title: Postmortem tissue distribution of atomoxetine following fatal and nonfatal doses--three case reports.
abstract: Atomoxetine (Strattera, Lilly) is a selective norepinephrine reuptake inhibitor (SNRI) prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults. It is the first nonstimulant drug-therapy option for ADHD. Three case reports are presented in which atomoxetine was detected in two individuals who died from causes unrelated to the drug and a third from the intentional ingestion of atomoxetine and other drugs. In addition, a brief description of the pharmacokinetics and side effects of atomoxetine are given. Postmortem fluid and tissue concentrations of atomoxetine were as follows: aortic blood, <0.1-8.3 mg/L; femoral blood, 0.33-5.4 mg/L; vitreous humor, 0.1-0.96 mg/L; bile, 1.0-33 g/L; urine, <0.1 mg/L; liver, <0.44-29 mg/kg; and gastric contents, 0.0097-16.8 mg total. Autopsy findings in the two cases in which death was not attributed to drug toxicity included arrhythmogenic right ventricular dysplasia and hypertrophic cardiomyopathy. The analytical method utilized was a modified basic drug, liquid-liquid procedure followed by gas chromatography/mass spectrometry and nitrogen phosphorous detection. Atomoxetine can be considered nontoxic at whole blood and liver concentrations below 1.3 mg/L and 5 mg/kg, respectively.
authors.affiliation: Office of the Chief Medical Examiner, Chapel Hill, NC 27599, USA. dgarside@ocme.unc.edu
authors.forename: Diana
authors.initials: D
authors.lastname: Garside
authors.forename: Jeri D
authors.initials: JD
authors.lastname: Ropero-Miller
authors.forename: Ellen C
authors.initials: EC
authors.lastname: Riemer
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000009:adverse effects / Q000737:chemistry / Q000493:pharmacokinetics*; D000328:Adult; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy; D002648:Child; D002849:Chromatography, Gas; D004347:Drug Interactions; D062787:Drug Overdose; D005260:Female; D006801:Humans; D008297:Male; D015394:Molecular Structure; D009638:Norepinephrine / Q000037:antagonists & inhibitors; D011180:Postmortem Changes; D011437:Propylamines / Q000009:adverse effects / Q000737:chemistry / Q000493:pharmacokinetics*; D013405:Suicide; D014018:Tissue Distribution
chemical_list: D018759:Adrenergic Uptake Inhibitors; D011437:Propylamines; D000069445:Atomoxetine Hydrochloride; D009638:Norepinephrine