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Addiction and Substance Abuse

Postmortem toxicology

01/09/2008

Question:

My brother died of multiple drug intoxication. We`re wondering what these levels mean:

1. Xanax - .34 mcg/mL 2. Benzoylecgonine - .27 mcg/mL 3. Amitriptyline - 1.6 mcg/mL 4. Nortriptyline - .59 mcg/mL 5. Ethanol - .10 gm%

The body was not discovered for four days. Can you tell us how much of each substance/drug would be required for these levels?

Answer:

I am so sorry to hear of your loss. It is unfortunately not an uncommon story in the field of medicine that I practice.

Your brother died of sedative, cocaine and tricyclic antidepressant overdose. Xanax and alcohol work the same and the effects are additive. The levels you provided need to be compared to the toxicology report of normal values the lab is using that analyzed his serum. There are too many variables for me to estimate the quantities involved that he ingested prior to death.

Nortriptyline and Amitriptyline are old antidepressants that are highly toxic and often fatal in overdose even by themselves. They cause fatal heart rhythm problems. Adding cocaine to it provides a deadly cardiac toxic combo. Also, the combination of alcohol and cocaine create a compound called cocaethylene, which is even more cardiotoxic and destroys heart muscle cells.

The medical examiner who did the autopsy should be able to provide you with more information about the drug levels and their significance. I would suggest that you call that physician or make an appointment to discuss this in detail. Benzoylecgonine is the metabolite that we measure when cocaine is ingested.

Again, I am sincerely sorry for your loss.

For more information:

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Response by:

Edna M Jones, MD, MRO Edna M Jones, MD, MRO
Emeritus Clinical Assistant Professor of Family Medicine
College of Medicine
The Ohio State University