title: A fatality due to alprazolam intoxication.
abstract: Alprazolam is one of the most widely prescribed benzodiazepines in the United States. It is generally considered a safe and effective drug for the treatment of anxiety disorders and panic attacks. Few overdoses that are due to the sole ingestion of alprazolam have been reported. This paper documents a fatality due to alprazolam intoxication and describes the distribution of alprazolam and an active metabolite, alpha-hydroxyalprazolam, in tissues obtained at autopsy. Qualitative identification of the drugs was achieved by full-scan gas chromatography-mass spectrometry, and quantitative analysis was performed by high-performance liquid chromatography. High concentrations of alprazolam were found in all specimens analyzed, but the metabolite was detected only in subclavian blood, urine, bile, and liver. A postmortem heart blood alprazolam concentration of 2.1 mg/L is the highest reported in the literature to date.
authors.affiliation: Office of the Chief Medical Examiner, State of Maryland, Baltimore 21201, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Jenkins
authors.forename: B
authors.initials: B
authors.lastname: Levine
authors.forename: J L
authors.initials: JL
authors.lastname: Locke
authors.forename: J E
authors.initials: JE
authors.lastname: Smialek
mesh_terms: D000328:Adult; D000525:Alprazolam / Q000031:analogs & derivatives* / Q000032:analysis / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning* / Q000652:urine; D014151:Anti-Anxiety Agents / Q000032:analysis / Q000493:pharmacokinetics / Q000506:poisoning*; D001646:Bile / Q000378:metabolism; D002851:Chromatography, High Pressure Liquid; D062787:Drug Overdose / Q000175:diagnosis; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006321:Heart / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000378:metabolism; D008099:Liver / Q000187:drug effects / Q000378:metabolism; D009206:Myocardium / Q000378:metabolism; D013405:Suicide; D014018:Tissue Distribution; D014822:Vitreous Body / Q000187:drug effects / Q000378:metabolism
chemical_list: D014151:Anti-Anxiety Agents; C032318:alpha-hydroxyalprazolam; D000525:Alprazolam