Abstract

A fatality following ingestion of the tricyclic antidepressant clomipramine (Anafranil®), alprazolam (Xanax®), and ethyl alcohol is described. Clomipramine and N-desmethylclomipramine were quantitated by high performance liquid chromatography and alprazolam by gas liquid chromatography. Concentrations of clomipramine and N-desmethylclomipramine were: in blood—0.84 and 1.4 mg/L; in urine—0.56 and 0.62 mg/L. Alprazolam concentration in blood was 0.069 mg/L. Ethyl alcohol was measured by headspace gas chromatography and found to be 375, 385, and 435 mg/dL in blood, urine, and vitreous humor, respectively. These findings are compared to previous reports of clomipramine related fatalities and alprazolam toxicity combined with ethyl alcohol.

References

1.
Hoffbrand
,
B. I.
and
Birdwood
,
G. F. B.
, “
Biological Aspects of Clomipramine II
,”
Postgraduate Medical Journal
 0032-5473, Vol.
53
, Suppl.
4
,
08
1977
, pp.
124
-
130
.
2.
Traskman
,
L.
,
Asberg
,
M.
,
Bertilsson
,
L.
,
Cronholm
,
B.
,
Mellstrom
,
B.
,
Neckers
,
L.
,
Sjoqvist
,
F.
,
Thoren
,
P.
, and
Tybring
,
G.
, “
Plasma Levels of Clomipramine and Its Demethyl Metabolite During Treatment of Depression
,”
Clinical Pharmacology and Therapeutics
 0009-9236, Vol.
26
, No.
5
,
11
1977
, pp.
600
-
615
.
3.
Rickels
,
K.
, “
Recent Advances in Anxiolytic Therapy
,”
Journal of Clinical Psychiatry
 0160-6689, Vol.
42
, No.
1
,
01
1981
, pp.
40
-
43
.
4.
Feighner
,
J. P.
,
Aden
,
G. C.
,
Fabre
,
L. F.
,
Rickels
,
K.
, and
Smith
,
W. T.
, “
Comparison of Alprazolam, Imipramine and Placebo in the Treatment of Depression
,”
Journal of the American Medical Association
 0098-7484, Vol.
249
,
10
06
1983
, pp.
3057
-
3064
.
5.
Hebb
,
J. H.
,
Caplan
,
Y. H.
,
Crooks
,
C. R.
, and
Mergner
,
W. J.
, “
Blood and Tissue Concentrations of Tricyclic Antidepressant Drugs in Post Mortem Cases: Literature Survey and a Study of Forty Deaths
,”
Journal of Analytical Toxicology
 0146-4760, Vol.
6
, No.
5
, Sept./Oct. 1982, pp.
209
-
216
.
6.
Bailey
,
D. N.
and
Shaw
,
R. F.
, “
Tricyclic Antidepressants: Interpretation of Blood and Tissue Levels in Fatal Overdose
,”
Journal of Analytical Toxicology
 0146-4760, Vol.
3
, No.
2
, March/April 1979, pp.
43
-
46
.
7.
Spiker
,
D. G.
, “
The Toxicity of Tricyclic Antidepressants
,”
Communications in Psychopharmacology
, Vol.
2
,
05
1978
, pp.
419
-
427
.
8.
Rose
,
J. B.
, “
Tricyclic Antidepressant Toxicity
,”
Clinical Toxicology
 0009-9309, Vol.
11
, No.
4
,
04
1977
, pp.
391
-
402
.
9.
Stevenson
,
A. J.
and
LaDelpha
,
S.
, “
Tricyclic Antidepressants—An 18 Month Experience
,”
Bulletin of the International Association of Forensic Toxicologists
, Vol.
16
, No.
3
,
07
1982
, pp.
12
-
15
.
10.
Haggai
,
M. T.
and
Gutteridge
,
D. R.
, “
Two Cases of Clomipramine Hydrochloride (Anafranil) Poisoning
,”
Forensic Sciences
, Vol.
3
, No.
1
,
01
1974
, pp.
83
-
87
.
11.
