Fatal amlodypine overdose: forensic and clinical features - a systematic review.

Area of Science:

• Pharmacology
• Toxicology
• Forensic Medicine

Background:

• Amlodipine, a widely prescribed dihydropyridine calcium channel blocker for hypertension, presents challenges in fatal overdose scenarios.
• Fatal amlodipine overdoses are infrequently described, complicating post-mortem diagnosis and clinical management.
• Understanding the circumstances and diagnostic findings in fatal amlodipine overdose is crucial for forensic pathology.

Purpose of the Study:

• To analyze documented cases of fatal amlodipine overdose.
• To investigate the circumstances surrounding these events and the diagnostic methods employed.
• To identify key findings relevant to post-mortem diagnosis of amlodipine poisoning.

Main Methods:

• A comprehensive literature review was conducted using specific keywords and boolean operators.
• Included studies published between 1997 and 2024, focusing on cases of fatal amlodipine overdose.
• Data extraction focused on case circumstances, autopsy findings, and toxicological analyses.

Main Results:

• Seventeen cases were identified from 13 articles, predominantly from Europe, with an average age of 43.8 years.
• Most overdoses were suicidal, occurring at home; common autopsy findings included pulmonary congestion and edema.
• Blood was the most frequent sample for toxicological testing; no specific histopathological findings were noted beyond gross observations.

Conclusions:

• Fatal amlodipine overdose presents diagnostic challenges, with pulmonary findings being common but non-specific.
• The location where the body is found is an important factor in assessing fatal overdose cases.
• Further research is needed to improve post-mortem diagnostic capabilities for amlodipine poisoning, given its widespread availability.