title: Determining the Toxicological Significance of Pregabalin in Fatalities.
abstract: Pregabalin has become more widely prescribed and abused in recent years but is still not always included in laboratory analysis. An LC-MS-MS method has been developed and applied to measure pregabalin in 93 postmortem cases, including drug-related deaths, alternative causes of death, and fatalities where pregabalin was likely to have contributed to death. Other drugs or alcohol was detected, and the most common drug types (in decreasing frequency) were antidepressants, opioids, benzodiazepines, opiates, alcohol, antipsychotics, cocaine, cardiac drugs, amphetamines, cannabis, anticonvulsants, and antihistamines. New psychoactive substances (methoxphenidine and synthetic cannabinoids) were only found in two cases. The results provide further data to assist in evaluating the significance of postmortem pregabalin concentrations and a toxicologically significant concentration of 25 mg/L is proposed. Pregabalin, especially with concomitant use of other CNS depressant drugs, presents a significant toxicological risk and existing laboratory protocols should be reviewed for their suitability to detect pregabalin.
authors.affiliation: Alere Forensics, Malvern Hills Science Park, Geraldine Road, Malvern, Worcestershire, WR14 3SZ, U.K.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Elliott
authors.affiliation: Alere Forensics, Malvern Hills Science Park, Geraldine Road, Malvern, Worcestershire, WR14 3SZ, U.K.
authors.forename: Timothy
authors.initials: T
authors.lastname: Burke
authors.affiliation: Alere Forensics, Malvern Hills Science Park, Geraldine Road, Malvern, Worcestershire, WR14 3SZ, U.K.
authors.forename: Christopher
authors.initials: C
authors.lastname: Smith
mesh_terms: D014151:Anti-Anxiety Agents / Q000097:blood*; D002853:Chromatography, Liquid; D053593:Forensic Toxicology; D006801:Humans; D013058:Mass Spectrometry; D009294:Narcotics / Q000097:blood; D004364:Pharmaceutical Preparations / Q000097:blood; D000069583:Pregabalin / Q000097:blood*; D019966:Substance-Related Disorders / Q000097:blood
chemical_list: D014151:Anti-Anxiety Agents; D009294:Narcotics; D004364:Pharmaceutical Preparations; D000069583:Pregabalin
keywords: casework; fatalities; forensic science; forensic toxicology; liquid chromatography-mass spectrometry; poly-drug use; postmortem; pregabalin