A tapentadol related fatality: Case report with postmortem concentrations.

Area of Science:

• Forensic Toxicology
• Pharmacology
• Clinical Chemistry

Background:

• Tapentadol (TAP) is an effective analgesic with a dual mechanism of action: mu-opioid receptor agonism and norepinephrine reuptake inhibition.
• While TAP is prescribed for pain management, fatalities associated with its use have been documented.
• There is limited published data on tapentadol concentrations in biological samples from fatal cases.

Observation:

• A 41-year-old female was found deceased, with autopsy findings including pulmonary edema and aspiration pneumonia.
• Postmortem analysis detected tapentadol in peripheral blood (1.1 mg/L), central blood (1.3 mg/L), liver (9.9 mg/kg), vitreous humor (0.94 mg/L), urine (88 mg/L), and gastric contents (2 mg).
• Oxycodone was also detected in the decedent's blood at a concentration of 0.58 mg/L.

Findings:

• The cause of death was determined to be mixed drug intoxication, specifically from the intentional ingestion of tapentadol and oxycodone.
• This case provides crucial postmortem concentration data for tapentadol across multiple biological matrices.
• The reported concentrations serve as valuable reference points for future forensic investigations of tapentadol toxicity.

Implications:

• This study highlights the importance of comprehensive toxicological analysis in cases of suspected drug-related fatalities.
• The documented tapentadol concentrations can assist forensic toxicologists in interpreting findings and determining cause of death.
• Understanding the toxicological profile of tapentadol in fatal cases is essential for public health and clinical practice.