LGC Forensics, F5 Culham Science Centre, Abingdon, Oxfordshire, UK.
Forensic Sci Int. 2012 Jan 10;214(1-3):e23-5. doi: 10.1016/j.forsciint.2011.07.032. Epub 2011 Aug 9.
Clozapine is a uniquely effective antipsychotic, but is very toxic in clozapine-naïve subjects. A 34-year-old male patient in a mental health facility, who was not prescribed clozapine, took 350 mg clozapine obtained from another patient at night. He was found dead the next morning. The presence of cardiomegaly related to obesity may have increased the risk of suffering an acute cardiac event after ingestion of clozapine. The medication prescribed to the patient was not thought to have contributed to the fatal outcome. Post mortem femoral blood clozapine and norclozapine concentrations were 0.48 and 0.20mg/L, respectively. By way of comparison, audit of 104,127 plasma samples (26,796 patients) assayed for therapeutic drug monitoring purposes 1993-2007, showed plasma clozapine 0.35 mg/L or more in 57.5% samples (8.4% 1mg/L or more). Those involved in the investigation of clozapine-associated deaths need to be aware that that death in an adult may occur after a single 'therapeutic' dose. A diagnosis of fatal clozapine poisoning cannot be made solely on the basis of a post mortem blood clozapine measurement.
氯氮平是一种非常有效的抗精神病药物，但对氯氮平初治患者毒性很大。一名 34 岁男性患者在精神卫生机构，未开氯氮平处方，夜间服用了从另一名患者处获得的 350 毫克氯氮平。第二天早上被发现死亡。与肥胖相关的心脏增大可能增加了摄入氯氮平后发生急性心脏事件的风险。给患者开的药物被认为不是导致致命后果的原因。尸检时股动脉血氯氮平和去甲氯氮平浓度分别为 0.48 和 0.20mg/L。相比之下，1993 年至 2007 年为治疗药物监测目的检测了 104127 份血浆样本（26796 名患者），显示氯氮平 0.35mg/L 或更高的样本占 57.5%（1mg/L 或更高的占 8.4%）。参与氯氮平相关死亡调查的人员需要意识到，成年人可能在单次“治疗”剂量后死亡。不能仅根据尸检血液氯氮平测量值来诊断致命性氯氮平中毒。
