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A nortriptyline death with unusually high tissue concentrations.

T P Rohrig1, R W Prouty

  • 1Office of the Chief Medical Examiner, Oklahoma City, Oklahoma 73117.

Journal of Analytical Toxicology
|September 1, 1989
PubMed
Summary

A man died from a nortriptyline overdose, with extremely high heart blood levels of 86.4 mg/L reported. This case highlights the potential toxicity of nortriptyline, even in non-therapeutic ranges.

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Area of Science:

  • Toxicology
  • Pharmacology
  • Clinical Medicine

Background:

  • Nortriptyline is a tricyclic antidepressant used to treat depression.
  • Overdose can lead to serious cardiovascular and neurological complications.
  • Therapeutic drug monitoring is crucial for managing toxicity.

Observation:

  • A 31-year-old male presented with a fatal suicidal overdose of nortriptyline.
  • An exceptionally high heart blood concentration of 86.4 mg/L was measured.
  • Femoral blood and tissue concentrations were also documented.

Findings:

  • The reported heart blood concentration significantly exceeds previously documented levels.
  • This concentration indicates massive nortriptyline absorption and distribution.
  • Corroboration with femoral blood and tissue data supports the systemic toxicity.

Implications:

  • This case underscores the severe cardiotoxic potential of nortriptyline at supratherapeutic levels.
  • It highlights the importance of considering high-level drug concentrations in overdose investigations.
  • Further research into nortriptyline pharmacokinetics and toxicodynamics in overdose is warranted.

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