Adverse events, toxicity and post-mortem data on duloxetine: Case reports and literature survey

• Published in: Journal of forensic and legal medicine Vol. 17; no. 4; pp. 175 - 185
• Main Authors: Vey, Eric L., Kovelman, Inna
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.05.2010; Churchill Livingstone Inc., Medical Publishers
• Subjects: Accidents; Adult; Aged; Analgesics, Opioid - analysis; Analgesics, Opioid - poisoning; Autopsies; Autopsy; Biological Availability; Coroners and Medical Examiners; Drug overdose; Drug Therapy, Combination - adverse effects; Duloxetine; Duloxetine Hydrochloride; Female; Fentanyl - analysis; Fentanyl - poisoning; Forensic engineering; Forensic pathology; Forensic Toxicology; Foundations; Gas Chromatography-Mass Spectrometry; Humans; Inhibitors; Male; Middle Aged; Overdose; Pathology; Post-mortem; Prescription drugs; Routines; Serotonin; Serotonin Uptake Inhibitors - adverse effects; Serotonin Uptake Inhibitors - analysis; Serotonin Uptake Inhibitors - pharmacokinetics; Serotonin Uptake Inhibitors - poisoning; Suicide; Suicides & suicide attempts; Tandem Mass Spectrometry; Thiophenes - adverse effects; Thiophenes - analysis; Thiophenes - pharmacokinetics; Thiophenes - poisoning; Thresholds; Toxic; Toxicity; Toxicology; Post-mortem; Overdose; Duloxetine; Suicide; Toxicity; Autopsy
• ISSN: 1752-928X; 1878-7487; 1878-7487
• DOI: 10.1016/j.jflm.2010.02.002

Duloxetine, a dual acting norepinephrine serotonin reuptake inhibitor, is a relatively new pharmacologic agent utilized in the treatment of depression, as well as diabetic neuropathic pain, fibromyalgia, and female stress urinary incontinence. This expanding scope of usage will inevitably lead to its eventual appearance during routine post-mortem toxicologic assays. Currently there is a paucity of post-mortem toxicologic data concerning duloxetine. The current report provides six additional case reports of post-mortem duloxetine levels, along with a review of duloxetine’s pharmacokinetics, and the toxicologic manifestations which have been reported in the literature. The post-mortem levels reported, including the highest level recorded to date, are integrated with previously published reports to generate a foundation for a nascent guide to the interpretation of post-mortem duloxetine levels that could be encountered during routine post-mortem toxicologic analyses, and establish a basis upon which the establishment of toxic and lethal thresholds for this compound can be further elucidated with greater clarity.