Avella Joseph, Lehrer Michael, Katz Michael, Minden Edward
Department of Health Services, Division of Medical-Legal and Forensic Investigations, Suffolk County, New York, NY 11788-0099, USA.
J Anal Toxicol. 2004 Sep;28(6):504-8. doi: 10.1093/jat/28.6.504.
Clomipramine and its active metabolite norclomipramine were identified and quantitated in multiple tissues recovered from two postmortem cases using liquid chromatography-mass spectrometry. In both cases clomipramine toxicity was assessed primarily upon levels determined from brain samples. This communication supplements the database on clomipramine and norclomipramine by providing quantitative determinations of both parent drug and metabolite in multiple tissues. A literature search revealed a paucity of data on clomipramine and norclomipramine levels in general and a total absence of documented brain levels. In patients who have undergone long-term tricyclic antidepressant (TCA) therapy, blood and liver analysis alone may not be sufficient to establish toxicity. Such patients can sequester substantial amounts in liver, a concern because the TCAs are subject to significant postmortem redistribution. When conducting postmortem investigations, the inclusion of brain determination provides valuable information in assessing the magnitude of toxicity in cases involving clomipramine and its active metabolite norclomipramine.
采用液相色谱-质谱联用技术，在两例尸检病例的多种组织中鉴定并定量了氯米帕明及其活性代谢产物去甲氯米帕明。在这两例病例中，氯米帕明毒性主要根据脑样本中测定的水平进行评估。本报告通过提供母体药物及其代谢产物在多种组织中的定量测定结果，补充了氯米帕明和去甲氯米帕明的数据库。文献检索表明，关于氯米帕明和去甲氯米帕明水平的数据普遍较少，且完全没有记录在案的脑内水平。在接受长期三环类抗抑郁药（TCA）治疗的患者中，仅进行血液和肝脏分析可能不足以确定毒性。这类患者可能会在肝脏中蓄积大量药物，这是一个需要关注的问题，因为三环类抗抑郁药会发生显著的死后再分布。在进行尸检调查时，纳入脑内测定可为评估涉及氯米帕明及其活性代谢产物去甲氯米帕明的病例中的毒性程度提供有价值的信息。
