Franco Dori M, Ali Zabiullah, Levine Barry, Middleberg Robert A, Fowler David R
From the *Office of the Armed Forces Medical Examiner, Rockville; †Office of the Chief Medical Examiner, State of Maryland, Baltimore, MD; and ‡NMS Labs, Willow Grove, PA.
Am J Forensic Med Pathol. 2014 Dec;35(4):234-6. doi: 10.1097/PAF.0b013e3182887804.
Tapentadol (Nucynta) is a centrally acting opioid analgesic prescribed for the treatment of moderate to severe acute pain. Its efficacy is believed to be due to μ-opioid receptor agonist activity and inhibition of norepinephrine reuptake resulting in increased norepinephrine concentrations. There is only one other case in the literature relating to the toxicity of this agent or report of a fatality. This case report documents a case in which tapentadol was identified as the cause of death. The tapentadol concentration found in the heart blood submitted in this case was more than 20 times the upper limit of the therapeutic range. Possible mechanisms of death include respiratory depression, central nervous system depression, and serotonin syndrome. Based on the scene investigation and autopsy findings in this case, the medical examiner determined that the cause of death was narcotic (Nucynta) intoxication and the manner of death was undetermined.
曲马多（Nucynta）是一种中枢性阿片类镇痛药，用于治疗中度至重度急性疼痛。其疗效被认为归因于μ-阿片受体激动剂活性以及抑制去甲肾上腺素再摄取，从而导致去甲肾上腺素浓度升高。文献中仅有另一例与该药物毒性或死亡报告相关的案例。本病例报告记录了一例曲马多被认定为死亡原因的案例。在该病例中提交的心血中发现的曲马多浓度超过治疗范围上限的20倍。可能的死亡机制包括呼吸抑制、中枢神经系统抑制和血清素综合征。基于该病例的现场调查和尸检结果，法医判定死亡原因是麻醉药（Nucynta）中毒，死亡方式无法确定。
