Introduction. Amlodipine and Diltiazem are calcium channel blocking agents used as antihypertensive. In this study we describe two fatal overdoses of these drugs. In the first case the deceased was a 45-year-old man who ingested an unknown number of amlodipine tablets. In the second case the deceased was a 38 year-old woman who ingested an unspecified amount of diltiazem tablets. Both cases were classified as suicide. Methods. Postmortem analysis were performed by LC-MS/MS on blood, urine, bile and stomach contents. Calibration curves were prepared in blood, urine and bile. Mefenamic acid was used as internal standard, samples were diluted 1:1 with methanol and ten microliters were injected into the LC-MS/MS system. Results. Amlodipine concentrations were 173 ng/ml in femoral blood, 128 ng/ml in urine and 5,150 ng/ml in bile. Diltiazem levels were 17.4 g/ml in femoral blood, 28.2 g/ml in cardiac blood, 4.5 g/ml in urine and 72.7 g/ml in bile. Amlodipine and Diltiazem were still identified in gastric contents. In both cases the concentrations of these drugs found in urine were lower than in blood samples. Conclusions. We have developed a simple and reliable method to determine this class of drugs in biological samples. The concentration of Amlodipine in blood sample was very low if compared with earlier reported cases; on the contrary as regards Diltiazem, concentrations in body fluids were very high, and the heart/femoral blood ratio was 1.62. In both cases autopsy did not show any signs of disease and Amlodipine and Diltiazem were the only drugs found in toxic levels in blood.

Calcium channel blocking agents fatal poisoning: determination of amlodipine and diltiazem by LC-MS/MS.

VIGNALI, CLAUDIA MARIA;MORINI, LUCA;STRAMESI, CRISTIANA;GROPPI, ANGELO
2012

Abstract

Introduction. Amlodipine and Diltiazem are calcium channel blocking agents used as antihypertensive. In this study we describe two fatal overdoses of these drugs. In the first case the deceased was a 45-year-old man who ingested an unknown number of amlodipine tablets. In the second case the deceased was a 38 year-old woman who ingested an unspecified amount of diltiazem tablets. Both cases were classified as suicide. Methods. Postmortem analysis were performed by LC-MS/MS on blood, urine, bile and stomach contents. Calibration curves were prepared in blood, urine and bile. Mefenamic acid was used as internal standard, samples were diluted 1:1 with methanol and ten microliters were injected into the LC-MS/MS system. Results. Amlodipine concentrations were 173 ng/ml in femoral blood, 128 ng/ml in urine and 5,150 ng/ml in bile. Diltiazem levels were 17.4 g/ml in femoral blood, 28.2 g/ml in cardiac blood, 4.5 g/ml in urine and 72.7 g/ml in bile. Amlodipine and Diltiazem were still identified in gastric contents. In both cases the concentrations of these drugs found in urine were lower than in blood samples. Conclusions. We have developed a simple and reliable method to determine this class of drugs in biological samples. The concentration of Amlodipine in blood sample was very low if compared with earlier reported cases; on the contrary as regards Diltiazem, concentrations in body fluids were very high, and the heart/femoral blood ratio was 1.62. In both cases autopsy did not show any signs of disease and Amlodipine and Diltiazem were the only drugs found in toxic levels in blood.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11571/580667
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