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Postmortem Tissue Distribution of Atomoxetine Following Fatal and Nonfatal Doses—Three Case Reports
Author(s) -
Garside Diana,
RoperoMiller Jeri D.,
Riemer Ellen C.
Publication year - 2006
Publication title -
journal of forensic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.715
H-Index - 96
eISSN - 1556-4029
pISSN - 0022-1198
DOI - 10.1111/j.1556-4029.2005.00021.x
Subject(s) - atomoxetine , atomoxetine hydrochloride , medicine , pharmacokinetics , forensic toxicology , pharmacology , anesthesia , attention deficit hyperactivity disorder , chemistry , methylphenidate , psychiatry , chromatography
Atomoxetine (Strattera ® , Lilly) is a selective norepinephrine reuptake inhibitor (SNRI) prescribed for the treatment of attention‐deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults. It is the first nonstimulant drug‐therapy option for ADHD. Three case reports are presented in which atomoxetine was detected in two individuals who died from causes unrelated to the drug and a third from the intentional ingestion of atomoxetine and other drugs. In addition, a brief description of the pharmacokinetics and side effects of atomoxetine are given. Postmortem fluid and tissue concentrations of atomoxetine were as follows: aortic blood, <0.1–8.3 mg/L; femoral blood, 0.33–5.4 mg/L; vitreous humor, 0.1–0.96 mg/L; bile, 1.0–33 g/L; urine, <0.1 mg/L; liver, <0.44–29 mg/kg; and gastric contents, 0.0097–16.8 mg total. Autopsy findings in the two cases in which death was not attributed to drug toxicity included arrhythmogenic right ventricular dysplasia and hypertrophic cardiomyopathy. The analytical method utilized was a modified basic drug, liquid–liquid procedure followed by gas chromatography/mass spectrometry and nitrogen phosphorous detection. Atomoxetine can be considered nontoxic at whole blood and liver concentrations below 1.3 mg/L and 5 mg/kg, respectively.