HPLC-DAD and HPLC-MS findings in fatality involving (Z)-cis-clopenthixol (zuclopenthixol)

A fatality that was due to massive ingestion of the thioxanthene neuroleptic (Z)-cis-clopenthixol (zuclopenthixol, Z-CPT) is described. The total toxicological screening and the quantitation of both the ingested drugs and its inactive isomer (E)-trans-clopenthixol (E-CPT, produced by in vivo isomerization) in postmortem fluids and viscerae were produced by high-performance liquid chromatography (HPLC)-diode array detection. Drug confirmation was carried out by HPLC-mass spectrometry with an ionspray interface. Although death occurred 40 h after the drug intake, postmortem blood concentrations were 391 and 275 mg/mL for Z-CPT and E-CPT, respectively (50 to 100 times the usual therapeutic values). The cause of death was suicide, and the manner was acute neuroleptic overdosage.