Logan Barry K, Goldfogel Gary, Hamilton Rebecca, Kuhlman James
NMS Labs, 3701 Welsh Road, Willow Grove, Pennsylvania 19090, USA.
J Anal Toxicol. 2009 Mar;33(2):99-103. doi: 10.1093/jat/33.2.99.
Dextromethorphan is a widely available over-the-counter antitussive that produces intoxicating, hallucinogenic, and dissociative effects at doses significantly exceeding the therapeutic range. We report the deaths of five teenage males in three incidents in three states (WA, FL, and VA) who purposefully ingested large doses of dextromethorphan for recreational purposes and died as a result of the direct toxic effects of the drug. The dextromethorphan was obtained from the same internet supplier in each case. Postmortem blood dextromethorphan concentrations ranged from 950 to 3230 ng/mL (median 1890 ng/mL). Three subjects had diphenhydramine present, one had a trace of alprazolam, and two were positive for cannabinoids. In each case, the death was attributed to dextromethorphan toxicity or toxicity from dextromethorphan and other drugs. The article discusses the metabolism, pharmacology, and potential for drug interactions for dextromethorphan and the likely mechanisms for toxicity. The dextromethorphan concentrations in all five subjects significantly exceeded the therapeutic range and are consistent with concentrations reported in other cases of dextromethorphan abuse and toxicity. The deaths resulted in the prosecution of three individuals involved in sale or distribution of the drug.
右美沙芬是一种广泛使用的非处方止咳药，在剂量显著超过治疗范围时会产生中毒、致幻和解离作用。我们报告了三起事件中五名青少年男性的死亡，这三起事件分别发生在三个州（华盛顿州、佛罗里达州和弗吉尼亚州），他们出于娱乐目的故意摄入大量右美沙芬，最终因药物的直接毒性作用而死亡。在每起案件中，右美沙芬均来自同一家互联网供应商。死后血液中右美沙芬浓度范围为950至3230纳克/毫升（中位数为1890纳克/毫升）。三名受试者体内含有苯海拉明，一名含有微量阿普唑仑，两名大麻素检测呈阳性。在每起案件中，死亡均归因于右美沙芬毒性或右美沙芬与其他药物的毒性。本文讨论了右美沙芬的代谢、药理学、药物相互作用的可能性以及可能的毒性机制。所有五名受试者体内的右美沙芬浓度均显著超过治疗范围，与其他右美沙芬滥用和中毒案例报告的浓度一致。这些死亡事件导致三名涉及该药物销售或分销的人员被起诉。
