@article{ref1,
title="Fatal intoxications due to administration of isosorbide tablets contaminated with pyrimethamine",
journal="Journal of forensic sciences",
year="2016",
author="Imran, Muhammad and Shafi, Humera and Mahmood, Zahid and Sarwar, Mohammad and Usman, Hafiz Faisal and Tahir, Mohammad Ashraf and Ashiq, Muhammad Zar",
volume="61",
number="5",
pages="1382-1385",
abstract="In January 2012, 664 cases of pyrimethamine toxicity and 151 deaths were reported among cardiac patients that had recently received free medicines from pharmacy of Punjab Institute of Cardiology, Lahore, Pakistan. These patients, ages ranged from 58 to 75 years, were prescribed simvastatin, clopidogrel, aspirin soluble, isosorbide mononitrate, and amlodipine. On examination of medications being given to them, it was found that a particular batch of isosorbide mononitrate tablets was contaminated with 50 mg pyrimethamine. Cardiac patients were taking isosorbide contaminated with pyrimethamine twice daily (100 mg pyrimethamine/day), whereas therapeutic dose of pyrimethamine for malaria is 25 mg/week. Postmortem urine, cardiac blood, and femoral blood specimens of three deceased males were submitted to author's laboratory for analysis. Postmortem toxicological analysis revealed that pyrimethamine concentration fell within the range of 1-10 μg/mL by liquid chromatography. Clinical, autopsy, histopathological, and toxicological findings strongly suggested toxicity due to pyrimethamine accumulation that resulted in deaths of these cardiac patients.<br><br>© 2016 American Academy of Forensic Sciences.<p /> <p>Language: en</p>",
language="en",
issn="0022-1198",
doi="10.1111/1556-4029.13125",
url="http://dx.doi.org/10.1111/1556-4029.13125"
}