title: Carisoprodol intoxications: a retrospective study of forensic autopsy material from 1992-2003.
abstract: Carisoprodol is commonly prescribed as a centrally acting muscle relaxant, but it is also subject to abuse. The literature describing fatal intoxications with the drug is limited to a relatively small number of cases, and there are inconsistencies with regard to which concentration levels that are toxic. We therefore investigated all forensic autopsies at the Norwegian Institute of Public Health during the period 1992-2003 where carisoprodol was detected. The median concentrations of carisoprodol in intoxication with carisoprodol only or with only minor other analytical findings was 36 mg/l (range 8-65 mg/l; n=5). In the rest of the intoxications, the relevance of carisoprodol relative to the other drugs detected was variable (n=93). When the number of intoxications with carisoprodol each year were divided by the number of defined daily doses (DDD) sold, a fatal toxicity index between 5.6 and 6.9 deaths/1 million DDD was obtained. The total number of cases where carisoprodol was detected increased during the period studied, which correlated to sales figures for the drug. We conclude that carisoprodol can be fatal in concentrations below those indicated in some of the previously published literature. There were, however, only a small number of cases where the cause of death can be attributed to use of carisoprodol alone.
authors.affiliation: Division of Forensic Toxicology and Drug Abuse, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, 0403 Oslo, Norway. gugu@fhi.no
authors.forename: Gudrun
authors.initials: G
authors.lastname: Høiseth
authors.forename: Jørgen G
authors.initials: JG
authors.lastname: Bramness
authors.forename: Asbjørg S
authors.initials: AS
authors.lastname: Christophersen
authors.forename: Jørg
authors.initials: J
authors.lastname: Mørland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002328:Carisoprodol / Q000032:analysis / Q000506:poisoning*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D053593:Forensic Toxicology; D006801:Humans; D008297:Male; D008620:Meprobamate / Q000032:analysis / Q000506:poisoning; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000032:analysis / Q000506:poisoning*; D011041:Poisoning / Q000401:mortality; D012189:Retrospective Studies; D015813:Substance Abuse Detection; D013405:Suicide
chemical_list: D009125:Muscle Relaxants, Central; D002328:Carisoprodol; D008620:Meprobamate