Vignali Claudia, Groppi Angelo, Brandolini Francesca, Avato Francesco Maria, Talarico Anna, Gaudio Rosa Maria, Morini Luca
Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy.
Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy.
Forensic Sci Int. 2017 Jul;276:e8-e12. doi: 10.1016/j.forsciint.2017.04.025. Epub 2017 May 8.
Mirtazapine is a noradrenergic and specific serotoninergic antidepressant agent that stimulates norepinephrine and serotonin release while also blocking serotonin receptors (5-HT2 and 5-HT3). Although the drug is used extensively, at present we do not know of any fatal cases due to mirtazapine alone. On the contrary, the published literature describes several fatal poisoning cases related to the intake of mirtazapine together with other drugs. Here we describe a fatal case of mirtazapine self-poisoning, since the other drug detected (lorazepam), was within the therapeutic range. Analyses were performed by LC-MS/MS on body fluids and a hair sample and mirtazapine concentration measured in blood was very high: 9.3mg/L. N-Desmethylmirtazapine was also quantitated. We then compared our results with those of previously published cases. In conclusion, even though mirtazapine can be considered a relatively safe drug, taking a large amount alone or in combination with other drugs, could lead to death.
米氮平是一种去甲肾上腺素能和特异性5-羟色胺能抗抑郁药，它能刺激去甲肾上腺素和5-羟色胺释放，同时还能阻断5-羟色胺受体（5-HT2和5-HT3）。尽管该药物被广泛使用，但目前我们尚未知晓任何仅因米氮平导致的致命病例。相反，已发表的文献描述了几起因同时服用米氮平和其他药物而导致的致命中毒病例。在此，我们描述一例米氮平自服中毒致死的病例，因为检测到的另一种药物（劳拉西泮）处于治疗范围内。通过液相色谱-串联质谱法对体液和一份毛发样本进行了分析，血液中测得的米氮平浓度非常高：9.3mg/L。同时也对N-去甲基米氮平进行了定量分析。然后我们将我们的结果与先前发表的病例结果进行了比较。总之，尽管米氮平可被认为是一种相对安全的药物，但单独大量服用或与其他药物联合服用都可能导致死亡。
