A mixed-drug intoxication involving venlafaxine and verapamil.
This case report describes the suicide of a 52-year-old woman whose cause of death was attributed to a mixed-drug intoxication involving venlafaxine and verapamil. Venlafaxine is prescribed for the treatment of depression and should be used with caution in patients with cardiovascular disease. Verapamil is a calcium channel blocker primarily used for treatment of cardiovascular disorders. The following drug concentrations were determined in postmortem fluids: verapamil--3.5 mg/L (femoral blood), 9.4 mg/L (subclavian blood), and 1.0 mg/L (vitreous fluid); norverapamil--1.0 mg/L (femoral blood), 2.1 mg/L (subclavian blood), and 0.20 mg/L (vitreous fluid); verapamil and norverapamil could not be detected in bile or urine due to the high levels of erythromycin present; venlafaxine--6.2 mg/L (femoral blood), 8.6 mg/L (subclavian blood), 5.3 mg/L (vitreous fluid), 54.0 mg/L (bile), and 72.3 mg/L (urine); and O-desmethylvenlafaxine--5.4 mg/L (femoral blood), 8.3 mg/L (subclavian blood), positive (vitreous fluid), 29.2 mg/L (bile), and 9.5 mg/L (urine). The cause of death was determined to be a mixed-drug intoxication resulting from an overdose of verapamil and venlafaxine. The manner of death was determined to be suicide.
Bexar County Medical Examiner's Office and Forensic Toxicology Laboratory, San Antonio, TX 78229-4565, USA.
G W
GW
Kunsman
C M
CM
Kunsman
C L
CL
Presses
J C
JC
Garavaglia
N J
NJ
Farley
D018687:Antidepressive Agents, Second-Generation / Q000506:poisoning*; D001344:Autopsy; D002121:Calcium Channel Blockers / Q000506:poisoning*; D002423:Cause of Death; D003511:Cyclohexanols / Q000506:poisoning*; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008875:Middle Aged; D013405:Suicide; D000069470:Venlafaxine Hydrochloride; D014700:Verapamil / Q000506:poisoning*
D018687:Antidepressive Agents, Second-Generation; D002121:Calcium Channel Blockers; D003511:Cyclohexanols; D000069470:Venlafaxine Hydrochloride; D014700:Verapamil