Post-mortem detection and identification of sildenafil (Viagra) and its metabolites by LC/MS and LC/MS/MS

The highly putrefied corpse of an 80-year-old man was found in the apartment which he had rented to a prostitute. A package of Viagra 25 was found beside the corpse and three tablets were missing. Autopsy revealed severe coronary artery sclerosis as well as signs of previous myocardial infarctions. For the detection and identification of sildenafil and three metabolites in urine and tissue samples, solid-phase extraction, LC/MS and MS/MS methods were developed. Blood was not available for toxicological analysis due to the putrefaction. For method development, urine from a volunteer who had ingested 25 mg sildenafil was collected over 8 h, and three metabolites were identified by MS/MS. These metabolites were also found in the victim's urine. These findings prove that sildenafil was taken some time prior to death, but the causality of sildenafil intake and fatal cardiac failure could not be proven, since no blood was available for analysis. However, the administration of sildenafil was contraindicated due to several previous myocardial infarctions.