title: Deaths involving the benzodiazepine flunitrazepam.
abstract: A study of eight deaths involving the benzodiazepine flunitrazepam was performed to assess the contribution of this drug to the fatalities. Coronial deaths in Victoria in the 2-year period to mid-1991 were selected in which either flunitrazepam or flunitrazepam and ethanol were the principal toxicological findings. All bodies were subject to a full autopsy by forensic pathologists, and a full toxicological examination. No significant pathology was found at autopsy in any case. Very high concentrations of 7-aminoflunitrazepam, a metabolite of flunitrazepam, were present in all cases. In four cases no other significant drug was detected, whereas in the other four cases there were significant concentrations of ethanol (mean 1.6 g/L). In these two groups of cases the concentrations of 7-aminoflunitrazepam were 0.45 mg/L and 0.16 mg/L, respectively. Only moderate levels of flunitrazepam were detected, suggesting that 7-aminoflunitrazepam is produced postmortem and may be an important marker of flunitrazepam usage. The causes of death in these eight cases were probably either flunitrazepam toxicity or a combination of flunitrazepam and ethanol toxicity. Only one case appeared likely to have been a suicide. Our observations in these cases suggest that flunitrazepam may cause death in the absence of other drugs or significant disease. The presence of ethanol reduces the amount of flunitrazepam needed to cause death.
authors.affiliation: Victorian Institute of Forensic Pathology, South Melbourne, Australia.
authors.forename: O H
authors.initials: OH
authors.lastname: Drummer
authors.forename: M L
authors.initials: ML
authors.lastname: Syrjanen
authors.forename: S M
authors.initials: SM
authors.lastname: Cordner
mesh_terms: D000328:Adult; D000368:Aged; D002851:Chromatography, High Pressure Liquid; D062787:Drug Overdose; D005260:Female; D005445:Flunitrazepam / Q000097:blood / Q000506:poisoning*; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D005445:Flunitrazepam