A Multi‐Drug Intoxication Fatality Involving Xyrem® (GHB)

• Published in: Journal of forensic sciences Vol. 54; no. 2; pp. 495 - 496
• Main Authors: Akins, Brianne E., Miranda, Estuardo, Matthew Lacy, J., Logan, Barry K.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.03.2009; Wiley Subscription Services, Inc
• Subjects: Amines - analysis; Amines - poisoning; Benzhydryl Compounds - analysis; Benzhydryl Compounds - poisoning; Carisoprodol - analysis; Carisoprodol - poisoning; Central Nervous System Depressants - analysis; Central Nervous System Depressants - poisoning; Cetirizine - analysis; Cetirizine - poisoning; Cyclohexanecarboxylic Acids - analysis; Cyclohexanecarboxylic Acids - poisoning; Drug Interactions; Drug overdose; Drug Therapy, Combination; Female; forensic science; Forensic sciences; Forensic Toxicology; gamma-Aminobutyric Acid - analysis; gamma-Aminobutyric Acid - poisoning; Gamma‐hydroxybutyrate; Gastrointestinal Contents - chemistry; Humans; Medical treatment; Middle Aged; Narcolepsy - drug therapy; overdose; postmortem; Prescription drugs; sleep apnea; Sleep Apnea Syndromes - complications; Sleep disorders; Snoring - complications; Sodium Oxybate - analysis; Sodium Oxybate - poisoning; Toxicology; Tramadol - adverse effects; Tramadol - analysis; Vitreous Body - chemistry; Xyrem
• ISSN: 0022-1198; 1556-4029; 1556-4029
• DOI: 10.1111/j.1556-4029.2008.00965.x

:  Gamma‐hydroxybutyrate (GHB) is best known as a recreational depressant drug, whose use has also been implicated in drug facilitated sexual assault cases. It is also available as a therapeutic agent (Xyrem®) used for the treatment of daytime sleepiness or cataplexy associated with narcolepsy. This is a report of a case of a 53‐year‐old woman undergoing treatment with Xyrem® for narcolepsy. The decedent was also prescribed tramadol, gabapentin, cetirizine, modafinil, carisoprodol, and Xyrem®. Toxicological analysis of the blood revealed GHB 165.6 mg/L, and 90.7 mg/L in the urine. Blood GHB concentrations in the range 156–260 mg/L have been reported to induce moderately sound sleep. The combined use of central nervous system depressant drugs, together with her problematic sleep apnea, and snoring (both contraindications for GHB use) were determined to have caused this subject’s death. The manner of death was determined to be accidental.