Meatherall
,
R. C.
,
Guay
,
D. R. P.
, and
Chalmers
,
J. L.
, “
A Fatal Overdose with Clomipramine
,”
Journal of Analytical Toxicology
 0146-4760, Vol.
7
, No.
4
, July/Aug. 1983, pp.
168
-
171
.
12.
Davidow
,
B.
,
Petri
,
N. L.
, and
Quame
,
B.
, “
A Thin Layer Chromatographic Procedure for Detecting Drugs of Abuse
,”
American Journal of Clinical Pathology
 0002-9173, Vol.
50
, No.
6
,
12
1968
, pp.
714
-
719
.
13.
Higgins
,
G.
and
Leach
,
H.
, “
Screening Tests for Common Drugs
,” in
Isolation and Identification of Drugs in Pharmaceutical, Body Fluids and Post-Mortem Material
,
E. G. C.
Clarke
, Ed.,
The Pharmaceutical Press
,
London
,
1975
, p. 896.
14.
Moffatt
,
A. C.
, “
Alprazolam Case
,”
Toxilogic
, Vol.
8
,
12
1982
, p. 7.
15.
Machata
,
G.
, “
Determination of Alcohol in Blood by Gas Chromatography—Head Space Analysis
,”
Clinical Chemistry Newsletter
, Vol.
4
, No.
2
,
03
1972
, pp.
29
-
32
.
16.
National Psychopharmacology Laboratory Inc.
,
9401 Parkwest Blvd.
,
Knoxville, TN
,
1984
.
17.
Montgomery
,
S. A.
,
Montgomery
,
D. B.
,
McAulay
,
R.
,
Dawling
,
S.
, and
Braithwaite
,
R. A.
, “
Plasma Concentration of Clomipramine and N-Desmethylclomipramine and Clinical Response in Depressed Patients
,”
Postgraduate Medical Journal
 0032-5473, Vol.
56
, Suppl.
D
,
04
1980
, pp.
130
-
133
.
18.
Miller
,
M. B.
,
Fones
,
R. B.
,
Seldrup
,
J.
,
Beaumont
,
G.
, and
John
,
V.
, “
Relationships Between Clinical Response, Plasma Levels and Side Effects of Clomipramine (Anafranil) in General Practitioner Trials
,”
Journal of International Medical Research
 0300-0605, Vol.
5
, Suppl.,
06
1977
, pp.
108
-
118
.
19.
Broadhurst
,
A. D.
,
James
,
H. D.
,
Della Corte
,
L.
, and
Heeley
,
A. F.
, “
Clomipramine Plasma Level and Clinical Response
,”
Postgraduate Medical Journal
 0032-5473, Vol.
53
, Suppl.
4
,
08
1977
, pp.
139
-
145
.
20.
Baselt
,
R. C.
, “
Disposition of Toxic Drugs and Chemicals in Man
,” second ed.,
Biomedical Publications
,
Davis, CA
,
1982
, pp.
182
-
184
and
299
-
303
.
21.
McCormick
,
S. R.
,
Nielson
,
J.
, and
Jatlow
,
P.
, “
Quantification of Alprazolam in Serum or Plasma by Liquid Chromatography
,”
Clinical Chemistry
 0009-9147, Vol.
30
,
10
1984
, pp.
1652
-
1655
.
22.
Abernethy
,
D. R.
,
Greenblatt
,
D. J.
,
Divoll
,
N.
, and
Shader
,
R. J.
, “
Pharmacokinetics of Alprazolam
,”
Journal of Clinical Psychiatry
 0160-6689, Vol.
44
,
01
1983
, pp.
45
-
47
.
23.
Drug Experience Unit
,
Upjohn Company
,
Kalamazoo, MI
,
1985
.
24.
Ueki
,
S.
,
Watanabe
,
S.
,
Yamamoto
,
T.
,
Kataoka
,
Y.
,
Tazoe
,
N.
,
Shibata
,
S.
,
Ohta
,
H.
,
Kauahara
,
K.
,
Takano
,
M.
,
Suwandi
,
D.
,
Lee
,
S. C.
, and
Liow
,
S. X.
, “
Behavioral and Electroencephalographic Effects of Alprazolam and Its Metabolites
,”
Nippon-Yakurisaku Zasshi
, Vol.
77
,
05
1981
, pp.
483
-
509
.
This content is only available via PDF.
You do not currently have access to this content.