title: An acute gabapentin fatality: a case report with postmortem concentrations.
abstract: Gabapentin (GBP) (Neurontin®, Horizant®, Gralise®) is a widely prescribed medication used primarily for the treatment of epilepsy and neuropathic pain. GBP has a favorable adverse effect profile in therapeutic dosing with the most common reported effects being dizziness, fatigue, drowsiness, weight gain, and peripheral edema. Even with intentional GBP self-poisonings, serious effects are rare. A 47-year-old female was found dead at work with her daughter's bottle of GBP 600 mg. There were 26 tablets missing and the decedent's only known medication was hydrocodone/acetaminophen. Following initial detection by an alkaline drug screen (GC-MS), analysis utilizing specific liquid chromatography-mass spectrometry revealed an elevated postmortem GBP peripheral blood concentration of 37 mg/L, central blood 32 mg/L, liver 26 mg/kg, vitreous 32 mg/L, and gastric contents 6 mg. Screening for volatiles, drugs of abuse, alkaline compounds, and acid/neutral compounds was negative with the exception of ibuprofen (<2 mg/L) detected in peripheral blood. This report presents a fatality that appears to be associated with an isolated and acute GBP ingestion.
authors.affiliation: California Poison Control System, San Diego Division, 200 W. Arbor Dr., San Diego, CA, 92103-8925, USA, lcantrell@calpoison.org.
authors.forename: F Lee
authors.initials: FL
authors.lastname: Cantrell
authors.forename: Othon
authors.initials: O
authors.lastname: Mena
authors.forename: Ray D
authors.initials: RD
authors.lastname: Gary
authors.forename: Iain M
authors.initials: IM
authors.lastname: McIntyre
mesh_terms: D000588:Amines / Q000032:analysis / Q000506:poisoning*; D000700:Analgesics / Q000032:analysis / Q000506:poisoning*; D002318:Cardiovascular Diseases; D002853:Chromatography, Liquid; D003509:Cyclohexanecarboxylic Acids / Q000032:analysis / Q000506:poisoning*; D005260:Female; D000077206:Gabapentin; D008401:Gas Chromatography-Mass Spectrometry; D005766:Gastrointestinal Contents / Q000737:chemistry; D006801:Humans; D008099:Liver / Q000737:chemistry; D008875:Middle Aged; D009765:Obesity; D014822:Vitreous Body / Q000737:chemistry; D005680:gamma-Aminobutyric Acid / Q000032:analysis / Q000506:poisoning*
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin