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Massive intoxication involving unusual high concentration of amitriptyline
Cláudia Margalho
Instituto Nacional de Medicina Legal, Delegação de Coimbra, Largo da Sé Nova, 3000-213 Coimbra, Portugal, claudiamargalho{at}iol.pt
Mário Barroso
Instituto Nacional de Medicina Legal, Delegação de Coimbra, Largo da Sé Nova, 3000-213 Coimbra, Portugal
Eugenia Gallardo
Instituto de Medicina Legal, Servicio de Toxicología Forense, San Francisco s/n, 15786 Santiago de Compostela, Spain
Paula Monsanto
Instituto Nacional de Medicina Legal, Delegação de Coimbra, Largo da Sé Nova, 3000-213 Coimbra, Portugal
Duarte Nuno Vieira
Instituto Nacional de Medicina Legal, Delegação de Coimbra, Largo da Sé Nova, 3000-213 Coimbra, Portugal
Amitriptyline is a tricyclic antidepressant widely used in the treatment of depression. Antidepressant drugs are among the most commonly encountered causes of self-poisoning, as illustrated by several published cases in the literature. This investigation reports a case of massive amitriptyline intoxication, involving a 44-year old female found dead in bed. The presence of this tricyclic antidepressant was revealed by a routine screening procedure. The concentration was calculated by gas chromatography/ electron ionization-mass spectrometry in the selected ion monitoring mode after solid-phase extraction using proadifen as internal standard and was in the post-mortem whole blood sample 85.9 µg/mL. This value was much higher than the reported toxic values ever found in the literature, and may therefore have caused the victim's death. Nortriptyline was also detected in the toxic concentration range, as well as therapeutic levels of diazepam and nor-diazepam. Taking into account both the available circumstantial information and toxicological results, it is very likely that death was caused by self-poisoning. Human & Experimental Toxicology (2007) 26, 667—670
Key Words: amitriptyline • blood • massive intoxication
References
- Baselt RC Disposition of toxic drugs and chemicals in man, 7th ed., Biomedical Publications, Foster City, 2004: 55—59.
- Baldessarini RJ Drugs and the treatment of psychiatric disorders. In Hardman JG, and Limbird LE Editors-in-chief. Goodman & Gillman's the pharmacological basis of therapeutics, 9th ed., McGraw-Hill, New York, 1996: 431—59.
- Prahlow JA, Landrum JE Amitriptyline abuse and misuse. Am J Forensic Med Pathol 2005; 26: 86—88.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Mosby's drug consult [document online] [cited July 2005]. Available from URL: http://www.home.mdconsult.com.
- del Río J. Fármacos antidepresivos y antimaníacos. In Flórez J ed. Farmacología humana 3th ed. Masson, S.A. Barcelona, 1997: 549—63.
- Uges D. Therapeutic and toxic drug concentrations list. TIAFT [document online] [cited 8th July 2005]. Available from URL: http://www.tiaft.org/tmembers/ttv/ttv_ps.html.
- Reppeto M R., Reppeto M. Tabla de valores de referencia en fluidos biologicos, pp. 3, Instituto Nacional de Toxicologia de Sevilla, España, [document online] [cited 23rd June 2005]. Available from URL: http://www.us.es/toxicologia/13conc/val%2520ref.pdf.
- Tracqui A., Kintz P., Ritter-Lohner S., Mangin P., Lugnier A., Chaumont A. Toxicological findigs after fatal amitriptyline self-poisoning. Hum Exp Toxicol 1990; 9: 257—61.[Web of Science][Medline]
[Order article via Infotrieve]
- Musshof F., Padosh S., Steinborn S., Madea B. Fatal blood and tissue concentrations of more than 200 drugs. Forensic Sci Int 2004; 142: 161—210.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Bynum ND, Poklis JL, Gaffney-Kraft M., Garside D., Ropero-Miller JD Postmortem distribution of tramadol, amitriptyline, and their metabolites in a suicidal overdose. J Anal Toxicol 2005; 29: 401—406.[Web of Science][Medline]
[Order article via Infotrieve]
- Koski A., Vuori E., Ojanperä I. Relation of post-mortem blood alcohol and drug concentrations in fatal poisonings involving amitriptyline, propoxyphene and promazine. Hum Exp Toxicol 2005; 24: 389—96.[Abstract/Free Full Text]
- Hanzlick RL Post-mortem blood concentrations of parent tricyclic antidepressant drugs in 11 cases of suicide. Am J Forensic Med Pathol 1984; 5:11—13.[Web of Science][Medline]
[Order article via Infotrieve]
- Hebb JH Jr, Caplan YH, Crooks CR, Mergner WJ Blood and tissue concentrations of tricyclic antidepressant drugs in post mortem cases: literature survey and a study of forty deaths. J Anal Toxicol 1982; 6: 209—16.[Web of Science][Medline]
[Order article via Infotrieve]
- Food and Drug Administration: U.S. Department of Health and Human Services, Guidance for Industry, Bioanalytical Method Validation. FDA [document online] [cited 21st June 2003]. Available from URL: www.fda.gov/cder/guidance/4252fnl.pdf.
- International Conference on Harmonization (ICH), Validation of Analytical Procedures: Methodology ICH Q2 B. In Note for guidance on validation of analytrical methods: Methodology Geneve, 1996 [document online] [cited 5th June 2003]. Available from URL: http://www.eudra.org/emea.html.
- Peters FT, Maurer HH Bioanalytical method validation and its implications for forensic and clinical toxicology — a review. Accredit Qual Assur 2002; 7: 441—49.[CrossRef]
- Pounder DJ, Owen V., Quigley C. Postmortem changes in blood amitriptyline concentration. Am J Forensic Med Pathol 1994; 15: 224—30.[Web of Science][Medline]
[Order article via Infotrieve]
Human & Experimental Toxicology, Vol. 26, No. 8,
667-670 (2007)
DOI: 10.1177/0960327107076813
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