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An intoxication involving BRON and verapamil
1Division of Forensic Toxicology, Armed Forces Institute of Pathology, Washington, D.C. 20306-6000.
Journal of Analytical Toxicology
|October 1, 1993
Summary
A 19-year-old male died from multiple drug intoxication, confirmed by toxicologic analysis. The cause was suicide involving several prescription and over-the-counter medications.
Area of Science:
- Forensic Toxicology
- Clinical Toxicology
- Pharmacology
Background:
- Sudden, unexplained deaths necessitate comprehensive toxicological investigation.
- Over-the-counter (OTC) medications, especially when combined, can pose significant toxicity risks.
- Identifying specific drug combinations is crucial for determining cause of death.
Observation:
- Toxicologic analysis of blood, urine, and vitreous fluid was performed.
- Comprehensive drug screening identified multiple substances including chlorpheniramine, dihydrocodeine, methylephedrine, salicylate, and verapamil.
- The combination of chlorpheniramine, dihydrocodeine, and methylephedrine is found in a Japanese over-the-counter cold medication (BRON).
Findings:
- No ethanol or volatile substances were detected.
- Significant blood concentrations of identified drugs were quantified: chlorpheniramine (2.6 mg/L), dihydrocodeine (4.7 mg/L), methylephedrine (5.6 mg/L), salicylate (150 mg/L), and verapamil (6.0 mg/L).
- The cause of death was determined to be multiple drug intoxication.
Implications:
- Highlights the potential lethality of combined over-the-counter medications when misused.
- Underscores the importance of comprehensive toxicologic screening in unexplained deaths.
- This case emphasizes the need for awareness regarding the risks associated with certain multi-ingredient medications, particularly in suicide cases.