Postmortem Tissue Distribution of Olanzapine and Citalopram in a Drug Intoxication

A 40-year-old white male was found dead in bed in a group home for mentally ill adults. The decedent had been diagnosed a paranoid schizophrenic. An autopsy was performed at the Office of the Cuyahoga County Coroner in Cleveland, Ohio. Toxicological testing detected olanzapine and citalopram in post...

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Published in:	Journal of forensic sciences Vol. 50; no. 3; pp. 1 - 3
Main Authors:	Horak, EL, Jenkins, AJ
Format:	Journal Article
Language:	English
Published:	United States Wiley Subscription Services, Inc 01-05-2005
Subjects:	Adult Antidepressive Agents, Second-Generation - administration & dosage Antidepressive Agents, Second-Generation - pharmacokinetics Antidepressive Agents, Second-Generation - poisoning Antipsychotic Agents - administration & dosage Antipsychotic Agents - pharmacokinetics Antipsychotic Agents - poisoning Autopsy Benzodiazepines - administration & dosage Benzodiazepines - pharmacokinetics Benzodiazepines - poisoning Citalopram - administration & dosage Citalopram - pharmacokinetics Citalopram - poisoning Drug Overdose - diagnosis Drug Overdose - pathology Forensic pathology Humans Male Postmortem Changes Prescription drugs Schizophrenia, Paranoid Tissue Distribution Tissues Toxicology forensic science olanzapine postmortem citalopram
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Abstract	A 40-year-old white male was found dead in bed in a group home for mentally ill adults. The decedent had been diagnosed a paranoid schizophrenic. An autopsy was performed at the Office of the Cuyahoga County Coroner in Cleveland, Ohio. Toxicological testing detected olanzapine and citalopram in post mortem specimens. Multiple fluids and tissues were assayed by liquid-liquid extraction followed by gas chromatography with nitrogen phosphorus detection, and qualitative confirmation by electron impact gas chromatography/mass spectrometry. Drug concentrations [olanzapine : citalopram; mg/L or mg/Kg] determined in this case are the highest reported to date involving these drugs- 1.38:3.35 heart blood, 1.11:1.65 femoral blood, 60.24:32.43 urine, 6.47:10:71 liver, and 38.36:49.16 lung, respectively. Drug concentrations in tissues were found to be the highest in lung for both drugs and lowest in the heart. Citalopram but not olanzapine was detected in bone. The cause of death was ruled acute intoxication by the combined effects of olanzapine and citalopram and the manner, accident.
AbstractList	A 40-year-old white male was found dead in bed in a group home for mentally ill adults. The decedent had been diagnosed a paranoid schizophrenic. An autopsy was performed at the Office of the Cuyahoga County Coroner in Cleveland, Ohio. Toxicological testing detected olanzapine and citalopram in post mortem specimens. Multiple fluids and tissues were assayed by liquid-liquid extraction followed by gas chromatography with nitrogen phosphorus detection, and qualitative confirmation by electron impact gas chromatography/mass spectrometry. Drug concentrations [olanzapine : citalopram; mg/L or mg/Kg] determined in this case are the highest reported to date involving these drugs- 1.38:3.35 heart blood, 1.11:1.65 femoral blood, 60.24:32.43 urine, 6.47:10:71 liver, and 38.36:49.16 lung, respectively. Drug concentrations in tissues were found to be the highest in lung for both drugs and lowest in the heart. Citalopram but not olanzapine was detected in bone. The cause of death was ruled acute intoxication by the combined effects of olanzapine and citalopram and the manner, accident. A 40-year-old white male was found dead in bed in a group home for mentally ill adults. The decedent had been diagnosed a paranoid schizophrenic. An autopsy was performed at the Office of the Cuyahoga County Coroner in Cleveland, Ohio. Toxicological testing detected olanzapine and citalopram in post mortem specimens. Multiple fluids and tissues were assayed by liquid-liquid extraction followed by gas chromatography with nitrogen phosphorus detection, and qualitative confirmation by electron impact gas chromatography/mass spectrometry. Drug concentrations [olanzapine : citalopram; mg/L or mg/Kg] determined in this case are the highest reported to date involving these drugs- 1.38:3.35 heart blood, 1.11:1.65 femoral blood, 60.24:32.43 urine, 6.47:10:71 liver, and 38.36:49.16 lung, respectively. Drug concentrations in tissues were found to be the highest in lung for both drugs and lowest in the heart. Citalopram but not olanzapine was detected in bone. The cause of death was ruled acute intoxication by the combined effects of olanzapine and citalopram and the manner, accident. [PUBLICATION ABSTRACT]
