title: A tapentadol related fatality: Case report with postmortem concentrations.
abstract: Tapentadol (TAP) is an analgesic agent indicated for the management of different types of pain. It has a novel mechanism of action in that it induces analgesia via both μ-opioid receptor agonism and norepinephrine reuptake inhibition. Although deaths associated with TAP use have been reported, there is a paucity of published literature regarding TAP concentrations in biological samples obtained from TAP-associated fatalities. We report a case of TAP toxicity resulting in death with postmortem peripheral and central blood concentrations, liver, vitreous, urine, and gastric contents. A 41-year-old female was found slumped over a sink at home following a welfare check by police. She was transported to a local hospital where she was pronounced dead despite all resuscitative measures. The autopsy was remarkable only for pulmonary edema and signs of aspiration pneumonia. Postmortem concentrations of TAP were confirmed in peripheral blood at 1.1mg/L, central blood 1.3mg/L, liver 9.9mg/kg, vitreous humor 0.94mg/L, urine 88mg/L, and the gastric contained 2mg. Also of note, oxycodone was found in the decedent's blood at a concentration of 0.58mg/L. We report a death related to an intentional ingestion of TAP and oxycodone-the cause and manner of death were determined to be mixed drug intoxication; suicide. We hope that the variety of TAP concentrations identified in this case provide valuable points of reference for future cases of TAP intoxication.
authors: California Poison Control System, San Diego Division, Clinical Pharmacy, University of California, San Francisco, 200 W. Arbor Dr., San Diego, CA 92103-8925, USA. Electronic address: lcantrell@calpoison.org.
authors: F Lee
authors: FL
authors: Cantrell
authors: County of San Diego Medical Examiner's Department, 5570 Overland Ave., Suite 101, San Diego, CA 92123, USA.
authors: Phyllis
authors: P
authors: Mallett
authors: County of San Diego Medical Examiner's Department, 5570 Overland Ave., Suite 101, San Diego, CA 92123, USA.
authors: Lenore
authors: L
authors: Aldridge
authors: County of San Diego Medical Examiner's Department, 5570 Overland Ave., Suite 101, San Diego, CA 92123, USA.
authors: Kimi
authors: K
authors: Verilhac
authors: County of San Diego Medical Examiner's Department, 5570 Overland Ave., Suite 101, San Diego, CA 92123, USA.
authors: Iain M
authors: IM
authors: McIntyre
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000032:analysis / Q000506:poisoning*; D005260:Female; D005766:Gastrointestinal Contents / Q000737:chemistry; D006801:Humans; D008099:Liver / Q000737:chemistry; D010098:Oxycodone / Q000097:blood / Q000506:poisoning; D010636:Phenols / Q000032:analysis / Q000506:poisoning*; D013405:Suicide; D000077432:Tapentadol; D014822:Vitreous Body / Q000737:chemistry
chemical_list: D000701:Analgesics, Opioid; D010636:Phenols; D010098:Oxycodone; D000077432:Tapentadol
keywords: Fatality; Liver; Postmortem blood; Postmortem redistribution; Tapentadol