Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba, 260-8670, Japan.
Laboratory of Forensic Toxicology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba, 260-8670, Japan.
Forensic Toxicol. 2022 Jan;40(1):173-179. doi: 10.1007/s11419-021-00593-8. Epub 2021 Aug 14.
Ropinirole is an antiparkinsonian drug and has recently been suggested to be effective in amyotrophic lateral sclerosis. It is expected that ropinirole prescriptions will increase in the near future. However, the fatal concentration in blood is unclear at this time. Therefore, we report a fatal case involving ropinirole intoxication and discuss the fatal concentrations with reference to several autopsy cases involving ropinirole.
Ropinirole was quantified in femoral vein blood, cardiac blood, and urine from five autopsy cases in which ropinirole was detected by drug screening in our laboratory. One is a ropinirole intoxication case (this report) and the others were non-intoxication cases. Their ropinirole concentrations were compared and discussed.
The ropinirole concentration in this case was 100 ng/mL in femoral blood, 160 ng/mL in cardiac blood, and 1840 ng/mL in urine. The ropinirole concentrations in the four non-ropinirole poisoning cases were 7-35 ng/mL (mean: 24 ng/mL) in femoral blood, 13-100 ng/mL (mean: 60 ng/mL) in cardiac blood, and 140-1090 ng/mL (mean: 640 ng/mL) in urine. Cardiac/peripheral ratios were in the range of 1.6-2.1 (mean 1.8).
There were no obvious signs of overdose, and the high cardiac/peripheral blood ratio suggested that postmortem redistribution may have occurred, but the peripheral blood ropinirole concentration (100 ng/mL) was obviously higher than that reported in the previous fatal case of ropinirole poisoning (64 ng/mL). Based on these results, the cause of death in this case was considered to be shock and fatal arrhythmia due to ropinirole poisoning. This case provides important data on postmortem blood and urinary levels of ropinirole poisoning.
罗匹尼罗是一种抗帕金森病药物，最近有研究表明其对肌萎缩侧索硬化症有效。预计在不久的将来，罗匹尼罗的处方量将会增加。然而，目前其血液中的致死浓度尚不清楚。因此，我们报告了一例因罗匹尼罗中毒导致的死亡病例，并参考几例涉及罗匹尼罗的尸检案例讨论了其致死浓度。
对本实验室药物筛查发现的 5 例尸检案例中的股静脉血、心血和尿液中的罗匹尼罗进行了定量分析。其中 1 例为罗匹尼罗中毒病例（本报告），其余 4 例为非中毒病例。对它们的罗匹尼罗浓度进行了比较和讨论。
本例中，股血中的罗匹尼罗浓度为 100ng/mL，心血中的浓度为 160ng/mL，尿液中的浓度为 1840ng/mL。在 4 例非罗匹尼罗中毒的案例中，股血中的浓度为 7-35ng/mL（平均值：24ng/mL），心血中的浓度为 13-100ng/mL（平均值：60ng/mL），尿液中的浓度为 140-1090ng/mL（平均值：640ng/mL）。心/外周比值在 1.6-2.1 之间（平均值为 1.8）。
没有明显的过量迹象，且高的心/外周血比值提示可能发生了死后再分布，但外周血罗匹尼罗浓度（100ng/mL）明显高于先前报告的罗匹尼罗中毒致死浓度（64ng/mL）。基于这些结果，本例的死亡原因被认为是罗匹尼罗中毒导致的休克和致命性心律失常。本病例为罗匹尼罗中毒死后血液和尿液水平提供了重要数据。
