title: An unusual multiple drug intoxication case involving citalopram.
abstract: A 47-year-old male with a history of drug abuse and suicide attempts was found dead at home. The death scene investigation showed evidence of cocaine abuse and multiple drug ingestion. Citralopram, a new selective serotonin reuptake inhibitor, cocaine, oxycodone, promethazine, propoxyphene, and norpropoxyphene were identified and quantitated in the postmortem samples by gas chromatography-mass spectrometry. The concentration of citalopram in the femoral blood was 0.88 mg/L. The heart blood concentration was 1.16 mg/L. Femoral blood concentrations of the other drugs were as follows: cocaine, 0.03 mg/L; oxycodone, 0.06 mg/L; promethazine, 0.02 mg/L; propoxyphene, 0.02 mg/L; and norpropoxyphene, 0.07 mg/L. Other tissue samples were also analyzed. The concentrations of cocaine, oxycodone, promethazine, and propoxyphene in the blood, liver, brain, and gastric contents did not suggest an intentional overdose. However, the possibility of multiple drug interactions including citalopram was evident. In this case, the citalopram concentrations were consistent with those reported in fatal cases involving multiple drug use. Citalopram was present in urine at a concentration of 0.9 mg/L.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Alabama at Birmingham, 35233-7331, USA.
authors.forename: K
authors.initials: K
authors.lastname: Fu
authors.forename: R J
authors.initials: RJ
authors.lastname: Konrad
authors.forename: R W
authors.initials: RW
authors.lastname: Hardy
authors.forename: R M
authors.initials: RM
authors.lastname: Brissie
authors.forename: C A
authors.initials: CA
authors.lastname: Robinson
mesh_terms: D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects* / Q000493:pharmacokinetics; D015283:Citalopram / Q000009:adverse effects* / Q000493:pharmacokinetics; D003042:Cocaine / Q000493:pharmacokinetics; D011431:Dextropropoxyphene / Q000493:pharmacokinetics; D004357:Drug Synergism; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D010098:Oxycodone / Q000493:pharmacokinetics; D011398:Promethazine / Q000493:pharmacokinetics; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000493:pharmacokinetics; D014018:Tissue Distribution
chemical_list: D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram; D003042:Cocaine; D011431:Dextropropoxyphene; D010098:Oxycodone; D011398:Promethazine; D017367:Selective Serotonin Reuptake Inhibitors