Clocapramine-related fatality. Postmortem drug levels in multiple psychoactive drug poisoning.

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.

Lofepramine overdosage.

Data presented show that lofepramine has lower acute toxicity for animals than other antidepressants tested. Review of 55 case reports of acute lofepramine overdose in man shows that hypotension was rare and convulsions did not occur, although in some cases large overdoses of several grams of drug had been taken. No deaths have been recorded due to overdose with lofepramine alone, and the fatal toxicity index for lofepramine (deaths per million prescriptions, England, Wales and Scotland, 1982-1986) is significantly lower than the mean of all antidepressants (P less than 0.001). It thus appears that the low toxicity of lofepramine in animal experiments applies also to man, and that this drug has a favourable safety profile when taken in acute overdose.

[Findings in chronic use and acute overdose of Leponex]. / Befunde bei chronischer Einnahme und akuter Uberdosierung von Leponex.

Two fatal cases are represented in which the intake of the tricyclic neuroleptic drug with the active ingredient clozapine was involved. The chemical toxiological results are showed and in connection with the results of the autopsies and the case history discussed.

A carpipramine related fatality.

A fatality following ingestion of the tricyclic antidepressant carpipramine (Prazinil) and ethyl alcohol is described. Carpipramine was quantitated by high performance liquid chromatography. The concentration of carpipramine was 2.0 mg/L in blood and 0.44 mg/L in urine. Ethyl alcohol was measured by headspace gas chromatography and found to be 105 mg/dL in blood and 55 mg/dL in the urine. Quantitative analysis of stomach contents was positive for carpipramine by thin-layer chromatography. To our knowledge, this is the first reported fatality involving carpipramine.

Metapramine overdose: report of two cases and analytical determinations.

Two metapramine overdoses due to deliberate ingestion are described. The analytical procedures for the determination of metapramine in biological specimens have been reported.

[Acute voluntary carpipramine poisoning with ventricular tachycardia]. / Intoxication volontaire aiguë par la carpipramine avec tachycardie ventriculaire.

A case of carpipramine overdose is reported. The patient was admitted with ventricular tachycardia 4 h after taking 2.40 g of the drug. This disappeared at the sixth hour. In overdoses with other tricyclics, ventricular tachycardia was successfully treated within 30 min of starting a sodium lactate perfusion. In the case presented, reversal of the ventricular tachycardia coincided with the half-life of the drug; the effects of perfusing 1000 ml sodium lactate over 2 h seemed doubtful. This sodium resistance may be related to a relative hypokalemia (3.4 mmol X 1(-1) ). The use of sodium lactate for the treatment of overdoses with drugs with short-half lives appeared questionable.

Toxicological findings in a death resulting from the ingestion of trimipramine.

A fatality following ingestion of the tricyclic antidepressant trimipramine is presented. Whole blood concentrations of trimipramine and its metabolite N-desmethyltrimipramine were measured by gas-liquid chromatography and found to be 400 and 1130 ng/mL, respectively. These findings are compared to those of previous unpublished trimipramine fatalities and fatalities caused by other tricyclic antidepressants.

Convulsive attacks due to antidepressant drug overdoses: case reports and discussion.

Antidepressant drug overdoses have been reported to induce seizures, but the etiology of this phenomenon is still unclear. Recently we treated three patients who suffered from epileptic seizures after acute overdoses of three antidepressant drugs: (a) Dibenzepin HCl (Noveril), (b) Maprotiline HCl (Ludiomil), and (c) Clorimipramine (Anafranil). After a review of the pertinent literature, the possible role of antidepressant drugs in the genesis of epileptic seizures is discussed.

[Arrhythmias in poisoning with tricyclic antidepressive agents. Successful treatment with physostigmine and sodium]. / Arrhythmien bei Vergiftung durch trizyklische Antidepressiva. Erfolgreiche Behandlung mit Physostigmin und Natrium.

A 26-year-old female patient was admitted 30 minutes after suicidal poisoning with 750 mg amitriptyline (Saroten), 4800 mg dibenzepine (Noveril retard) and 2100 mg thioridazine (Melleril). Life threatening disturbances of cardiac rhythm occurred in addition to coma, pulmonary insufficiency requiring assisted ventilation, and hypotension. Physostigmine only caused temporary improvement and the arrhythmias only resolved completely after additional administration of NaCl.

[Possible malignant hyperthermia as reaction to an overdose of myotonolytic, antidepressive and sedative drugs (author's transl)]. / Fragliche maligne Hyperthermiekrise bei Medikamentenintoxikation.

A 51-year-old male patient with no history of musculo-skeletal or myopathic abnormalities, but suffering from manic-depressive psychosis, attempted suicide with an overdose of dolpersin hydrochloride (Mydocalm), dipenzepine hydrochloride (Noveril), meprobamate (Mepronox) and nitrazepam (Mogadon). He developed high fever, muscle rigidity, tachycardia, arrhythmias, hypotension and mottled cyanosis, symptoms well-known in persons with malignant hyperthermia, an autosomally inherited disease of skeletal muscle. There is also discussed the manifestation and the symptoms of an acute rhabdomyolysis. The diagnosis was confirmed by chemical pathological laboratory findings, including respiratory and metabolic acidosis, myoglobinaemia accompanied by myoglobin diuresis, and elevated creatine phosphokinase (CPK values up to 2790 U/l). Electron microscopic examination of muscle tissue revealed signs of myolysis and mitochondrial reactions with pleoconic hyperplasia. No inhalation anaesthetics or skeletal muscle relaxants, such as succinyl choline, were used in this case. Therefore, malignant hyperthermia might have been induced by a combination of drugs which were not known to induce this abnormal muscular reaction. However, the muscle relaxant effect of dolpersin hydrochloride may have acted as a possible inducer of the attack.