Author	Jenkins, AJ Horak, EL
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References	Flanagan; 35 Rasmussen, Brosen; 22 Dams, Benijts, Lambert, Van Bocxlaer, Van Varenbergh, Van Peteghem; 25 Baumann; 11 Olesen, Linnet; 21 Jenkins, Sarconi, Raaf Merrick, Felo, Jenkins; 22 Shimada, Yamazaki, Mimura, Inui, Guengerich; 270 Weigmann, Gerek, Zeisig, Muller, Hartter, Hiemke Fulton, Goa; 53 Jenkins, Gubanich; 47 Baumann (2024022821102971900_c13) 1996; 11 (2024022821102971900_c9) 2004 Jenkins (2024022821102971900_c3) 1998 Jenkins (2024022821102971900_c2) 2002; 47 Olesen (2024022821102971900_c8) 1999; 21 Dams (2024022821102971900_c14) 2001; 25 Fulton (2024022821102971900_c7); 53 Merrick (2024022821102971900_c4) 2001; 22 Levine (2024022821102971900_c6) Shimada (2024022821102971900_c11) 1994; 270 Anderson (2024022821102971900_c5) Weigmann (2024022821102971900_c10) 2001 Rasmussen (2024022821102971900_c12) 2000; 22 Flanagan (2024022821102971900_c1) 1998; 35
References_xml	– volume: 35 start-page: 261 issn: 0004-5632 article-title: Guidelines for the interpretation of analytical toxicology results and unit of measurement conversion factors publication-title: Ann Clin Biochem contributor: fullname: Flanagan – volume: 21 start-page: 87 issn: 0163-4356 article-title: Olanzapine serum concentrations in psychiatric patients given standard doses: the influence of comedication publication-title: Ther Drug Monit contributor: fullname: Linnet – volume: 25 start-page: 147 issn: 0146-4760 article-title: A fatal case of serotonin syndrome after combined moclobemide-citalopram intoxication publication-title: J Anal Toxicol contributor: fullname: Van Peteghem – volume: 11 start-page: 5 issn: 0268-1315 issue: Suppl1 article-title: Pharmacology and pharmacokinetics of citalopram and other SSRIs publication-title: Int Clin Psychopharmacol contributor: fullname: Baumann – start-page: 605 issn: 0146-4760 issue: 22 article-title: Determination of olanzapine in a postmortem case publication-title: J Anal Toxicol contributor: fullname: Raaf – start-page: 410 issn: 0163-4356 issue: 23 article-title: Fluvoxamine but not sertraline inhibits the metabolism of olanzapine: evidence from a therapeutuc drug monitoring service publication-title: Ther Drug Monit contributor: fullname: Hiemke – volume: 270 start-page: 414 issn: 0022-3565 article-title: Interindividual variations in human liver cytochrome P-450 enzymes involved in the oxidation of drugs, carcinogens and toxic chemicals: studies with liver microsomes of 30 Japanese and 30 Caucasians publication-title: J Pharmacol Exp Ther contributor: fullname: Guengerich – volume: 22 start-page: 143 issn: 0163-4356 article-title: Is therapeutic drug monitoring a case for optimizing clinical outcome and avoiding interactions of the selective serotonin reuptake inhibitors? publication-title: Ther Drug Monit contributor: fullname: Brosen – volume: 47 start-page: 159 issn: 0022-1198 issue: 1 article-title: Disposition of citalopram in biological specimens from postmortem cases publication-title: J Forensic Sci contributor: fullname: Gubanich – volume: 22 start-page: 270 issn: 0195-7910 issue: 3 article-title: Tissue distribution of olanzapine in a postmortem case publication-title: Amer J Forensic Med Pathol contributor: fullname: Jenkins – volume: 53 start-page: 281 issn: 0012-6667 issue: 2 article-title: Olanzapine A review of its pharmacological properties and therapeutic efficacy in the management of schizophrenia and related psychoses publication-title: Drugs contributor: fullname: Goa – volume: 35 start-page: 261 issn: 0004-5632 year: 1998 ident: 2024022821102971900_c1 article-title: Guidelines for the interpretation of analytical toxicology results and unit of measurement conversion factors publication-title: Ann Clin Biochem doi: 10.1177/000456329803500210 contributor: fullname: Flanagan – volume: 22 start-page: 270 issn: 0195-7910 issue: 3 year: 2001 ident: 