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Cliburn KD, Kemp PM, Huestis MA, Wagner JR, Payton M, Liu L, Liang Y, Maxwell LK. Time- and temperature-dependent postmortem ∆9-tetrahydrocannabinol concentration changes in rabbits following controlled inhaled cannabis administration. J Anal Toxicol 2023; 47:850-857. [PMID: 37758448 DOI: 10.1093/jat/bkad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/14/2023] [Accepted: 09/27/2023] [Indexed: 10/03/2023] Open
Abstract
ostmortem redistribution (PMR), a well-known phenomenon in forensic toxicology, can result in substantial changes in drug concentrations after death, depending on the chemical characteristics of the drug, blood collection site, storage conditions of the body and postmortem interval (PMI). Limited PMR data are available for ∆9-tetrahydrocannabinol (THC), the primary psychoactive component in Cannabis sativa. PMR was evaluated after controlled cannabis inhalation via a smoking machine and exposure chamber in New Zealand white rabbits. Necropsies were performed on five control rabbits immediately after euthanasia, whereas 27 others were stored at room temperature (21°C) or refrigerated conditions (4°C) until necropsy at 2, 6, 16, 24 or 36 h after death. THC and its Phase I and glucuronidated Phase II metabolites were quantified in blood, vitreous humor, urine, bile and tissues by liquid chromatography-tandem mass spectrometry (LC-MS-MS). Under refrigerated temperature, heart blood THC concentrations significantly increased at PMI 2 h in rabbits, whereas peripheral blood THC concentrations showed a significant increase at PMI 16 h. Central:peripheral blood and liver:peripheral blood ratios for THC ranged from 0.13 to 4.1 and 0.28 to 8.9, respectively. Lung revealed the highest THC concentrations, while brain and liver exhibited the most stable THC concentrations over time. This report contributes much needed data to our understanding of postmortem THC behavior and can aid toxicologists in the interpretation of THC concentrations in medicolegal death investigations.
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Affiliation(s)
- Kacey D Cliburn
- College of Veterinary Medicine, Department of Physiological Sciences, Oklahoma State University, 205 McElroy Hall, Stillwater, OK 74078, United States
- Office of the Chief Medical Examiner, Toxicology Laboratory, 921 NE 23rd St, Oklahoma City, OK 73105, United States
| | - Philip M Kemp
- Randall University, Biology Department, 3701 S I-35 Service Rd, Moore, OK 73160, United States
- School of Forensic Sciences, Oklahoma State University Center for Health Sciences, 1111 W. 17th St, Tulsa, OK 74107, United States
| | - Marilyn A Huestis
- School of Forensic Sciences, Oklahoma State University Center for Health Sciences, 1111 W. 17th St, Tulsa, OK 74107, United States
- Institute for Emerging Health Professions, Thomas Jefferson University, 683 Shore Road, Severna, MD 21146, United States
| | - Jarrad R Wagner
- School of Forensic Sciences, Oklahoma State University Center for Health Sciences, 1111 W. 17th St, Tulsa, OK 74107, United States
| | - Mark Payton
- Department of Biomedical Sciences, Rocky Vista University, 8401 S Chambers Rd, Parker, CO 80134, United States
| | - Lin Liu
- College of Veterinary Medicine, Department of Physiological Sciences, Oklahoma State University, 205 McElroy Hall, Stillwater, OK 74078, United States
| | - Yurong Liang
- College of Veterinary Medicine, Department of Physiological Sciences, Oklahoma State University, 205 McElroy Hall, Stillwater, OK 74078, United States
| | - Lara K Maxwell
- College of Veterinary Medicine, Department of Physiological Sciences, Oklahoma State University, 205 McElroy Hall, Stillwater, OK 74078, United States
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2
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Gao Q, Lv B, Huang W, Sun T, Dong H. Fatal self-poisoning with amitriptyline: a case report and brief review of literature. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2070873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Qing Gao
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, PR China
- Department of Forensic Medicine, Wuhan University Taikang Medical School (School of Basic Medical Sciences), Wuhan, Hubei, PR China
| | - Bin Lv
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, PR China
- Medical Affairs Office, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Weisheng Huang
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Tianying Sun
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Hongmei Dong
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, PR China
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The acid sphingomyelinase/ceramide system in COVID-19. Mol Psychiatry 2022; 27:307-314. [PMID: 34608263 PMCID: PMC8488928 DOI: 10.1038/s41380-021-01309-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/10/2021] [Accepted: 09/14/2021] [Indexed: 02/08/2023]
Abstract
Acid sphingomyelinase (ASM) cleaves sphingomyelin into the highly lipophilic ceramide, which forms large gel-like rafts/platforms in the plasma membrane. We showed that SARS-CoV-2 uses these platforms for cell entry. Lowering the amount of ceramide or ceramide blockade due to inhibitors of ASM, genetic downregulation of ASM, anti-ceramide antibodies or degradation by neutral ceramidase protected against infection with SARS-CoV-2. The addition of ceramide restored infection with SARS-CoV-2. Many clinically approved medications functionally inhibit ASM and are called FIASMAs (functional inhibitors of acid sphingomyelinase). The FIASMA fluvoxamine showed beneficial effects on COVID-19 in a randomized prospective study and a prospective open-label real-world study. Retrospective and observational studies showed favorable effects of FIASMA antidepressants including fluoxetine, and the FIASMA hydroxyzine on the course of COVID-19. The ASM/ceramide system provides a framework for a better understanding of the infection of cells by SARS-CoV-2 and the clinical, antiviral, and anti-inflammatory effects of functional inhibitors of ASM. This framework also supports the development of new drugs or the repurposing of "old" drugs against COVID-19.
