title: A case of sudden cardiac death following Domperidone self-medication.
abstract: The phenomenon of sudden cardiac death is usually related to the worsening of existing heart conditions leading to ventricular arrhythmia (VA). One of the well-known triggers of SCD is drug-induced prolongation of the QT interval, such as that caused by Domperidone (D). Despite its risk to prolong the QT interval and associated narrow therapeutic index, D is available as an over-the-counter (OTC) drug in many countries such as Italy, Ireland, Netherlands, China, South Africa, Mexico, New Zealand and Chile to treat gastroesophageal reflux and functional dyspepsia. The present paper reports a case of SCD that occurred some hours after D self-administration in a 47-year-old female subject with mitral valve prolapse, thus, predisposed to both VA and SCD. Despite the risks related to D administration, to the best of our knowledge, this particular issue has not been discussed in the medico-legal literature. For this reason, the forensic implications of D administration are discussed focusing on issues related to the self-administration as an OTC drug (as seen in this case), administration to incapacitated subjects, prescription to patients with contraindications and the off-label drug use of D at high and hazardous concentrations to stimulate lactation.
authors.affiliation: University of Verona, Department of Public Health and Community Medicine - Unit of Forensic Medicine, P.le L.A. Scuro 10, Verona, Italy. Electronic address: paolo.fais@yahoo.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fais
authors.affiliation: University of Verona, Department of Public Health and Community Medicine - Unit of Forensic Medicine, P.le L.A. Scuro 10, Verona, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Vermiglio
authors.affiliation: University of Verona, Department of Public Health and Community Medicine - Unit of Forensic Medicine, P.le L.A. Scuro 10, Verona, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Laposata
authors.affiliation: University of New Haven, Department of Forensic Science, 300 Boston Post Road, West Haven, CT 06516, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Lockwood
authors.affiliation: University of Verona, Department of Public Health and Community Medicine - Unit of Forensic Medicine, P.le L.A. Scuro 10, Verona, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Gottardo
authors.affiliation: University of Verona, Department of Public Health and Community Medicine - Unit of Forensic Medicine, P.le L.A. Scuro 10, Verona, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: De Leo
mesh_terms: D000437:Alcoholism / Q000150:complications; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004294:Domperidone / Q000009:adverse effects* / Q000097:blood; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects* / Q000097:blood; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000150:complications; D004366:Nonprescription Drugs; D012651:Self Medication / Q000009:adverse effects*
chemical_list: D005765:Gastrointestinal Agents; D004366:Nonprescription Drugs; D004294:Domperidone
keywords: Autopsy; Domperidone; Long QT; Sudden cardiac death