title: Fatal cyclobenzaprine overdose with postmortem values.
abstract: There are only two published cases of overdose with postmortem blood cyclobenzaprine concentrations, both with confounding factors. We report two additional cases of fatal cyclobenzaprine overdose with postmortem values. Case 1: a 56-year-old female was found in full cardiopulmonary arrest after a verbal suicide threat to a friend. Postmortem blood concentrations were cyclobenzaprine 0.96 mg/L and diazepam 0.3 mg/L. Case 2: a 37-year-old male was found in full arrest by a family member after an intentional ingestion of cyclobenzaprine. Postmortem blood concentrations were cyclobenzaprine 0.8 mg/L and ethanol 0.174 gm/dL. The concentrations of diazepam and ethanol reported in these two patients were not found in quantities usually associated with a fatal outcome, suggesting that the cyclobenzaprine was the primary cause of the fatality. Additionally, the blood was drawn from a femoral site, so that postmortem redistribution is not a likely factor. Blood concentration of > or = 0.8 mg/L cyclobenzaprine may be associated with a fatal outcome.
authors.affiliation: Kentucky Regional Poison Control Center, Louisville, KY 40232-5070, USA. henry.spiller@nortonhealthcare.org
authors.forename: Henry A
authors.initials: HA
authors.lastname: Spiller
authors.forename: Letizia
authors.initials: L
authors.lastname: Cutino
mesh_terms: D000328:Adult; D000639:Amitriptyline / Q000031:analogs & derivatives / Q000097:blood / Q000737:chemistry / Q000506:poisoning*; D018712:Analgesics, Non-Narcotic / Q000097:blood / Q000737:chemistry / Q000506:poisoning*; D003975:Diazepam / Q000097:blood; D062787:Drug Overdose; D000431:Ethanol / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015394:Molecular Structure; D009125:Muscle Relaxants, Central / Q000097:blood; D013405:Suicide
chemical_list: D018712:Analgesics, Non-Narcotic; D009125:Muscle Relaxants, Central; D000639:Amitriptyline; D000431:Ethanol; C004704:cyclobenzaprine; D003975:Diazepam