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Kornhuber J, Gulbins E. New Molecular Targets for Antidepressant Drugs. Pharmaceuticals (Basel) 2021; 14:894. [PMID: 34577594 PMCID: PMC8472072 DOI: 10.3390/ph14090894] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 12/27/2022] Open
Abstract
Major depressive disorder (MDD) is a common and severe mental disorder that is usually recurrent and has a high risk of suicide. This disorder manifests not only with psychological symptoms but also multiple changes throughout the body, including increased risks of obesity, diabetes, and cardiovascular disease. Peripheral markers of oxidative stress and inflammation are elevated. MDD is therefore best described as a multisystem whole-body disease. Pharmacological treatment with antidepressants usually requires several weeks before the desired effects manifest. Previous theories of depression, such as the monoamine or neurogenesis hypotheses, do not explain these characteristics well. In recent years, new mechanisms of action have been discovered for long-standing antidepressants that also shed new light on depression, including the sphingolipid system and the receptor for brain-derived neurotrophic factor (BDNF).
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Affiliation(s)
- Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Erich Gulbins
- Department of Molecular Biology, University of Duisburg-Essen, 45117 Essen, Germany;
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45267, USA
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5
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Hansen SL, Nielsen MKK, Linnet K, Rasmussen BS. Simple implementation of muscle tissue into routine workflow of blood analysis in forensic cases - A validated method for quantification of 29 drugs in postmortem blood and muscle samples by UHPLC-MS/MS. Forensic Sci Int 2021; 325:110901. [PMID: 34245938 DOI: 10.1016/j.forsciint.2021.110901] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/26/2021] [Accepted: 07/01/2021] [Indexed: 11/18/2022]
Abstract
Whole blood is most often the matrix of choice for postmortem analysis but it is not always available. In these cases, muscle tissue can be used as an alternative matrix. Therefore, an ultra-high-performance liquid chromatography-tandem mass spectrometry method for the quantification of 29 drugs and metabolites of toxicological interest in postmortem muscle tissue was developed and validated. Additionally, a validation of whole blood was carried out to compare the results from the two matrices. Solid-phase extraction was performed by an automated robotic system to minimize manual labour and risk of human errors, and increase robustness, sample throughput and sample traceability. The method was validated in terms of selectivity, matrix effect, extraction recovery, process efficiency, measuring range, lower limit of quantification, carry-over, stability, precision and accuracy. To correct for any inter-individual variability in matrix effects on analyte accuracy and precision, deuterated analogues of each analyte were used as internal standards. The lower limit of quantification in both blood and muscle homogenate ranged between 0.002 and 0.005 mg/kg, while the upper limit of quantification spanned from 0.20 to 1.0 mg/kg. Corrected with the 4-fold dilution factor, the corresponding concentrations in muscle tissue were 0.008-0.02 mg/kg at the lower limit of quantification and 0.80-4.0 mg/kg at the upper limit of quantification. The method showed acceptable precision and accuracy, with precision below 12% and accuracies ranging from 87% to 115% at up to 6 levels for all analytes in both matrices. In addition, comparison between calibration standards in spiked muscle homogenate and spiked blood showed that analyte concentrations in muscle samples could be quantified by using spiked blood samples as calibration standards with acceptable precision and accuracy when using deuterated analogues as internal standards. The investigation of matrix effects showed no great difference between blood and homogenates of non-decomposed and decomposed muscle tissue for most analytes. In the samples where high ion suppression or enhancement was observed, the results were corrected by the internal standards. Statistical comparison of quality control samples in blood and muscle tissue showed no obvious differences, and therefore muscle tissue was included in the routine method for analysis of blood samples and used in autopsy cases where no blood was available. By adding a semi-automated homogenization step before the remaining automated sample preparation, muscle tissue samples were easily incorporated into the workflow of the existing routine method. The present method has been successfully implemented in routine analysis of blood and muscle tissue since 2019.
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Affiliation(s)
- Stine Lund Hansen
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Marie Katrine Klose Nielsen
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Kristian Linnet
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Brian Schou Rasmussen
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Carpinteiro A, Edwards MJ, Hoffmann M, Kochs G, Gripp B, Weigang S, Adams C, Carpinteiro E, Gulbins A, Keitsch S, Sehl C, Soddemann M, Wilker B, Kamler M, Bertsch T, Lang KS, Patel S, Wilson GC, Walter S, Hengel H, Pöhlmann S, Lang PA, Kornhuber J, Becker KA, Ahmad SA, Fassbender K, Gulbins E. Pharmacological Inhibition of Acid Sphingomyelinase Prevents Uptake of SARS-CoV-2 by Epithelial Cells. Cell Rep Med 2020; 1:100142. [PMID: 33163980 PMCID: PMC7598530 DOI: 10.1016/j.xcrm.2020.100142] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/23/2020] [Accepted: 10/22/2020] [Indexed: 12/20/2022]
Abstract
The acid sphingomyelinase/ceramide system plays an important role in bacterial and viral infections. Here, we report that either pharmacological inhibition of acid sphingomyelinase with amitriptyline, imipramine, fluoxetine, sertraline, escitalopram, or maprotiline or genetic downregulation of the enzyme prevents infection of cultured cells or freshy isolated human nasal epithelial cells with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or vesicular stomatitis virus (VSV) pseudoviral particles (pp-VSV) presenting SARS-CoV-2 spike protein (pp-VSV-SARS-CoV-2 spike), a bona fide system mimicking SARS-CoV-2 infection. Infection activates acid sphingomyelinase and triggers a release of ceramide on the cell surface. Neutralization or consumption of surface ceramide reduces infection with pp-VSV-SARS-CoV-2 spike. Treating volunteers with a low dose of amitriptyline prevents infection of freshly isolated nasal epithelial cells with pp-VSV-SARS-CoV-2 spike. The data justify clinical studies investigating whether amitriptyline, a safe drug used clinically for almost 60 years, or other antidepressants that functionally block acid sphingomyelinase prevent SARS-CoV-2 infection.
