title: Postmortem distribution of tapentadol and N-desmethyltapentadol.
abstract: Postmortem distribution concentrations of the pain medication tapentadol and its metabolite N-desmethyltapentadol are reported. Tapentadol (Nucynta®) is a synthetic mu-opioid receptor agonist that also has norepinephrine reuptake inhibitor action. The laboratory received two cases. Case 1: a 19-year-old, morbidly obese male with sudden unexpected death. Toxicology results revealed tapentadol (femoral blood: 0.77 mg/L, liver: 1.65 mg/kg), N-desmethyltapentadol (femoral blood: 0.07 mg/L, liver: 0.19 mg/kg), diazepam (femoral blood: 0.04 mg/L), nordiazepam (femoral blood: 0.06 mg/L) and amiodarone (femoral blood: 5.30 mg/L). Case 2: a 60-year-old female who died from complications following hip replacement. Only tapentadol (femoral blood: 0.26 mg/L, liver: 0.52 mg/kg) was found in the toxicology results. Quantitative results of tapentadol/N-desmethyltapentadol were achieved using liquid chromatography-tandem mass spectrometry in multiple reactions monitoring mode. This is the first known distribution study of tapentadol and N-desmethyltapentadol values in postmortem cases.
authors.affiliation: Office of the Chief Medical Examiner, District of Columbia, 1910 Massachusetts Avenue, S.E., Bldg. 27, Washington, D.C., USA. scott.larson@dc.gov
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Larson
authors.forename: Joseph
authors.initials: J
authors.lastname: Pestaner
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Prashar
authors.forename: Ciena
authors.initials: C
authors.lastname: Bayard
authors.forename: Lucas W
authors.initials: LW
authors.lastname: Zarwell
authors.forename: Marie
authors.initials: M
authors.lastname: Pierre-Louis
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000032:analysis* / Q000097:blood / Q000493:pharmacokinetics; D001711:Biotransformation; D005260:Female; D006801:Humans; D008099:Liver / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D014179:Neurotransmitter Uptake Inhibitors / Q000032:analysis* / Q000097:blood / Q000493:pharmacokinetics; D010636:Phenols / Q000032:analysis* / Q000097:blood / Q000493:pharmacokinetics; D017450:Receptors, Opioid, mu / Q000819:agonists*; D000077432:Tapentadol; D014018:Tissue Distribution; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; C568350:N-desmethyltapentadol; D014179:Neurotransmitter Uptake Inhibitors; D010636:Phenols; D017450:Receptors, Opioid, mu; D000077432:Tapentadol