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A fatality involving clomipramine.

A D Fraser, A F Isner, M A Moss

    Journal of Forensic Sciences
    |April 1, 1986
    PubMed
    Summary
    This summary is machine-generated.

    This case report details a fatality involving clomipramine (Anafranil), alprazolam (Xanax), and high levels of ethyl alcohol. The combined toxicity of these substances likely contributed to the fatal outcome.

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    Area of Science:

    • Forensic Toxicology
    • Clinical Pharmacology

    Background:

    • Tricyclic antidepressants like clomipramine can be lethal, especially when combined with other central nervous system depressants.
    • Alprazolam, a benzodiazepine, potentiates central nervous system depression.
    • Ethyl alcohol is a common co-ingestant in overdose cases, significantly increasing toxicity.

    Observation:

    • A fatality occurred following the ingestion of clomipramine, alprazolam, and ethyl alcohol.
    • Quantification revealed significant blood concentrations of clomipramine (0.84 mg/L), N-desmethylclomipramine (1.4 mg/L), and alprazolam (0.069 mg/L).
    • Elevated ethyl alcohol levels were measured in blood (375 mg/dL), urine (385 mg/dL), and vitreous humor (435 mg/dL).

    Findings:

    • High-performance liquid chromatography and gas liquid chromatography were used for accurate drug quantitation.

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  • Headspace gas chromatography confirmed substantial ethyl alcohol levels.
  • The measured concentrations suggest a significant contribution of all three substances to the fatal event.

    • Implications:

    • This case highlights the severe risks associated with polydrug use, particularly the combination of clomipramine, alprazolam, and alcohol.
    • It underscores the importance of comprehensive toxicological screening in post-mortem investigations.
    • Findings contribute to understanding the synergistic toxicity of these commonly abused substances.