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Affiliation(s)
- Alexander Carpinteiro
- Institute of Molecular Biology, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
- Department of Hematology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Michael J. Edwards
- Department of Surgery, University of Cincinnati Medical School, 231 Albert Sabin Way, ML0558, Cincinnati, OH 45267, USA
| | - Markus Hoffmann
- Infection Biology Unit, German Primate Center – Leibniz Institute for Primate Research, Göttingen, Germany
- Faculty of Biology and Psychology, University of Göttingen, 37073 Göttingen, Germany
| | - Georg Kochs
- Institute of Virology and Faculty of Medicine, University of Freiburg, Hermann-Herder-Strasse 11, 79104 Freiburg, Germany
| | - Barbara Gripp
- Zentrum für Seelische Gesundheit des Kindes- und Jugendalters, Sana-Klinikum Remscheid GmbH, Burger Strasse 211, 42859 Remscheid, Germany
| | - Sebastian Weigang
- Institute of Virology and Faculty of Medicine, University of Freiburg, Hermann-Herder-Strasse 11, 79104 Freiburg, Germany
| | - Constantin Adams
- Department of Paediatrics, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Elisa Carpinteiro
- Institute of Molecular Biology, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Anne Gulbins
- Institute of Molecular Biology, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Simone Keitsch
- Institute of Molecular Biology, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Carolin Sehl
- Institute of Molecular Biology, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Matthias Soddemann
- Institute of Molecular Biology, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Barbara Wilker
- Institute of Molecular Biology, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Markus Kamler
- Department of Thoracic and Cardiovascular Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Karl S. Lang
- Institute of Immunology, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Sameer Patel
- Department of Surgery, University of Cincinnati Medical School, 231 Albert Sabin Way, ML0558, Cincinnati, OH 45267, USA
| | - Gregory C. Wilson
- Department of Surgery, University of Cincinnati Medical School, 231 Albert Sabin Way, ML0558, Cincinnati, OH 45267, USA
| | - Silke Walter
- Department of Neurology, University Hospital of the Saarland, Kirrberger Strasse, 66421 Homburg/Saar, Germany
| | - Hartmut Hengel
- Institute of Virology and Faculty of Medicine, University of Freiburg, Hermann-Herder-Strasse 11, 79104 Freiburg, Germany
| | - Stefan Pöhlmann
- Infection Biology Unit, German Primate Center – Leibniz Institute for Primate Research, Göttingen, Germany
- Faculty of Biology and Psychology, University of Göttingen, 37073 Göttingen, Germany
| | - Philipp A. Lang
- Department of Molecular Medicine II, Medical Faculty, Heinrich Heine University, Universitaetsstrasse 1, 40225 Düsseldorf, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Katrin Anne Becker
- Institute of Molecular Biology, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Syed A. Ahmad
- Department of Surgery, University of Cincinnati Medical School, 231 Albert Sabin Way, ML0558, Cincinnati, OH 45267, USA
| | - Klaus Fassbender
- Department of Neurology, University Hospital of the Saarland, Kirrberger Strasse, 66421 Homburg/Saar, Germany
| | - Erich Gulbins
- Institute of Molecular Biology, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
- Department of Surgery, University of Cincinnati Medical School, 231 Albert Sabin Way, ML0558, Cincinnati, OH 45267, USA
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Dryburgh E, Honeybun L, Sturrock K, Savage A, Maskell PD. Using μX-Ray CT to observe postmortem diffusion from the stomach in a rat model. Forensic Sci Int 2020; 312:110310. [PMID: 32446139 DOI: 10.1016/j.forsciint.2020.110310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/08/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
The stomach has long been recognised as a depot for postmortem diffusion. A better understanding of the phenomena of postmortem diffusion would aid forensic practitioners in their interpretation of toxicological results. A limitation of previous stomach diffusion studies was the lack of ability to visualise postmortem diffusion in real time, the use of μX-ray Computed Tomography (CT) could overcome this problem. We utilised CT to track the diffusion of the contrast medium caesium ions (Cs+) (administered by oral gavage) from the rat stomach over 6 days. We investigated the influence of temperature (4°C and 20°C) and body position (horizontal and vertical). The results show that the a) diffusion of Cs+ from the stomach can be visualised over 6 days, over which a significant amount (∼50%) of the diffusion occurs in the first 24h following administration; b) storing the rat at 4°C reduces the distance of diffusion from the stomach by ∼66%; c) body position influences the route of diffusion and d) in 2 of the 16 rats studied Cs+ was found in the right lobe of the liver. Overall these results show that CT using Cs+ is a good model to visualise postmortem diffusion and that bodies show significant variation in postmortem diffusion. It is also clear that bodies should be refrigerated and postmortem samples should be taken as soon as possible to minimise the influences of postmortem diffusion from the stomach.
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Affiliation(s)
- Eve Dryburgh
- Division of Psychology and Forensic Sciences, School of Applied Sciences, Abertay University, Dundee DD1 1HG, Scotland, UK
| | - Llinos Honeybun
- Centre of Forensic Science, University of Strathclyde, Glasgow G1 1XQ, Scotland, UK
| | - Keith Sturrock
- Division of Psychology and Forensic Sciences, School of Applied Sciences, Abertay University, Dundee DD1 1HG, Scotland, UK
| | - Anne Savage
- Division of Health Sciences, School of Applied Sciences, Abertay University, Dundee DD11HG, Scotland, UK
| | - Peter D Maskell
- Division of Psychology and Forensic Sciences, School of Applied Sciences, Abertay University, Dundee DD1 1HG, Scotland, UK.
