimenting with street drugs or alcohol
- An adult who has been involved in an industrial chemical spillA senior who has made an error in their daily medicine routine
The Ontario, Manitoba & Nunavut Poison Centres offers a variety of resources related to poison prevention:
- First Aid
- Over the counter medication safety
- Plant safety
- Poison proof your home
- Opioid resuscitation recommendations
Shinya Ito, MD, FRCPC
Expand the section below for a list of key staff in our Clinical Pharmacology and Toxicology division at SickKids.
- Division Staff, Ruud Verstegen, MD, PhD
- Pharmacogenetics, Iris Cohn, MSc, RPh
Ontario, Manitoba & Nunavut Poison Centres:
- Medical Director, Margaret Thompson, MD, FRCPC
- Assistant Medical Director, Connie Mackenzie, MD, FRCPC
- Staff Toxicologist, Emily Austin, MD, FRCPC
- Staff Toxicologist, Chris Lazongas, MD, FRCPC
- David N. Juurlink, MD, PhD, FRCPC, FAACT, FACMT
- Howard An, MD, FRCPC
- Alya Kamani, MD, FRCPC
- Kaitlynn Rigg, MD, FRCPC
- Dennis Scolnik, FRCP(C), DCH, MSc, MB ChB
- Savithri Ratnapalan, MBBS, PhD, FRCP(UK), FRCP(C), FAAP
- Chris Parshuram, MB ChB, DPhil, FRACP
- Tom Leibson, MD
- Bonnie Stevens, PhD
- Anna Taddio, PhD
- Yaron Finkelstein, MD
- Hila Halshtok - Administrative Coordinator for the Division of Clinical Pharmacology and Toxicology
- Donna Tedesco - Administrative Assistant to the Ontario, Manitoba & Nunavut Poison Centers
Research areas of focus
Research programs at Clinical Pharmacology and Toxicology focus on drug metabolizing enzymes and its regulation, drug transporters, mammary gland drug transport and metabolism, and drug safety in all children. This includes all disease conditions.
This research focus is led by Shinya Ito and is closely tied with clinical activities. Studies include prospective cohort studies on drug safety during lactation.
With many new medications introduced in the market, or about to be introduced in the market, clinical data on safety and information on drug concentration in milk provide previous evidence for rationale therapeutics. Under the support from the Canadian Institutes of Health Research (CIHR), the “Drug in Lactation” Analysis Consortium (DLAC) has been developed as an infrastructure for milk sample collection, and at present, another CIHR-funded project, “Drug in Breast Milk”, is running.
With an updated list of target drugs, drug levels in milk are analyzed to estimate infant exposure levels through physiologically-based pharmacokinetic modeling analyses. Recently, we have been selected as one of the NIH-funded multicentre studies on drugs in breastfeeding.
The field of pharmacogenetics is expanding, but data remains relatively scarce for infants and children.
In addition to the nation-wide network for pharmacogenomics, we have been running a clinical implementation pilot study of pediatric pharmacogenomics service. This is to characterize practical hurdles in the implementation, and explore clinical values of the service.
Expand the sections below to learn about educational opportunities with Clinical Pharmacology and Toxicology at SickKids.
Our mandate is to train the next generation of pharmacologists and toxicologists who can contribute to safe and effective pharmacotherapy in paediatrics and further develop the discipline as a key component of clinical and academic medicine.
The University of Toronto Clinical Pharmacology and Toxicology Subspecialty Program is a Royal College of Physicians and Surgeons of Canada accredited two-year program, based at The Hospital for Sick Children (SickKids) and Sunnybrook Health Sciences Centre in Toronto.
We have a total of four Ministry-funded positions in the University over a two-year period and fellowship positions for advanced training are available. Further training is also possible, depending on the trainee's career plan. Eligible candidates may come either from paediatrics, internal medicine, anesthesia, psychiatry, or emergency medicine.
Our program is one of the few active clinical pharmacology programs in Canada, and the largest such residency program in North America.
In our program, the resident/fellow will train to become a consultant with a broad knowledge of human pharmacology, therapeutics, and toxicology, and special expertise in a specific area of pharmacotherapy. They participate in all levels of our clinical activities. We also put a strong emphasis on the development of research skills (clinical or basic). Graduates of the program have pursued careers in academia, government, industry, and private practice.
New regulations in the United States and Europe have begun to change the practices of paediatric drug trials. All paediatric subspecialties, as well as medicine subspecialties, deal with drug trials and the demand for expertise in clinical pharmacology has never been greater.
More information about our program and application inquiries:
Contact Name: Preeti Hans – Global Education Administrative Coordinator
One-month block elective opportunities exist in the Ontario, Manitoba & Nunavut Poison Centres.
For advanced trainees in Emergency Medicine, Pediatric Emergency Medicine, Critical Care Medicine, and other core residency programs. Contact Donna Tedesco (email@example.com) if interested.
Clinical Toxicology (Ontario, Manitoba & Nunavut Poison Centres)
Friday morning (every two weeks)
9 a.m. to 11 a.m.
Daily teaching when on elective rotations at the Ontario, Manitoba & Nunavut Poison Centers with Staff and Consultant Toxicologists.
Every Monday morning
9 a.m. to 10 a.m.
Clinical Pharmacology teaching rounds
Every Wednesday afternoon
1 p.m. to 2 p.m.
Research Program Rounds
Contact for details.
8:00 a.m. to 4:00 p.m.
How to reach us:
Division Contact: Hila Halshtok
Clinical Pharmacology and Toxicology
555 University Avenue
Ontario, Manitoba & Nunavut Poison Centres:
Contact: Donna Tedesco
The division was established in 1978 as one of the first Paediatric Clinical Pharmacology programs in North America. The initial focus on pharmacokinetics and diagnosis of drug hypersensitivity has been expanded in the late 1980s to drug safety during pregnancy and breastfeeding.
In addition to our pediatric pharmacology programs, the Division is a home to the Ontario, Manitoba & Nunavut Poison Centres (OPC), which provides expert poison advice 24 hours a day, seven days a week to the general public and health care professionals throughout Ontario, Manitoba and Nunavut.
Since 1977, OPC has been formally recognized by the provincial Ministry of Health of Ontario as a regional poison center. In 2005, OPC expanded its services to include the entire province with the closure of all remaining hospital and regional centers. Recently, the service also covers the province of Manitoba and Nunavut territory.
The last several years have seen substantial growth in the Division’s clinical activities. Most notably, the caseload at OPC has increased to more than 120,000 per year for the last several years. Similarly, our pharmacogenetics consultation has been growing in parallel to the emergence of the precision medicine initiative.