title: Death related to consumption of Rauvolfia sp. powder mislabeled as Tabernanthe iboga.
abstract: Powdered roots of iboga (Tabernanthe iboga) contain ibogaine, an alkaloid that has been used to treat addictions. We report the case of a 30-year-old woman who died after ingesting a powder labeled as Tabernanthe iboga she had bought online. Analysis of the powder revealed the absence of ibogaine but the presence of toxic alkaloids (ajmaline, yohimbine and reserpine) found in Rauvolfia sp. plant species. An original and specific LC-MS/MS method developed to quantify ajmaline, yohimbine and reserpine showed respective concentrations of 109.1ng/mL, 98.2ng/mL and 30.8ng/mL in blood, and 1528.2ng/mL, 914.2ng/mL and 561.2ng/mL in bile. Moreover, systematic toxicological analyses of biological samples showed the presence of oxazepam at therapeutic concentration and cannabinoids. Death could be attributed to ingestion of a substantial quantity of crushed roots of Rauvolfia in association with concomitant drug withdrawal.
authors.affiliation: Rennes University Hospital, Forensic and Toxicology Laboratory, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France; INSERM, UMR 991, University of Rennes 1, 2, avenue du Professeur Léon Bernard, 35043 Rennes Cedex, France. Electronic address: thomas.gicquel@chu-rennes.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gicquel
authors.affiliation: Rennes University Hospital, Department of Forensic Medicine, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Hugbart
authors.affiliation: PNSCM, CNRS, UMR 6226, Rennes Institute of Chemical Sciences (ISCR), University of Rennes 1, 35043 Rennes, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Le Devehat
authors.affiliation: Rennes University Hospital, Forensic and Toxicology Laboratory, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Lepage
authors.affiliation: Rennes University Hospital, Department of Forensic Medicine, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Baert
authors.affiliation: Rennes University Hospital, Department of Forensic Medicine, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France; University of Rennes 1, Faculty of Medicine, 2, avenue du Professeur Léon Bernard, 35043 Rennes Cedex, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Bouvet
authors.affiliation: Rennes University Hospital, Forensic and Toxicology Laboratory, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France; INSERM, UMR 991, University of Rennes 1, 2, avenue du Professeur Léon Bernard, 35043 Rennes Cedex, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Morel
mesh_terms: D000328:Adult; D002853:Chromatography, Liquid; D005260:Female; D053593:Forensic Toxicology; D006801:Humans; D011208:Powders; D011356:Product Labeling; D011926:Rauwolfia / Q000506:poisoning*; D046948:Secologanin Tryptamine Alkaloids / Q000302:isolation & purification / Q000506:poisoning*; D053719:Tandem Mass Spectrometry
chemical_list: D011208:Powders; D046948:Secologanin Tryptamine Alkaloids
keywords: Ajmaline; Poisoning; Rauvolfia; Reserpine; Yohimbine; iboga