title: Multidrug toxicity involving sumatriptan.
abstract: A multidrug fatality involving sumatriptan is reported. Sumatriptan is a tryptamine derivative that acts at 5-HT(1B/1D) receptors and is used for the treatment of migraines. The decedent was a 21-year-old white female found dead in bed by her spouse. No signs of physical trauma were observed and a large number of prescription medications were discovered at the scene. Toxicological analysis of the central blood revealed sumatriptan at a concentration of 1.03 mg/L. Following therapeutic dosing guidelines, sumatriptan concentrations do not exceed 0.095 mg/L. Sumatriptan was isolated by solid-phase extraction and analyzed using liquid chromatography-tandem mass spectrometry in multiple reaction monitoring mode. A tissue distribution study was completed with the following concentrations measured: 0.61 mg/L in femoral blood, 0.56 mg/L in iliac blood, 5.01 mg/L in urine, 0.51 mg/kg in liver, 3.66 mg/kg in kidney, 0.09 mg/kg in heart, 0.32 mg/kg in spleen, 0.01 mg/kg in brain, 15.99 mg/kg in lung and 78.54 mg/45 mL in the stomach contents. Carisoprodol, meprobamate, fluoxetine, doxylamine, orphenadrine, dextromethorphan and hydroxyzine were also present in the blood at the following concentrations: 3.35, 2.36, 0.63, 0.19, 0.06, 0.55 and 0.16 mg/L. The medical examiner ruled the cause of death as acute mixed drug toxicity and the manner of death as accident.
authors.affiliation: Division of Forensic Toxicology, Armed Forces Medical Examiner System, Dover AFB, Dover, DE 19902, USA jessica.l.knittel.ctr@mail.mil.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Knittel
authors.affiliation: Division of Forensic Toxicology, Armed Forces Medical Examiner System, Dover AFB, Dover, DE 19902, USA.
authors.forename: Shawn P
authors.initials: SP
authors.lastname: Vorce
authors.affiliation: Division of Forensic Toxicology, Armed Forces Medical Examiner System, Dover AFB, Dover, DE 19902, USA.
authors.forename: Barry
authors.initials: B
authors.lastname: Levine
authors.affiliation: Division of Forensic Toxicology, Armed Forces Medical Examiner System, Dover AFB, Dover, DE 19902, USA.
authors.forename: Rhome L
authors.initials: RL
authors.lastname: Hughes
authors.affiliation: Division of Forensic Toxicology, Armed Forces Medical Examiner System, Dover AFB, Dover, DE 19902, USA.
authors.forename: Thomas Z
authors.initials: TZ
authors.lastname: Bosy
mesh_terms: D001344:Autopsy; D002328:Carisoprodol / Q000097:blood; D002853:Chromatography, Liquid; D003915:Dextromethorphan / Q000097:blood; D004319:Doxylamine / Q000097:blood; D064420:Drug-Related Side Effects and Adverse Reactions / Q000097:blood*; D005069:Evaluation Studies as Topic; D017809:Fatal Outcome; D005260:Female; D005473:Fluoxetine / Q000097:blood; D053593:Forensic Toxicology; D006801:Humans; D006919:Hydroxyzine / Q000097:blood; D008099:Liver / Q000187:drug effects / Q000378:metabolism; D008620:Meprobamate / Q000097:blood; D009966:Orphenadrine / Q000097:blood; D015203:Reproducibility of Results; D013048:Specimen Handling; D018170:Sumatriptan / Q000493:pharmacokinetics / Q000506:poisoning*; D053719:Tandem Mass Spectrometry; D014018:Tissue Distribution; D055815:Young Adult
chemical_list: D005473:Fluoxetine; D002328:Carisoprodol; D006919:Hydroxyzine; D003915:Dextromethorphan; D018170:Sumatriptan; D004319:Doxylamine; D008620:Meprobamate; D009966:Orphenadrine