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8
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Ketola RA, Kriikku P. Drug concentrations in post‐mortem specimens. Drug Test Anal 2019; 11:1338-1357. [DOI: 10.1002/dta.2662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Raimo A. Ketola
- Forensic Toxicology UnitNational Institute for Health and Welfare (THL) Mannerheimintie 166 FI‐00270 Helsinki Finland
| | - Pirkko Kriikku
- Forensic Toxicology UnitNational Institute for Health and Welfare (THL) Mannerheimintie 166 FI‐00270 Helsinki Finland
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9
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Pélissier-Alicot AL. La redistribution post mortem : état des lieux en 2016. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2016. [DOI: 10.1016/j.toxac.2015.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Bernard JP, Khiabani HZ, Hilberg T, Karinen R, Slørdal L, Waal H, Mørland J. Characteristics of methadone-related fatalities in Norway. J Forensic Leg Med 2015; 36:114-20. [PMID: 26439870 DOI: 10.1016/j.jflm.2015.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/15/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
Abstract
There are currently over 7000 patients enrolled in opioid maintenance treatment (OMT) programs in Norway. A rise in methadone-related deaths proportional to increasing methadone sales over the period 2000-2006 has been observed, but the causative factors for these fatalities have been elusive. In the present study, individual characteristics, methadone concentrations and additional toxicological findings were analyzed. Methadone intoxication deaths (n = 264) were divided into 3 groups according to toxicological findings in whole blood: group 1 - methadone detected alone, or together with one additional drug at low or therapeutic levels, or a low concentration of ethanol (<1 g/L) (n = 21); group 2 - multiple additional drugs/substances detected below lethal levels (n = 175); group 3 - one or more additional drugs/substances detected at lethal levels, or ethanol >3 g/L (n = 55). Methadone blood concentrations in decedents who had been enrolled in OMT were higher than for decedents not in treatment, in all groups. Blood methadone concentrations around 1 mg/L were present in fatal multi-drug intoxications in OMT patients. Results suggest that some patients may be at risk of dying when combining therapeutic concentrations of methadone with other psychoactive substances. Somatic disease was a common finding among deceased OMT patients. Concentrations in methadone users not enrolled in OMT were predominantly between 0.3 and 0.4 mg/L and were not related to the presence of other drugs. However, methadone concentrations below 0.1 mg/L may be associated with intoxication following methadone use, both alone and in combination with other drugs. Younger male users (mean age 34 years) seemed to have a higher susceptibility to methadone intoxication.
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Affiliation(s)
- Jean-Paul Bernard
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway; Centre for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.
| | - Hassan Z Khiabani
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway; Oslo University Hospital, Rikshospitalet, Department of Pharmacology, Oslo, Norway
| | - Thor Hilberg
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway; Fürst Medical Laboratory, Oslo, Norway
| | - Ritva Karinen
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway
| | - Lars Slørdal
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Clinical Pharmacology, St. Olav's Hospital, Trondheim, Norway
| | - Helge Waal
- SERAF-Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway; Oslo University Hospital, Division of Mental Health and Addiction, Oslo, Norway
| | - Jørg Mørland
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway
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11
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A suicide involving intraperitoneal injection of pentobarbital. Int J Legal Med 2015; 130:1217-22. [PMID: 26174446 DOI: 10.1007/s00414-015-1231-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/30/2015] [Indexed: 10/23/2022]
Abstract
We present an unusual case of suicide by intraperitoneal injection of pentobarbital, an overdose of zolpidem and the intake of diazepam, ethanol and other psychoactive substances. The autopsy and specimen collection were conducted in a 10 to 18 h postmortem interval. The toxicological analysis revealed a significantly higher pentobarbital concentration in femoral blood compared to cardiac blood (36 vs. 15 mg/L). On the contrary, zolpidem and diazepam concentrations in cardiac blood (2700 and 590 µg/L) were found to be significantly higher than in femoral blood (1500 and 230 µg/L). These findings point to a postmortem redistribution with a distinct gradient from areas of high drug concentrations in the gastrointestinal tract (zolpidem and diazepam) and the injection site (pentobarbital) to peripheral tissue. Ethanol concentration was 0.95 ‰ which amplified the CNS depression. The choice of this unusual suicide method was associated with the deceased's former job as a veterinarian's assistant. In veterinary medicine, the intraperitoneal injection of a lethal dose of pentobarbital is quite commonly performed to euthanise small animals. Intraperitoneal injection is rare as route of administration in humans.
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12
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13
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Bierton C, Gilbert JD, Kostakis C, Langlois NEI. Route of drug administration may influence toxicological levels in the liver. J Clin Pathol 2013; 66:630-1. [PMID: 23418338 DOI: 10.1136/jclinpath-2013-201462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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14
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Sastre C, Baillif-Couniou V, Musarella F, Bartoli C, Mancini J, Piercecchi-Marti MD, Leonetti G, Pelissier-Alicot AL. Can subclavian blood be equated with a peripheral blood sample? A series of 50 cases. Int J Legal Med 2012; 127:379-84. [PMID: 22773273 DOI: 10.1007/s00414-012-0736-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 06/19/2012] [Indexed: 11/26/2022]
Abstract
If femoral blood is not available at autopsy, toxicological analyses, in particular blood ethanol measurements, are carried out on cardiac blood. This is known to be subject to major redistribution. We aimed to determine whether subclavian blood can be equated with a peripheral blood sample and could be used if femoral blood is not available. The study was based on 50 medicolegal autopsies in which we compared ethanol concentrations between subclavian blood, the different heart blood compartments (right and left cardiac blood), and femoral blood. Mechanisms that could lead to variations in concentration, i.e., postmortem redistribution and/or endogenous production, were also taken into account in interpreting the results. Ethanol concentrations were determined by headspace gas chromatography with a flame ionization detector. In each case, we recorded the circumstances of death, resuscitation attempts if any, degree of putrefaction, chest or abdominal trauma, and/or inhalation of gastric fluid in the airways. Ethanol concentrations in subclavian blood were found to be close to those in peripheral blood (p = 0.948) and were not influenced by the degree of putrefaction (r = 0.017, p = 0.904), gastric ethanol concentration (r = -0.011, p = 0.940), inhalation of gastric contents in the airways (p = 0.461), or cardiac resuscitation attempts (p = 0.368). We discuss the possible explanations for these findings and stress the value of sampling subclavian blood when femoral blood is not obtainable at autopsy.
