Postmortem Drug Redistribution: A Compilation of Postmortem/Antemortem Drug Concentration Ratios

Dylan Mantinieks; Dimitri Gerostamoulos; Linda Glowacki; Matthew Di Rago; Jennifer Schumann; Noel W. Woodford; Olaf H. Drummer

doi:10.1093/jat/bkaa107

Postmortem Drug Redistribution: A Compilation of Postmortem/Antemortem Drug Concentration Ratios

Dylan Mantinieks, Dimitri Gerostamoulos, Linda Glowacki, Matthew Di Rago, Jennifer Schumann, Noel W. Woodford, Olaf H. Drummer

Department of Forensic Medicine

Research output: Contribution to journal › Article › Research › peer-review

30 Citations (Scopus)

Abstract

Postmortem drug redistribution (PMR) is a well-known phenomenon in forensic toxicology with implications for medico-legal death investigations. Paired antemortem (AM) specimen and postmortem (PM) mortuary admission femoral blood drug concentrations from 811 coronial cases were used to construct a retrospective compilation of PM/AM drug concentration ratios for 42 parent drugs and metabolites. The median PM/AM ratios for all antidepressants were > 1 and consistent with PMR In contrast, the median PM/AM ratios of most benzodiazepines were < 1. The antipsychotics were varied (0.63-3.3) and suggest the mixed effects of PMR and drug instability. Amphetamines exhibited no trends (0.90-0.95) and are likely confounded by many factors. The PM/AM ratios of cardiovascular drugs, opioids and other drugs are also reported. This research represents an expansive retrospective compilation of paired AM and PM drug concentrations for many toxicologically relevant drugs. While the median PM/AM ratios demonstrate some drug-dependent trends, there was no obvious relationship between AM specimens and PM femoral blood taken at mortuary admission.

Original language	English
Pages (from-to)	368-377
Number of pages	10
Journal	Journal of Analytical Toxicology
Volume	45
Issue number	4
DOIs	https://doi.org/10.1093/jat/bkaa107
Publication status	Published - May 2021

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title = "Postmortem Drug Redistribution: A Compilation of Postmortem/Antemortem Drug Concentration Ratios",

abstract = "Postmortem drug redistribution (PMR) is a well-known phenomenon in forensic toxicology with implications for medico-legal death investigations. Paired antemortem (AM) specimen and postmortem (PM) mortuary admission femoral blood drug concentrations from 811 coronial cases were used to construct a retrospective compilation of PM/AM drug concentration ratios for 42 parent drugs and metabolites. The median PM/AM ratios for all antidepressants were > 1 and consistent with PMR In contrast, the median PM/AM ratios of most benzodiazepines were < 1. The antipsychotics were varied (0.63-3.3) and suggest the mixed effects of PMR and drug instability. Amphetamines exhibited no trends (0.90-0.95) and are likely confounded by many factors. The PM/AM ratios of cardiovascular drugs, opioids and other drugs are also reported. This research represents an expansive retrospective compilation of paired AM and PM drug concentrations for many toxicologically relevant drugs. While the median PM/AM ratios demonstrate some drug-dependent trends, there was no obvious relationship between AM specimens and PM femoral blood taken at mortuary admission.",

author = "Dylan Mantinieks and Dimitri Gerostamoulos and Linda Glowacki and {Di Rago}, Matthew and Jennifer Schumann and Woodford, {Noel W.} and Drummer, {Olaf H.}",

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AU - Mantinieks, Dylan

AU - Gerostamoulos, Dimitri

AU - Glowacki, Linda

AU - Di Rago, Matthew

AU - Schumann, Jennifer

AU - Woodford, Noel W.

AU - Drummer, Olaf H.

PY - 2021/5

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N2 - Postmortem drug redistribution (PMR) is a well-known phenomenon in forensic toxicology with implications for medico-legal death investigations. Paired antemortem (AM) specimen and postmortem (PM) mortuary admission femoral blood drug concentrations from 811 coronial cases were used to construct a retrospective compilation of PM/AM drug concentration ratios for 42 parent drugs and metabolites. The median PM/AM ratios for all antidepressants were > 1 and consistent with PMR In contrast, the median PM/AM ratios of most benzodiazepines were < 1. The antipsychotics were varied (0.63-3.3) and suggest the mixed effects of PMR and drug instability. Amphetamines exhibited no trends (0.90-0.95) and are likely confounded by many factors. The PM/AM ratios of cardiovascular drugs, opioids and other drugs are also reported. This research represents an expansive retrospective compilation of paired AM and PM drug concentrations for many toxicologically relevant drugs. While the median PM/AM ratios demonstrate some drug-dependent trends, there was no obvious relationship between AM specimens and PM femoral blood taken at mortuary admission.

AB - Postmortem drug redistribution (PMR) is a well-known phenomenon in forensic toxicology with implications for medico-legal death investigations. Paired antemortem (AM) specimen and postmortem (PM) mortuary admission femoral blood drug concentrations from 811 coronial cases were used to construct a retrospective compilation of PM/AM drug concentration ratios for 42 parent drugs and metabolites. The median PM/AM ratios for all antidepressants were > 1 and consistent with PMR In contrast, the median PM/AM ratios of most benzodiazepines were < 1. The antipsychotics were varied (0.63-3.3) and suggest the mixed effects of PMR and drug instability. Amphetamines exhibited no trends (0.90-0.95) and are likely confounded by many factors. The PM/AM ratios of cardiovascular drugs, opioids and other drugs are also reported. This research represents an expansive retrospective compilation of paired AM and PM drug concentrations for many toxicologically relevant drugs. While the median PM/AM ratios demonstrate some drug-dependent trends, there was no obvious relationship between AM specimens and PM femoral blood taken at mortuary admission.

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Postmortem Drug Redistribution: A Compilation of Postmortem/Antemortem Drug Concentration Ratios

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