title: Fatal moclobemide overdose or death caused by serotonin syndrome?
abstract: A 41-year-old man was found dead in a hotel room. He was previously diagnosed with depression. Multiple containers of medication and paraphenalia were found at the scene. Autopsy findings included fully developed rigor mortis and pulmonary edema with hemorrhage. Toxicologic analysis of different body fluids was performed and the following drugs were identified in the blood (mg/L): moclobemide (59.76), clomipramine (1.69), tramadol (10.89), diazepam (2.08), nordiazepam (0.82) and caffeine (9.64). A fatal serotonin syndrome was presumably developed as a result of moclobemide-clomipramine interaction as has been recently reported. Tramadol could have a synergistic effect on that syndrome. The forensic pathologists ruled that the cause of death was multiple drug intoxication resulting in serotonin syndrome and that the manner of death was suicide. However, an accidental death from drug abuse could be an alternative diagnosis.
authors.affiliation: Department of Legal Medicine and Toxicology Service, University of Granada, Spain.
authors.forename: A F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: M N
authors.initials: MN
authors.lastname: Montero
authors.forename: A
authors.initials: A
authors.lastname: Pla
authors.forename: E
authors.initials: E
authors.lastname: Villanueva
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000506:poisoning*; D001549:Benzamides / Q000506:poisoning*; D002423:Cause of Death; D002997:Clomipramine / Q000506:poisoning; D004347:Drug Interactions; D062787:Drug Overdose / Q000473:pathology*; D006801:Humans; D008297:Male; D020912:Moclobemide; D008996:Monoamine Oxidase Inhibitors / Q000506:poisoning*; D011619:Psychotropic Drugs / Q000506:poisoning; D012701:Serotonin / Q000097:blood*; D013405:Suicide / Q000331:legislation & jurisprudence*; D013577:Syndrome
chemical_list: D000928:Antidepressive Agents; D001549:Benzamides; D008996:Monoamine Oxidase Inhibitors; D011619:Psychotropic Drugs; D012701:Serotonin; D002997:Clomipramine; D020912:Moclobemide