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Gerostamoulos D, Beyer J, Staikos V, Tayler P, Woodford N, Drummer OH. The effect of the postmortem interval on the redistribution of drugs: a comparison of mortuary admission and autopsy blood specimens. Forensic Sci Med Pathol 2012; 8:373-9. [DOI: 10.1007/s12024-012-9341-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2012] [Indexed: 11/28/2022]
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16
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Brunet B, Hauet T, Hébrard W, Papet Y, Mauco G, Mura P. Postmortem redistribution of THC in the pig. Int J Legal Med 2010; 124:543-9. [PMID: 20052591 DOI: 10.1007/s00414-009-0403-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 12/10/2009] [Indexed: 11/30/2022]
Abstract
To improve the knowledge of the postmortem redistribution of Δ(9)-tetrahydrocannabinol (THC), an animal model using the Large White pig has been developed, whereby 15 pigs received an intravenous injection of THC (200 µg/kg body weight) and were euthanized 2 h after administration. An autopsy was performed on three pigs immediately after being euthanized while the others were stored in supine position at ambient temperature for 6, 15, 24, or 48 h. THC concentration in blood from the vena cava decreased after death whereas left or right cardiac blood concentrations increased. No blood specimens collected from different sites of the carcasses adequately reflected the perimortem THC concentrations. The highest concentrations of THC at anytime were observed in lung tissue, and brain tissue seemed to present the most stable concentrations over time. This study can assist toxicologists in determining which specimens can, most appropriately, be used for interpretation of cannabinoid concentrations in postmortem specimens.
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Affiliation(s)
- Bertrand Brunet
- INSERM U927, Université de Poitiers, Faculté de Médecine et Pharmacie, CHU de Poitiers, 6 rue de la Milétrie, BP 577, 86021, Poitiers, France.
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The evaluation of doxepin concentrations in postmortem blood as optional cause of death. Am J Forensic Med Pathol 2009; 30:298-300. [PMID: 19696593 DOI: 10.1097/paf.0b013e31819d2145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The problems concerning an unstable data basis with regard to lethal Doxepin concentrations have been manifested based on a case about a 39-year-old man, who was found dead in his apartment with strangulation marks on his neck, for which a lethal Doxepin intoxication entered the differential diagnosis discussion. For a long time it has been known that postmortem redistribution leads to a falsely inflated concentration as measured in cardiac blood, while the concentrations in peripheral postmortem blood change comparatively little. Despite this, most of the current literature relies on published case report, which fails to mention the location of blood sampling, whereby it is fairly safe to assume that a central sample is intended. Only 9 cases of an isolated lethal Doxepin intoxication have been found, in which the concentrations in blood samples from peripheral vessels had been measured. These values lie between 1.5 and 7.0 mg/L, which is in the lowest quarter of the span of lethal concentrations mentioned in literature without specific mention of the location of the blood sample.
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Abstract
Clinical pharmacology assumes that deductions can be made about the concentrations of drugs from a knowledge of the pharmacokinetic parameters in an individual; and that the effects are related to the measured concentration. Post-mortem changes render the assumptions of clinical pharmacology largely invalid, and make the interpretation of concentrations measured in post-mortem samples difficult or impossible. Qualitative tests can show the presence of substances that were not present in life, and can fail to detect substances that led to death. Quantitative analysis is subject to error in itself, and because post-mortem concentrations vary in largely unpredictable ways with the site and time of sampling, as a result of the phenomenon of post-mortem redistribution. Consequently, compilations of 'lethal concentrations' are misleading. There is a lack of adequate studies of the true relationship between fatal events and the concentrations that can be measured subsequently, but without such studies, clinical pharmacologists and others should be wary of interpreting post-mortem measurements.
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Affiliation(s)
- R E Ferner
- West Midlands Centre for Adverse Drug Reactions, City Hospital and Department of Clinical Pharmacology, The Medical School, University of Birmingham, Birmingham, UK.
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Høiseth G, Bramness JG, Christophersen AS, Mørland J. Carisoprodol intoxications: a retrospective study of forensic autopsy material from 1992–2003. Int J Legal Med 2006; 121:403-9. [PMID: 17115170 DOI: 10.1007/s00414-006-0139-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 10/13/2006] [Indexed: 10/23/2022]
Abstract
Carisoprodol is commonly prescribed as a centrally acting muscle relaxant, but it is also subject to abuse. The literature describing fatal intoxications with the drug is limited to a relatively small number of cases, and there are inconsistencies with regard to which concentration levels that are toxic. We therefore investigated all forensic autopsies at the Norwegian Institute of Public Health during the period 1992-2003 where carisoprodol was detected. The median concentrations of carisoprodol in intoxication with carisoprodol only or with only minor other analytical findings was 36 mg/l (range 8-65 mg/l; n=5). In the rest of the intoxications, the relevance of carisoprodol relative to the other drugs detected was variable (n=93). When the number of intoxications with carisoprodol each year were divided by the number of defined daily doses (DDD) sold, a fatal toxicity index between 5.6 and 6.9 deaths/1 million DDD was obtained. The total number of cases where carisoprodol was detected increased during the period studied, which correlated to sales figures for the drug. We conclude that carisoprodol can be fatal in concentrations below those indicated in some of the previously published literature. There were, however, only a small number of cases where the cause of death can be attributed to use of carisoprodol alone.
