A fatal intoxication case involving topiramate

Beer, Beate; Libiseller, Kathrin; Oberacher, Herbert; Pavlic, Marion

doi:10.1016/j.forsciint.2010.04.035

Cited by 11 publications

(9 citation statements)

References 21 publications

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“…Few case reports on topiramate levels in post-mortem specimens have been published until now. We have found much lower topiramate concentrations in both liver and kidney when compared with previous cases of intoxication described in literature [16,18,19]. In particular, liver concentrations of 29 µg/g [16] and 140 µg/g [19] were found in previous studies, which are higher than the value detected in this study (0,64 µg/g), as well as the kidney concentrations (55 µg/g vs 0,68 µg/g) [18].…”

Section: Resultscontrasting

confidence: 68%

Interpreting Results of Ethanol, Carbamazepine and Topiramate in Putrefied Postmortem Specimens: A Case Report

David¹,

Broccoli²,

Lionetto³

2016

JPP

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CBZ (carbamazepine), CBZ-epox (carbamazepine-10,11-epoxide), TPR (topiramate) and ethanol were detected in 37-year-old woman buried in the wall founded eighteen months after death. The woman was in treatment with anticonvulsants. The cause of death was strangulation investigated by immunohistochemical with GPA (glycophorin A). Routine analyses for drugs of abuse, therapeutic drugs and volatiles were conducted. Carbamazepine, Topiramate and Alcohol were quantified in abdominal effusion, gastric wall, spleen, douglas fluid, skeletal muscles, endothoracic fluid, kidney, liver, heart and bone marrow. CBZ, CBZ-epox and TPR were recovered in samples deproteinized by acetonitrile spiked with DNSnVal as Internal Standard. Compounds were detected by HPLC-MS/MS. Alcohol was detected in any specimens by HS-GC/FID. CBZ concentrations were ranged from 0.49 in liver to 13.6 µg/g in endothoracic fluid; CBZ-Epox 0.46 in skeletal muscle, and 1.13 µg/g in Douglas fluid; TPR 0.11 in gastric wall and 1.23 µg/g in endothoracic fluid; alcohol from 0.17 in bone marrow to 0,75 mg/g in Douglas fluid. To our knowledge this is the first report of the presence of carbamazepine, topiramate, and alcohol in post mortem putrefied specimens.

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Section: Resultscontrasting

confidence: 68%

Interpreting Results of Ethanol, Carbamazepine and Topiramate in Putrefied Postmortem Specimens: A Case Report

David¹,

Broccoli²,

Lionetto³

2016

JPP

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“…It is also indicated in the treatment of psychiatric illnesses. Several cases of an accidental overdose in children or an intentional or suicidal overdose in older individuals have been reported (6,9). At therapeutic levels, topiramate is benign, and the most prevalent adverse reactions are dizziness, somnolence, and ataxia.…”

Section: Discussionmentioning

confidence: 99%

“…However, acute psychosis, hepatic failure accompanied by encephalopathy, hyperthermia, hyperchloremic metabolic acidosis, nephrolithiasis, and parasthesia have also been reported (5,8,10,11). Beer et al reported a death following an overdose of topiramate and other drugs (6). A retrospective study of anticonvulsant overdoses by Wills et al indicated that 43% of patients had no symptoms and 34% had mild symptoms, while only 2o patients (4%) were severely affected (10).…”

Section: Discussionmentioning

confidence: 99%

“…Topiramate is also being used in the treatment of migraines, cluster headaches, essential tremors, binge eating disorders, acute mania, Tourette's syndrome, neuropathic pain, bipolar disorder, alcohol dependence, excess body weight, and smoking (4,5). Structurally, topiramate is unrelated to other anticonvulsants and acts by multiple neurostabilizing processes (6,7). The recommended adult dosage ranges from 200-400 mg/day.…”

Section: Introductionmentioning

confidence: 99%

“…The recommended adult dosage ranges from 200-400 mg/day. Topiramate peaks 2-3 hours after oral administration and its plasma elimination half-life is 18-24 hours (6,8). Its excretion is primarily (55-66%) via the kidneys (7).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Levetiracetam and topiramate poisoning: Two overdoses on those drugs with no lasting effects

Sarfaraz¹,

Syeda²

2017

DD&T

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Drug concentrations in post‐mortem specimens

Ketola

Kriikku

2019

Drug Testing and Analysis

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A meta‐analysis of drug concentrations in post‐mortem specimens is presented. The analysis involved 50 commonly used drugs and their concentrations in femoral blood, other blood (such as cardiac blood), vitreous humor, muscle, liver, kidney, brain, heart, lung, spleen, and bile. A total of 10 993 analytical results from 5375 post‐mortem cases in 388 studies were gathered and the ratios of drug concentrations in tissue material to median femoral blood concentrations were calculated. Analytical results from the laboratory's own database (years 2000–2018) were also included. The results show that the variation of ratios between post‐mortem specimens and femoral blood is highly compound dependent. This database can be utilized in interpretation of toxicological results in cases where femoral blood is not available. The specimens with similar concentrations as in femoral blood were vitreous humor, muscle, and other blood, such as cardiac blood, and the highest concentrations were generally measured from liver and bile. For these reasons we suggest the following order for biological specimens to be used for a quantitative toxicological analysis in cases where femoral blood is not available: 1. other blood, 2. muscle, 3. vitreous humor, 4. brain, 5. heart, 6. spleen, 7. kidney, 8. liver, and 9. bile.

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A fatal intoxication case involving topiramate

Cited by 11 publications

References 21 publications

Interpreting Results of Ethanol, Carbamazepine and Topiramate in Putrefied Postmortem Specimens: A Case Report

Interpreting Results of Ethanol, Carbamazepine and Topiramate in Putrefied Postmortem Specimens: A Case Report

Levetiracetam and topiramate poisoning: Two overdoses on those drugs with no lasting effects

Drug concentrations in post‐mortem specimens

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