Citation

Gheddar L, Feisthauer E, Eibel A, Ameline A, Géraut A, Raul JS, Kintz P. Toxicol. Anal. Clin. 2018; 30(3): 206-209.

Copyright

(Copyright © 2018, Société Française de Toxicologie Analytique, Publisher Elsevier Publishing)

DOI

10.1016/j.toxac.2018.03.004

PMID

unavailable

Abstract

Olanzapine is an atypical neuroleptic used as a mood regulator in the treatment of some mental disorders such as schizophrenia or bipolar disorder. In case of overdose, olanzapine may be associated with lethal outcomes due to a narrow therapeutic index. The authors present the case of a 19-year-old man found dead at home with empty boxes of Zyprexa® near the body. He was suffering from depression and obsessive-compulsive disorder (COD) and presented previous suicide attempts. The autopsy was not specific of any type of death and toxicological analyses were required. Analyses were performed within 72 hours after the autopsy. A specific quantitative method of olanzapine was developed using an ultra high performance liquid chromatography system (UHPLC®) coupled with a tandem mass spectrometer (Waters® Xevo TQD). Concentrations in the peripheral blood, cardiac blood, urine, bile, gastric fluid and hair were 4622 ng/mL, 5341 ng/mL, 54,756 ng/mL, 14,820 ng/mL, greater than 50,000 ng/mL and 1.9 ng/mg respectively. These values correspond to the data reported in the literature and are in accordance with a pure olanzapine fatal intoxication. Olanzapine was found unstable over time in blood. Despite an appropriate storage at +4 °C, a loss of 21 to 60% was observed over a period of 2 to 6 weeks respectively. Therefore, it is very important to perform the analysis quickly, in order to avoid a misinterpretation of the results. The instability of the molecule is to be taken into account for the final interpretation of the results. © 2018 Société Française de Toxicologie Analytique

Language: en

Keywords

adult; Intoxication; human; Death; male; case report; depression; suicide attempt; drug overdose; Olanzapine; blood sampling; clinical article; drug intoxication; drug fatality; olanzapine; obsessive compulsive disorder; Article; tandem mass spectrometry; young adult; ultra performance liquid chromatography; UHPLC-MS/MS