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.
Kunsman
G W
GW
Bexar County Medical Examiner's Office and Forensic Toxicology Laboratory, San Antonio, TX 78229-4565, USA.
Kunsman
C M
CM
Presses
C L
CL
Garavaglia
J C
JC
Farley
N J
NJ
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