Distribution of paroxetine in three postmortem cases

Paroxetine (Paxil) is a selective serotonin reuptake inhibitor, one of a new class of antidepressants used in the treatment of obsessive-compulsive disorder, panic disorder, and depression. Paroxetine potentiates serotonergic activity through the selective inhibition of serotonin reuptake in the central nervous system. There are few reported overdoses in the literature, and of these, three were fatal. Three coroner's cases in which paroxetine was directly associated with the cause of death are reported. In case #1, paroxetine was the only drug detected in significant concentrations. The heart blood paroxetine concentration was 4.0 mg/L. Case #2 was a known suicide in which the decedent herself admitted taking pills and alcohol. The hospital blood sample drawn at admission was analyzed and contained a 0.25% ethanol level and no paroxetine. Death occurred 10 h later. The postmortem heart blood contained ethanol at 0.06%, paroxetine at 3.7 mg/L, fluoxetine at 0.86 mg/L, and norfluoxetine at 0.65 mg/L. In case #3, death was attributed to an apparent adverse drug interaction between paroxetine and imipramine/desipramine. The postmortem heart blood contained paroxetine at 1.4 mg/L, imipramine at 3.0 mg/L, and desipramine at 9.6 mg/L.