Fatal Intoxications Due to Administration of Isosorbide Tablets Contaminated with Pyrimethamine.
In January 2012, 664 cases of pyrimethamine toxicity and 151 deaths were reported among cardiac patients that had recently received free medicines from pharmacy of Punjab Institute of Cardiology, Lahore, Pakistan. These patients, ages ranged from 58 to 75 years, were prescribed simvastatin, clopidogrel, aspirin soluble, isosorbide mononitrate, and amlodipine. On examination of medications being given to them, it was found that a particular batch of isosorbide mononitrate tablets was contaminated with 50 mg pyrimethamine. Cardiac patients were taking isosorbide contaminated with pyrimethamine twice daily (100 mg pyrimethamine/day), whereas therapeutic dose of pyrimethamine for malaria is 25 mg/week. Postmortem urine, cardiac blood, and femoral blood specimens of three deceased males were submitted to author's laboratory for analysis. Postmortem toxicological analysis revealed that pyrimethamine concentration fell within the range of 1-10 μg/mL by liquid chromatography. Clinical, autopsy, histopathological, and toxicological findings strongly suggested toxicity due to pyrimethamine accumulation that resulted in deaths of these cardiac patients.
Forensic Toxicology Department, Punjab Forensic Science Agency, Thokar Niaz Baig, Multan Road, Lahore, Pakistan.
Muhammad
M
Imran
Forensic Toxicology Department, Punjab Forensic Science Agency, Thokar Niaz Baig, Multan Road, Lahore, Pakistan. humera.shafi@yahoo.com.
Humera
0000-0002-8997-9870
H
Shafi
Forensic Toxicology Department, Punjab Forensic Science Agency, Thokar Niaz Baig, Multan Road, Lahore, Pakistan.
Zahid
Z
Mahmood
Forensic Toxicology Department, Punjab Forensic Science Agency, Thokar Niaz Baig, Multan Road, Lahore, Pakistan.
Mohammad
M
Sarwar
Forensic Toxicology Department, Punjab Forensic Science Agency, Thokar Niaz Baig, Multan Road, Lahore, Pakistan.
Hafiz Faisal
HF
Usman
Forensic Toxicology Department, Punjab Forensic Science Agency, Thokar Niaz Baig, Multan Road, Lahore, Pakistan.
Mohammad Ashraf
MA
Tahir
Forensic Toxicology Department, Punjab Forensic Science Agency, Thokar Niaz Baig, Multan Road, Lahore, Pakistan.
Muhammad Zar
MZ
Ashiq
D000368:Aged; D000981:Antiprotozoal Agents / Q000506:poisoning*; D002853:Chromatography, Liquid; D004340:Drug Contamination; D006801:Humans; D007547:Isosorbide / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011739:Pyrimethamine / Q000506:poisoning*; D013607:Tablets
D000981:Antiprotozoal Agents; D013607:Tablets; D007547:Isosorbide; D011739:Pyrimethamine
accumulative effect; contamination; forensic science; isosorbide; pyrimethamine; toxicity