Reactions 1426 - 3 Nov 2012

★ O SRopinirole overdose

First report of fatal intoxication: case reportA 37-year-old man experienced fatal intoxication after

consuming an overdose of ropinirole [dosage and route notstated].

The man was found dead approximately 24 hours afterbeing left alone after attending a party with his brother[time to reaction onset not clearly stated]. No obvious signsof drug overdose were evident at the scene. An autopsywas performed 36 hours after his body was discovered. Acause of death was not apparent based on the pathologicalfindings but did reveal signs of cardiac arrhythmia includingintra-alveolar pulmonary oedema and diffuse visceralcongestion. Toxicological results revealed the presence ofropinirole, paracetamol [acetaminophen] and alcohol. Hisperipheral blood concentration of ropinirole was 64 ng/mL(therapeutic range 0.4–6 ng/mL). Ropinirole concentrationsin urine, bile and vitreous humor were 2670 ng/mL,826 ng/mL and 11 ng/mL, respectively. His blood alcoholand urine alcohol concentrations were 2.26 g/L and2.94 g/L, respectively. Paracetamol was detected at aconcentration of < 2 µg/mL. These results confirmed thepreliminary morphological findings of an acute ropiniroleintoxication with alcohol intoxication playing a minor role.

Author comment: "[T]he present case demonstrates a fatalintoxication involving the antiparkinsonian drug ropinirole.The assessed ropinirole concentration of 64 ng/mL inperipheral blood clearly exceeds the therapeutic range andmay represent a highly cardiac toxic, even lethalconcentration".Duband S, et al. A fatal intoxication case involving ropinirole. Journal of forensicand legal medicine 19: 422-425, No. 7, Oct 2012. Available from: URL: http://dx.doi.org/10.1016/j.jflm.2012.04.013 - France 803079102

» Editorial comment: A search of AdisBase, Medline andEmbase did not reveal any previous case reports of fatalintoxication associated with ropinirole. The WHO ADRdatabase contained 12 reports of toxicity to various agentsand 49 reports of death associated with ropinirole.

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Reactions 3 Nov 2012 No. 14260114-9954/10/1426-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved