Flunitrazepam in stomach contents may be a good indicator of its massive ingestion

Kojima, Hiroshi; Tanaka, Naoko; Takakura, Ayaka; Kumihashi, Mitsuru; Jamal, Mostofa; Ito, Asuka; Tsutsui, Kunihiko; Kimura, Shoji; Matsubara, Shuji; Ameno, Kiyoshi

doi:10.4323/rjlm.2017.193

Cited by 8 publications

(4 citation statements)

References 6 publications

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“…Toxicological analyses using liquid chromatography tandem mass spectrometry (LC-MS/MS) were performed as described previously ( Kinoshita et al, 2017 ). In brief, liquid chromatography separations were carried out using an Ekspert TM UltraLC 100-XL system (Eksigent part of Sciex, Framingham, MA, United States of America).…”

Section: Case Reportmentioning

confidence: 99%

Case report: Fatal poisoning caused by additive effects of two barbiturates

et al. 2023

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A case of fatal poisoning involving multiple psychotropic drugs is presented. Quantitative toxicological analysis showed femoral blood concentrations of pentobarbital, phenobarbital, duloxetine, acetaminophen and tramadol were 10.39, 22.57, 0.22, 0.61 and 0.22 μg/ml, respectively. We concluded that the death was due to the additive effects of two barbiturates. As both pentobarbital and phenobarbital act on gamma-aminobutyric acid (GABA) receptors, central nervous system activity was suppressed, causing respiratory depression. Additive pharmacological effects should be considered in cases of massive ingestion of multiple drugs.

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Section: Case Reportmentioning

confidence: 99%

Case report: Fatal poisoning caused by additive effects of two barbiturates

et al. 2023

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“…All samples were used for toxicological analysis. Toxicological analysis was performed by liquid chromatographytandem mass spectrometry [3]. Briefly, liquid chromatography separations were carried out using EkspertTM UltraLC 100-XL (Eksigent part of AB Sciex, Framingham, MA, USA).…”

Section: Biological and Toxicological Examinationmentioning

confidence: 99%

An Autopsy Case of Drowning Under the Influence of Etizolam: A Case Report

Takei

Kojima

Jamal

et al. 2023

IJMTFM

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A fatal case of drowning under the influence of etizolam is presented. Quantitative toxicological analysis revealed etizolam concentrations of 0.50 µg/mL and 0.068 µg/mL in femoral venous blood and urine, respectively. According to the autopsy findings, the results of toxicological examinations, and the investigation by the authorities, it is concluded that the cause of death is drowning under the influence of etizolam.

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“…Toxicological analysis using liquid chromatography tandem mass spectrometry (LC-MS/MS) was performed using a slightly modified method from that previously reported 6 .…”

Section: Case Reportmentioning

confidence: 99%

Fatal poisoning case involving drug interaction due to the inhibition of cytochrome P450

Kojima

Tanaka

Kumihashi

et al. 2021

VSP

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Background/Aim. Cytochrome P450 (CYP) enzymes are responsible for the metabolism of various drugs and chemicals. Forensic pathologist should consider not only pharmacodynamic interactions by multiple drugs, but also the pharmacokinetic drug interactions of each drug in casework of multiple drug ingestion. Case report. A female in her forties, receiving therapy for alcohol dependence, was found dead in her house.Medico-legal autopsy revealed no findings suggestive of natural disease. Quantitative toxicological analysis showed that levomepromazine, promethazine, dextromethorphan, estazolam, clomipramine, risperidone, and flunitrazepam concentrations in femoral blood were 0.750 µg/mL, 0.701 µg/mL, 0.332 µg/mL, 0.390 µg/mL, 0.216 µg/mL, 0.031 µg/mL, and 0.002 µg/mL, respectively, along with a blood ethanol level of 377 mg/dL. Conclusion. We concluded that the cause of death was interaction between ethanol and multiple psychotropic drugs. Pharmacokinetic drug interactions due to the inhibition of CYPs should be considered in the evaluation of toxicity in poisoning cases involving multiple drugs. Key words: drug interaction; overdose; levomepromazine; cytochrome P450 (CYP); dextromethorphan. Apstrakt Uvod. Enzimi P450 (CYP) su odgovorni za metabolizam različitih lekova i hemikalija. Forenzički patolog treba da razmotri ne samo farmakodinamske interakcije više lekova već i farmakokinetičke interakcije svakog leka u slučaju multiple ingestije lekova. Prikaz bolesnika. Žena 40-ih godina, na lečenju od zavisnosti od alkohola, nađena je mrtva u svojoj kući. Medikolegalnom autopsijom nisu nađeni zanci koji bi upućivali na prirodnu bolest. Kvantitativnom toksikološkom analizom nađeno je da su koncentracije levomepromazina, prometazina, dekstrometorfana, estazolama, klomipramina, risperidona i flunitrazepama u femoralnoj krvi bile: 0.750 µg/mL, 0.701 µg/mL, 0.332 µg/mL, 0.390 µg/mL, 0.216 µg/mL, 0.031 µg/mL, and 0.002 µg/mL, redom, uz etil alkohol u krvi u koncentraciji od 377 mg/dL. Zaključak. Zaključili smo da je uzrok smrti bila interakcija između etil alkohola i više psihotropnih lekova. Farmakokinetičke interakcije lekova zbog inhibicije CYP-a treba da budu razmotrene u proceni toksičnosti kod slučajeva trovanja koji uključuju više lekova. Ključne reči: interakcija lekova, overdoza, levomepromazin, citohrom P450 (CYP), dekstrometorfan.

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Flunitrazepam in stomach contents may be a good indicator of its massive ingestion

Cited by 8 publications

References 6 publications

Case report: Fatal poisoning caused by additive effects of two barbiturates

Case report: Fatal poisoning caused by additive effects of two barbiturates

An Autopsy Case of Drowning Under the Influence of Etizolam: A Case Report

Fatal poisoning case involving drug interaction due to the inhibition of cytochrome P450

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