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Deaths involving the benzodiazepine flunitrazepam
O H Drummer1, M L Syrjanen, S M Cordner
1Victorian Institute of Forensic Pathology, South Melbourne, Australia.
The American Journal of Forensic Medicine and Pathology
|September 1, 1993
Summary
Flunitrazepam can cause death, even without other drugs or disease. High levels of its metabolite, 7-aminoflunitrazepam, indicate usage and potential toxicity.
Area of Science:
- Forensic Toxicology
- Pharmacology
Background:
- Investigated eight deaths in Victoria linked to flunitrazepam.
- Focused on cases where flunitrazepam or flunitrazepam and ethanol were primary toxicological findings.
Observation:
- Autopsies revealed no significant pathology in any case.
- Consistently high concentrations of 7-aminoflunitrazepam, a flunitrazepam metabolite, were detected.
- Moderate flunitrazepam levels suggested postmortem metabolite production.
Findings:
- Four cases involved flunitrazepam alone; four involved flunitrazepam and ethanol (mean 1.6 g/L).
- Higher 7-aminoflunitrazepam levels (0.45 mg/L) were found in flunitrazepam-only cases compared to those with ethanol (0.16 mg/L).
- Deaths were attributed to flunitrazepam or flunitrazepam-ethanol toxicity.
Implications:
- 7-aminoflunitrazepam may serve as a crucial postmortem marker for flunitrazepam use.
- Flunitrazepam can be lethal independently or potentiated by ethanol.
- Highlights the potential for flunitrazepam toxicity in cases lacking other contributing factors.