title: Adverse events, toxicity and post-mortem data on duloxetine: case reports and literature survey.
abstract: Duloxetine, a dual acting norepinephrine serotonin reuptake inhibitor, is a relatively new pharmacologic agent utilized in the treatment of depression, as well as diabetic neuropathic pain, fibromyalgia, and female stress urinary incontinence. This expanding scope of usage will inevitably lead to its eventual appearance during routine post-mortem toxicologic assays. Currently there is a paucity of post-mortem toxicologic data concerning duloxetine. The current report provides six additional case reports of post-mortem duloxetine levels, along with a review of duloxetine's pharmacokinetics, and the toxicologic manifestations which have been reported in the literature. The post-mortem levels reported, including the highest level recorded to date, are integrated with previously published reports to generate a foundation for a nascent guide to the interpretation of post-mortem duloxetine levels that could be encountered during routine post-mortem toxicologic analyses, and establish a basis upon which the establishment of toxic and lethal thresholds for this compound can be further elucidated with greater clarity.
authors.affiliation: Erie County Coroner's Office, Erie, PA 16501, USA. padrdeat@velocity.net
authors.forename: Eric L
authors.initials: EL
authors.lastname: Vey
authors.forename: Inna
authors.initials: I
authors.lastname: Kovelman
mesh_terms: D000059:Accidents; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000032:analysis / Q000506:poisoning; D001682:Biological Availability; D003334:Coroners and Medical Examiners; D004359:Drug Therapy, Combination / Q000009:adverse effects; D000068736:Duloxetine Hydrochloride; D005260:Female; D005283:Fentanyl / Q000032:analysis / Q000506:poisoning; D053593:Forensic Toxicology; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000032:analysis / Q000493:pharmacokinetics / Q000506:poisoning; D013405:Suicide; D053719:Tandem Mass Spectrometry; D013876:Thiophenes / Q000009:adverse effects* / Q000032:analysis / Q000493:pharmacokinetics / Q000506:poisoning
chemical_list: D000701:Analgesics, Opioid; D000068736:Duloxetine Hydrochloride; D005283:Fentanyl; D017367:Selective Serotonin Reuptake Inhibitors; D013876:Thiophenes