Distribution of venlafaxine and O-desmethylvenlafaxine in a fatal case.

Venlafaxine is an extensively used antidepressant drug; it is considered to be quite safe and only a few pure cases of fatal poisoning have been reported. Here we describe a fatal case of venlafaxine self-poisoning including detailed tissue distribution of the drug and its metabolite O-desmethylvenlafaxine and the exact time sequence of events, as reported in the patient's clinical record. Qualitative analyses were performed by GC-MS while quantitative analyses were carried out by LC-MS/MS. We then compared our results with those of previously published cases. Fatal venlafaxine poisoning often occurs after the intake of an extremely elevated number of tablets, corresponding to tens of grams of the drug, or it can be due to interaction between the drug and other substances. In the present case, no other drugs or ethanol were found and death occurred 12h after ingesting only 3g of venlafaxine, despite timely medical treatment.