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A cyproheptadine fatality
B Levine1, D Green-Johnson, S Hogan
1Office of the Chief Medical Examiner, Baltimore, Maryland 21201, USA.
Insights
A man died from combined ethanol and cyproheptadine intoxication. Autopsy revealed no anatomical cause, but high levels of both substances in blood indicated toxicity.
Area of Science:
- Toxicology
- Forensic Pathology
Background:
- Ethanol (alcohol) is a common cause of intoxication.
- Cyproheptadine is an antihistamine and serotonin antagonist with potential toxicity at high doses.
Observation:
- A 28-year-old male was found deceased with no apparent anatomical cause of death.
- Blood ethanol concentration was 0.09 g/dL.
- Cyproheptadine was detected in heart blood at 0.46 mg/L, significantly above therapeutic levels.
Findings:
- The combined presence of ethanol and a high concentration of cyproheptadine was identified as the cause of death.
- Literature review confirmed that therapeutic cyproheptadine use results in only trace amounts in blood.
Implications:
- This case highlights the potential for fatal drug interactions and overdoses, even with prescribed medications.
- Accurate toxicological analysis is crucial in undetermined death investigations.
Abstract:
A 28-year-old man was found dead by his girlfriend. No anatomic cause of death was identified at autopsy. The heart-blood ethanol concentration was 0.09 g/dL. Comprehensive testing for abused and therapeutic drugs in the blood and urine identified cyproheptadine, a serotonin and histamine antagonist. This was one of the medications prescribed for the girlfriend, who admitted that several tablets were missing from the vial. The heart blood contained 0.46 mg/L of cyproheptadine. A review of the literature indicated that only trace amounts of parent drug are identified in the blood following therapeutic use of cyproheptadine. Therefore, the medical examiner concluded that the cause of death in this case was ethanol and cyproheptadine intoxication.