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Fatal atomoxetine overdose in Japan: a forensic autopsy case report
Akina Nara1, Chiho Yamada2, Yu Kozakai2
1Division of Legal Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai-shi, Miyagi, 983-8536, Japan. akina@tohoku-mpu.ac.jp.
International Journal of Legal Medicine
|November 23, 2025
Summary
This case report details a rare instance of fatal acute atomoxetine intoxication. High concentrations of atomoxetine in blood samples confirmed it as the primary cause of death.
Area of Science:
- Forensic Toxicology
- Pharmacology
Background:
- Atomoxetine is a widely prescribed medication for attention-deficit/hyperactivity disorder (ADHD) globally.
- Prescription in Japan began in 2009 for children and 2012 for adults.
- No prior forensic autopsy cases identified atomoxetine as the primary cause of acute intoxication death.
Purpose of the Study:
- To report the first forensic autopsy case of fatal acute atomoxetine intoxication.
- To present toxicological findings in a fatal overdose case.
Main Methods:
- Semi-quantitative screening of cardiac blood for multiple substances.
- Quantitative analysis of atomoxetine and bromazepam using ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS).
Main Results:
- Multiple prescribed medications were detected, including atomoxetine and bromazepam.
- Blood concentrations of atomoxetine (23.2-24.0 µg/mL) and bromazepam (0.71-0.78 µg/mL) exceeded therapeutic ranges.
- Acute atomoxetine intoxication was identified as the primary cause of death.
Conclusions:
- Fatal acute atomoxetine intoxication is a potential risk, even with prescribed use.
- Toxicological analysis is crucial for determining cause of death in complex overdose cases.
- Bromazepam was excluded as a direct contributing factor to the fatality.
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