Clomipramine + alprazolam overdose Coma and death

A 51-year-old woman with a history of alcohol abuse and depression received treatment for alcohol withdrawal symptoms. Several days later she received clomipramine and alprazolam treatment.

On the following day she was observed to be drunk and later to be heavily asleep but rousable. She was discovered dead on the next day. 57 alprazolam O.5mg tablets and 42 clomipramine 25mg tablets were missing and the patient had consumed a pint of liquor and 6 bottles of beer.

Toxicological analysis showed blood and urine clomipramine concentrations of 0.84 and 0.56 mg/L, respectively (therapeutic serum concentrations range from 24 to 200 Ilg/L): and N-desmethylclomipramine concentrations of 1.4 and 0.62 mg/L, respectively (therapeutic serum concentrations range from 36 to 300 Ilg/L). Alprazolam blood concentration was 0.069 mg/L (therapeutic range 0.02 to 0055 mg/L) Ethyl alcohol concentrations were 375 mg/dl in blood, 380 mg/dl in urine and 435 mg/dl in the vitreous humour.

The authors concluded that '_ . _ the major factor in this fatality is clomipramine and N­desmethylclomipramine with an uncertain contribution by alprazolamj ethyl alcohol'. Fraser AD Isner AF. Moss MA Journal of ForenSIc SCiences 31 762-767. Apr 1986

0157-7271/86/0920-0007/0$01.00/0 © ADIS Press Reactions® 6 Sep 1986 7

Clomipramine + alprazolam overdose Coma and death

A 51-year-old woman with a history of alcohol abuse and depression received treatment for alcohol withdrawal symptoms. Several days later she received clomipramine and alprazolam treatment.

On the following day she was observed to be drunk and later to be heavily asleep but rousable. She was discovered dead on the next day. 57 alprazolam O.5mg tablets and 42 clomipramine 25mg tablets were missing and the patient had consumed a pint of liquor and 6 bottles of beer.

Toxicological analysis showed blood and urine clomipramine concentrations of 0.84 and 0.56 mg/L, respectively (therapeutic serum concentrations range from 24 to 200 Ilg/L): and N-desmethylclomipramine concentrations of 1.4 and 0.62 mg/L, respectively (therapeutic serum concentrations range from 36 to 300 Ilg/L). Alprazolam blood concentration was 0.069 mg/L (therapeutic range 0.02 to 0055 mg/L) Ethyl alcohol concentrations were 375 mg/dl in blood, 380 mg/dl in urine and 435 mg/dl in the vitreous humour.

The authors concluded that '_ . _ the major factor in this fatality is clomipramine and N­desmethylclomipramine with an uncertain contribution by alprazolamj ethyl alcohol'. Fraser AD Isner AF. Moss MA Journal of ForenSIc SCiences 31 762-767. Apr 1986

0157-7271/86/0920-0007/0$01.00/0 © ADIS Press Reactions® 6 Sep 1986 7