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Mirtazapine fatal poisoning
Claudia Vignali1, Angelo Groppi1, Francesca Brandolini1
1Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy.
Forensic Science International
|May 25, 2017
Summary
Mirtazapine is generally safe, but a fatal case of self-poisoning occurred with very high blood levels. This highlights potential risks even when taken alone, emphasizing careful dosage in antidepressant therapy.
Area of Science:
- Pharmacology
- Toxicology
- Clinical Medicine
Background:
- Mirtazapine is a noradrenergic and specific serotoninergic antidepressant.
- It stimulates norepinephrine and serotonin release while blocking specific serotonin receptors.
- While widely used, fatal cases of mirtazapine alone are not well-documented, with most fatalities involving co-ingestion of other drugs.
Observation:
- This report details a rare fatal case of mirtazapine self-poisoning.
- The patient presented with extremely high blood mirtazapine concentrations (9.3 mg/L).
- Lorazepam, another detected drug, was within its therapeutic range, suggesting mirtazapine as the primary cause.
Findings:
- Liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis of body fluids and hair confirmed high mirtazapine levels.
- N-Desmethylmirtazapine, a metabolite, was also quantified.
- Comparison with existing literature indicates this case represents a significant mirtazapine overdose.
Implications:
- Mirtazapine, though relatively safe, can be lethal in large doses, even without other interacting substances.
- This case underscores the critical importance of monitoring mirtazapine dosage and patient adherence.
- Further research into the toxicology of high-dose mirtazapine is warranted.