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Affiliation(s)
- Gudrun Høiseth
- Division of Forensic Toxicology and Drug Abuse, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, 0403 Oslo, Norway.
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Brunet B, Doucet C, Venisse N, Hauet T, Hébrard W, Papet Y, Mauco G, Mura P. Validation of Large White Pig as an animal model for the study of cannabinoids metabolism: application to the study of THC distribution in tissues. Forensic Sci Int 2006; 161:169-74. [PMID: 16859848 DOI: 10.1016/j.forsciint.2006.04.018] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2005] [Revised: 04/16/2006] [Accepted: 04/16/2006] [Indexed: 10/24/2022]
Abstract
This study presents a new animal model, the Large White Pig, which was tested for studying cannabinoids metabolism. The first step has focused on determination of plasma kinetics after injection of Delta(9)-tetrahydrocannabinol (THC) at different dosages. Seven pigs received THC by intravenous injections (50, 100 or 200 microg/kg). Plasma samples were collected during 48 h. Determination of cannabinoids concentrations were performed by gas chromatography/mass spectrometry. Results showed that plasma kinetics were comparable to those reported in humans. Terminal half-life of elimination was 10.6 h and a volume of distribution of 32 l/kg was calculated. In a second step, this model was used to determine the kinetic profile of cannabinoids distribution in tissues. Eight Large White male pigs received an injection of THC (200 microg/kg). Two pigs were sacrificed 30 min after injection, two others after 2, 6 and 24 h. Different tissues were sampled: liver, kidney, heart, lung, spleen, muscle, fat, bile, blood, vitreous humor and several brain areas. The fastest THC elimination was noted in liver tissue, where it was completely eliminated in 6 h. THC concentrations decreased in brain tissue slower than in blood. The slowest THC elimination was observed for fat tissue, where the molecule was still present at significant concentrations 24 h later. After 30 min, THC concentration in different brain areas was highest in the cerebellum and lowest in the medulla oblongata. THC elimination kinetics noted in kidney, heart, spleen, muscle and lung were comparable with those observed in blood. 11-Hydroxy-THC was only found at high levels in liver. THC-COOH was less than 5 ng/g in most tissues, except in bile, where it increased for 24 h following THC injection. This study confirms, even after a unique administration, the prolonged retention of THC in brain and particularly in fat, which could be at the origin of different phenomena observed for heavy users such as prolonged detection of THC-COOH in urine or cannabis-related flashbacks. Moreover, these results support the interest for this animal model, which could be used in further studies of distribution of cannabinoids in tissues.
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Affiliation(s)
- Bertrand Brunet
- INSERM E-0324, Université de Poitiers, Faculté de Médecine et Pharmacie, CHU de Poitiers, BP 577, France
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22
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Pélissier-Alicot AL, Gaulier JM, Dupuis C, Feuerstein M, Léonetti G, Lachâtre G, Marquet P. Post-mortem redistribution of three beta-blockers in the rabbit. Int J Legal Med 2005; 120:226-32. [PMID: 16247634 DOI: 10.1007/s00414-005-0022-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2005] [Accepted: 05/23/2005] [Indexed: 10/25/2022]
Abstract
To consider the role of the physico-chemical properties of drugs in their post-mortem redistribution, we designed the present study to investigate the influence of lipophilicity using an experimental rabbit model. Three beta-blockers (BB), atenolol, metoprolol and propranolol, with a similar dissociation constant (pK (a)) and increasing partition coefficient (K (p)) were administered intravenously to 18 rabbits. One hour after the last administration, the animals were killed by thiopental injection and placed in a supine position at room temperature. Autopsies were performed at 0, 2, 6, 12, 24 and 48 h post-mortem. Concentrations of the three BB were determined in fluids (right and left cardiac blood, peripheral blood, urine, bile, stomach content, vitreous humour) and tissues (cardiac muscle, lungs, liver, brain, diaphragm, iliopsoas muscle) using a previously published, validated liquid chromatography-electrospray-mass spectrometry method. Our results show that lipophilicity influences post-mortem redistribution of the molecules in a certain number of anatomical sites such as the stomach, lungs, cardiac muscle, cardiac blood or liver, but does not appear to intervene in other sites such as the brain or the vitreous humour.
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Kornhuber J, Weigmann H, Röhrich J, Wiltfang J, Bleich S, Meineke I, Zöchling R, Härtter S, Riederer P, Hiemke C. Region specific distribution of levomepromazine in the human brain. J Neural Transm (Vienna) 2005; 113:387-97. [PMID: 15997416 DOI: 10.1007/s00702-005-0331-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Accepted: 04/30/2005] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The aim of this study was to examine concentrations of levomepromazine and its metabolite desmethyl-levomepromazine in different regions of human brain and in relationship to drug-free time. METHODS Drug concentrations were measured in up to 43 regions of 5 postmortem human brains of patients previously treated with levomepromazine. To enable statistical comparison across brain regions several smaller brain areas were put together to form larger brain areas (cortex cerebri, limbic system, cerebellum, basal ganglia, thalamus). Mean values of drug concentrations in these larger brain areas were used in a repeated measurement ANOVA to analyze for region specific distribution. The elimination half-life in brain tissue was estimated with a NONMEM population kinetic analysis using the mean value of all brain regions of an individual case. RESULTS Levomepromazine and desmethyl-levomepromazine appear to accumulate in human brain tissue relative to blood. Mean concentrations differed largely between individual brains, in part due to differences in dose of drug, duration of treatment and drug-free time before death. There was an apparent region-specific difference in levomepromazine concentrations with highest values in the basal ganglia (mean 316 ng/g) and lowest values in the cortex cerebri (mean 209 ng/g). The elimination half-life from brain tissue is longer than from blood and was calculated to be about one week. Similar results were obtained with desmethyl-levomepromazine. CONCLUSIONS Levomepromazine shows a region-specific distribution in the human brain with highest values in the basal ganglia. This might be the consequence of low expression of the metabolic enzyme Cyp2D6 in the basal ganglia. If this finding is true also for other neuroleptic drugs it might increase our understanding of preferential toxicity of neuroleptic drugs against basal ganglia structures and higher volumes of basal ganglia of neuroleptic-treated patients. Furthermore, patients exposed to levomepromazine cannot be considered to be free of residual effects of the drug for a number of weeks after withdrawal.
