Open AccessCyclobenzaprine overdose: The importance of a clinical history in analytical toxicology
Author(s) -
Merigian Kevin S.,
Schoeder Timothy J.,
Tasset Jerry J.,
Pesce Amadeo J.
Publication year - 1987
Publication title -
journal of clinical laboratory analysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.536
H-Index - 50
eISSN - 1098-2825
pISSN - 0887-8013
DOI - 10.1002/jcla.1860010307
Subject(s) - amitriptyline , chromatography , chemistry , gas chromatography , thin layer chromatography , immunoassay , anesthesia , medicine , antibody , immunology
Abstract Clinicians have become increasingly dependent on advanced analytical technology to supplement their diagnostic impression of comatose patients. We report a comatose patient who had ingested cyclobenzaprine, penatazocine, and ethchlorvinyl. The cyclobenzaprine was mistakenly identified as amitriptyline. Structurally these two agents are very similar with the exception of one double bond at the central aromatic group. The techniques of conventional thin‐layer chromatography, high‐efficiency thin‐layer chromatography, Toxi‐Lab thin‐layer chromatography, gas chromatography, high‐performance liquid chromatography, EMIT enzyme immunoassay, and gas chromatography‐mass spectrometry could not distinguish between the two compounds. An additional investigation of urine specimens from four volunteers who took (1) 50 mg of amitriptyline, (2) 20 mg of cyclobenzaprine, and (3) both 50 mg of amitriptyline and 20 mg of cyclobenzaprine was unable to distinguish the two agents. These results serve to reinforce the necessity of a clinical history taken in conjunction with analytical techniques before identifying potential agents present in various biological material.