2024022821102971900_c4 article-title: Tissue distribution of olanzapine in a postmortem case publication-title: Amer J Forensic Med Pathol doi: 10.1097/00000433-200109000-00014 contributor: fullname: Merrick – volume: 22 start-page: 143 issn: 0163-4356 year: 2000 ident: 2024022821102971900_c12 article-title: Is therapeutic drug monitoring a case for optimizing clinical outcome and avoiding interactions of the selective serotonin reuptake inhibitors? publication-title: Ther Drug Monit doi: 10.1097/00007691-200004000-00001 contributor: fullname: Rasmussen – start-page: 605 issn: 0146-4760 issue: 22 year: 1998 ident: 2024022821102971900_c3 article-title: Determination of olanzapine in a postmortem case publication-title: J Anal Toxicol doi: 10.1093/jat/22.7.605 contributor: fullname: Jenkins – volume: 53 start-page: 281 issn: 0012-6667 issue: 2 ident: 2024022821102971900_c7 article-title: Olanzapine A review of its pharmacological properties and therapeutic efficacy in the management of schizophrenia and related psychoses publication-title: Drugs doi: 10.2165/00003495-199753020-00007 contributor: fullname: Fulton – start-page: 410 issn: 0163-4356 issue: 23 year: 2001 ident: 2024022821102971900_c10 article-title: Fluvoxamine but not sertraline inhibits the metabolism of olanzapine: evidence from a therapeutuc drug monitoring service publication-title: Ther Drug Monit doi: 10.1097/00007691-200108000-00015 contributor: fullname: Weigmann – volume-title: Physicians' Desk Reference year: 2004 ident: 2024022821102971900_c9 – volume-title: Proceedings of the SOFT/TIAFT Joint Meeting ident: 2024022821102971900_c5 article-title: Thirty-five case studies involving postmortem tissue distributions of olanzapine (Zyprexa) contributor: fullname: Anderson – volume: 21 start-page: 87 issn: 0163-4356 year: 1999 ident: 2024022821102971900_c8 article-title: Olanzapine serum concentrations in psychiatric patients given standard doses: the influence of comedication publication-title: Ther Drug Monit doi: 10.1097/00007691-199902000-00013 contributor: fullname: Olesen – volume: 11 start-page: 5 issn: 0268-1315 issue: Suppl1 year: 1996 ident: 2024022821102971900_c13 article-title: Pharmacology and pharmacokinetics of citalopram and other SSRIs publication-title: Int Clin Psychopharmacol doi: 10.1097/00004850-199603001-00002 contributor: fullname: Baumann – volume-title: Proceedings of the SOFT/TIAFT Joint Meeting ident: 2024022821102971900_c6 article-title: Olanzapine concentrations in forensic investigations contributor: fullname: Levine – volume: 270 start-page: 414 issn: 0022-3565 year: 1994 ident: 2024022821102971900_c11 article-title: Interindividual variations in human liver cytochrome P-450 enzymes involved in the oxidation of drugs, carcinogens and toxic chemicals: studies with liver microsomes of 30 Japanese and 30 Caucasians publication-title: J Pharmacol Exp Ther contributor: fullname: Shimada – volume: 25 start-page: 147 issn: 0146-4760 year: 2001 ident: 2024022821102971900_c14 article-title: A fatal case of serotonin syndrome after combined moclobemide-citalopram intoxication publication-title: J Anal Toxicol doi: 10.1093/jat/25.2.147 contributor: fullname: Dams – volume: 47 start-page: 159 issn: 0022-1198 issue: 1 year: 2002 ident: 2024022821102971900_c2 article-title: Disposition of citalopram in biological specimens from postmortem cases publication-title: J Forensic Sci doi: 10.1520/JFS15217J contributor: fullname: Jenkins
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SubjectTerms	Adult Antidepressive Agents, Second-Generation - administration & dosage Antidepressive Agents, Second-Generation - pharmacokinetics Antidepressive Agents, Second-Generation - poisoning Antipsychotic Agents - administration & dosage Antipsychotic Agents - pharmacokinetics Antipsychotic Agents - poisoning Autopsy Benzodiazepines - administration & dosage Benzodiazepines - pharmacokinetics Benzodiazepines - poisoning Citalopram - administration & dosage Citalopram - pharmacokinetics Citalopram - poisoning Drug Overdose - diagnosis Drug Overdose - pathology Forensic pathology Humans Male Postmortem Changes Prescription drugs Schizophrenia, Paranoid Tissue Distribution Tissues Toxicology
Title	Postmortem Tissue Distribution of Olanzapine and Citalopram in a Drug Intoxication
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