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Affiliation(s)
- J Kornhuber
- Department of Psychiatry, University of Erlangen, Germany.
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Ogawa Y, Tenderich G, Minami K, Schulz U, Kleikamp G, Hornik L, Koertke H, Koerfer R. Successful use of a cardiac allograft from tricyclic antidepressant intoxication. Transplantation 2003; 76:1239-40. [PMID: 14578762 DOI: 10.1097/01.tp.0000084555.37619.00] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Flanagan RJ, Amin A, Seinen W. Effect of post-mortem changes on peripheral and central whole blood and tissue clozapine and norclozapine concentrations in the domestic pig (Sus scrofa). Forensic Sci Int 2003; 132:9-17. [PMID: 12689746 DOI: 10.1016/s0379-0738(02)00414-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Interpretation of the results of psychoactive or other drug measurements in post-mortem blood specimens may not be straightforward, in part because analyte concentrations in blood may change after death. There is also the issue of comparability of plasma (or serum) results to those obtained in whole blood. To investigate these problems with respect to clozapine, this drug (10mg/kg daily) was given orally to two pigs. Blood was collected 3h post-dose on day 7, the animals were sacrificed, and blood taken from central and peripheral veins for up to 48 h after death. Tissue samples were also collected immediately after death and at 48 h. Ante-mortem whole blood clozapine/N-desmethylclozapine (norclozapine) concentrations were 0.86/1.07 and 1.11/1.15 mg/l in pigs 1 and 2, respectively. Blood clozapine and norclozapine concentrations generally increased after death (central vein: clozapine up to 300%, norclozapine up to 460%; peripheral vein: clozapine up to 155%, norclozapine up to 185%). Initial blood and kidney clozapine and norclozapine concentrations were comparable in both animals, but were some two-fold higher in heart, liver and striated muscle in pig 2. In both animals, the heart and striated muscle clozapine and norclozapine concentrations had increased some two- to three-fold at 48 h, whilst the liver and kidney concentrations were essentially unchanged. The reason for the increase in heart and striated muscle concentrations at 48 h is unclear, but could be simple variation in sample site. The plasma:whole blood distribution of clozapine and norclozapine was studied in vitro. In human blood (one volunteer donor, haematocrit 0.50) the plots of plasma versus whole blood concentration were linear for both analytes across the range 0.1-1.5mg/l, although clozapine favoured plasma (plasma:whole blood ratio=1.12), whereas norclozapine favoured whole blood (ratio 0.68). In pig blood, the plots of plasma versus whole blood were non-linear in both cases, although clozapine favoured plasma to a greater extent than norclozapine. This may be due to lower plasma clozapine and norclozapine protein binding capacity in the pig as compared to man.
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Affiliation(s)
- R J Flanagan
- Medical Toxicology Unit, Guy's and St Thomas' Hospital Trust, Avonley Road, London SE14 5ER, UK.
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Kłys M, Bujak-Gizycka B, Klementowicz W, Kunz J. Case Study: Distribution and Redistribution of Levomepromazine and its Metabolites in a Fatal Poisoning. CANADIAN SOCIETY OF FORENSIC SCIENCE JOURNAL 2003. [DOI: 10.1080/00085030.2003.10757555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Koreeda A, Yonemitsu K, Ng'walali PM, Muraoka N, Tsunenari S. Clocapramine-related fatality. Postmortem drug levels in multiple psychoactive drug poisoning. Forensic Sci Int 2001; 122:48-51. [PMID: 11587865 DOI: 10.1016/s0379-0738(01)00442-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A suicide caused by ingestion of multiple psychoactive drugs is reported. A 42-year-old man with a history of psychosis was found dead in a blood pool in his room. The forensic autopsy revealed two stab wounds on his chest. However, these wounds could not explain the cause of death. Eighty-six tablets were found in his stomach. Four psychoactive drugs; clocapramine (CC), chlorpromazine (CP), promethazine (PM) and clotiazepam (CT) were detected in blood and tissues. The concentrations of CC, CP, PM and CT in the femoral vein (FV) blood were 0.39, 0.61, 1.23 and 0.09 microg/ml, respectively. The cause and manner of death were attributed to suicidal multiple psychoactive drug poisoning. Postmortem drug redistribution showed great site-dependent variations with the lowest level in the FV blood. Remarkable variations were observed in CC, CP and PM, but not in CT compared to other three drugs. The variations were dependent on the volume of distribution (Vd) of the drugs. Our human case has demonstrated drugs with higher Vd values showed higher degree of postmortem redistribution of the drug and vice versa.
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Affiliation(s)
- A Koreeda
- Department of Forensic Medicine, Kumamoto University School of Medicine, 2-2-1 Honjyo, 860-0811, Kumamoto, Japan.
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Cook DS, Braithwaite RA, Hale KA. Estimating antemortem drug concentrations from postmortem blood samples: the influence of postmortem redistribution. J Clin Pathol 2000; 53:282-5. [PMID: 10823124 PMCID: PMC1731178 DOI: 10.1136/jcp.53.4.282] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To compare blood drug concentrations during life with postmortem drug concentrations measured from a peripheral site and a central site. METHODS Coroner's cases from October 1990 to July 1997 were reviewed. Six cases had data on both antemortem and postmortem blood drug concentrations. The postmortem to antemortem ratio was compared with the postmortem central to peripheral ratio, using cardiac blood as a central site and femoral blood as a peripheral site. RESULTS Drugs that have a high postmortem central to peripheral ratio; that is, drugs that exhibit considerable postmortem redistribution, also have high postmortem to antemortem ratios. CONCLUSIONS A large degree of error can arise from attempting to estimate antemortem drug concentrations and the ingested dose from postmortem measurements. The chosen site and technique for postmortem blood sampling can greatly influence the concentration of drug measured.
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Affiliation(s)
- D S Cook
- Regional Laboratory for Toxicology, City Hospital NHS Trust, Birmingham, UK
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Rogde S, Hilberg T, Teige B. Fatal combined intoxication with new antidepressants. Human cases and an experimental study of postmortem moclobemide redistribution. Forensic Sci Int 1999; 100:109-16. [PMID: 10356779 DOI: 10.1016/s0379-0738(98)00184-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Three cases are presented in which death was caused by suicidal intoxication with moclobemide in combination with a selective serotonin reuptake inhibitor. Both antidepressant drug types are considered to be relatively safe with regard to lethal overdose. However, the combination may cause the serotonin syndrome, a condition with a high mortality rate. In one of the cases, there was clinical information consistent with the serotonin syndrome, in the two other cases, there was no information of the clinical course. Postmortem redistribution of the selective monoamine oxidase inhibitor moclobemide was investigated in a rat model. Postmortem concentrations in blood from the vena cava and the heart were found to be in good accordance with antemortem concentrations. Postmortem concentrations in vitreous humour and various tissues were also measured. The apparent volume of distribution was calculated to be 0.95 +/- 0.10 l/kg, which is in the same range as that reported in man.
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Affiliation(s)
- S Rogde
- Institute of Forensic Medicine, University of Oslo, Norway.
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Postmortem Drug Redistribution—Human Cases Related to Results in Experimental Animals. J Forensic Sci 1999. [DOI: 10.1520/jfs14404j] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Postmortem Amitriptyline Pharmacokinetics in Pigs after Oral and Intravenous Routes of Administration. J Forensic Sci 1998. [DOI: 10.1520/jfs16151j] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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von Moltke LL, Greenblatt DJ, Schmider J, Wright CE, Harmatz JS, Shader RI. In vitro approaches to predicting drug interactions in vivo. Biochem Pharmacol 1998; 55:113-22. [PMID: 9448733 DOI: 10.1016/s0006-2952(97)00239-6] [Citation(s) in RCA: 143] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In vitro metabolic models using human liver microsomes can be applied to quantitative prediction of in vivo drug interactions caused by reversible inhibition of metabolism. One approach utilizes in vitro Ki, values together with in vivo values of inhibitor concentration to forecast in vivo decrements of clearance caused by coadministration of inhibitor. A critical limitation is the lack of a general scheme for assigning intrahepatic exposure of enzyme to inhibitor or substrate based only on plasma concentration; however, the assumption that plasma protein binding necessarily restricts hepatic uptake is not tenable. Other potential limitations include: flow-dependent hepatic clearance, "mechanism-based" chemical inhibition, concurrent induction, or a major contribution of gastrointestinal P450-3A isoforms to presystemic extraction. Nonetheless, the model to date has provided reasonably accurate forecasts of in vivo inhibition of clearance of several substrates (desipramine, terfenadine, triazolam, alprazolam, midazolam) by coadministration of selective serotonin reuptake-inhibitor antidepressants and azole antifungal agents. Such predictive models deserve further evaluation, since they may ultimately yield more cost-effective and expeditious screening for drug interactions, with reduced human drug exposure and risk.
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Affiliation(s)
- L L von Moltke
- Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine, Boston, MA 02111, USA.
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Postmortem Serum and Tissue Redistribution of Fluoxetine and Norfluoxetine in Dogs Following Oral Administration of Fluoxetine Hydrochloride (Prozac®). J Forensic Sci 1997. [DOI: 10.1520/jfs14213j] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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A Compilation of Fatal and Control Concentrations of Drugs in Postmortem Femoral Blood. J Forensic Sci 1997. [DOI: 10.1520/jfs14071j] [Citation(s) in RCA: 173] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Fattinger KE, Rentsch KM, Meier PJ, Dazzi H, Krähenbühl S. Safety of liver donation after fatal intoxication with the tricyclic antidepressant trimipramine. Transplantation 1996; 62:1259-62. [PMID: 8932268 DOI: 10.1097/00007890-199611150-00014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report the case of a patient receiving long-term treatment with the tricyclic antidepressant trimipramine who died 10 days after a trimipramine overdose. A few hours before death, the serum trimipramine concentration had fallen to 80 microg/L. Similar values are reported for patients taking therapeutic trimipramine doses. At this serum concentration, the liver content of trimipramine and it's 2-hydroxy and N-desmethyl metabolites was 1750 microg/kg, 850 microg/kg, and 225 microg/kg, respectively. The liver was morphologically normal. Back calculations suggest that a liver transplant obtained from a donor dying from a trimipramine overdose should be safe, if the serum trimipramine concentration has fallen below 2000 microg/L. If higher serum trimipramine concentrations are present, harvesting should be delayed to avoid trimipramine toxicity in the recipient.
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Affiliation(s)
- K E Fattinger
- Division of Clinical Pharmacology and Toxicology, Department of Internal Medicine, University Hospital, Zurich, Switzerland
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