An autopsy case of BRONTM overdose with multiple drug ingestion |
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| Affiliation: | 1. Department of Forensic Medicine, Kagawa University, 1750-1 Miki, Kita, Kagawa 761-0793, Japan;2. Biodesign Inc., 3-25-15 Nishi Ikebukuro, Toshima, Tokyo 171-0021, Japan;3. Department of Hygiene, Kagawa University, 1750-1 Miki, Kita, Kagawa 761-0793, Japan;1. Instituto de Investigación en Genética Molecular, Universidad de Guadalajara (CUCiénega-UdeG), Av. Universidad 1115, Paso Blanco, Ocotlán, Jalisco CP 47810, Mexico;2. Laboratorio DNA Profile, Delgadillo Araujo #305, Col. El Rosario, Ocotlán, Jalisco CP 47849, Mexico;1. Division of Medical Education, Nihon University School of Medicine, Tokyo, Japan;2. Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan;3. Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan;4. Department of Legal Medicine, Nihon University School of Medicine, Tokyo, Japan;5. Department of Clinical Laboratory, Nihon University Itabashi Hospital, Tokyo, Japan;6. Research Institute of Medical Research Support Center Electron Microscope Laboratory, Nihon University School of Medicine, Tokyo, Japan;7. Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan;8. Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan;1. Department of Forensic Medicine, University Hospital of Montpellier, Montpellier, France;2. EDPFM, UR-UM212, University of Montpellier, Montpellier, France;1. Department of Oral and Craniofacial Sciences, Faculty of Dentistry, Universiti Malaya, Malaysia;2. Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, Malaysia;3. Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Malaysia;4. Department of Artificial Intelligence, Faculty of Computer Science & Information Technology, Universiti Malaya, Malaysia;1. Division of Legal Medicine, Department of Social Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-cho, Miyazaki 889-1692, Japan;2. Radiology Division, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Japan;3. Medical Student, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-cho, Miyazaki 889-1692, Japan;4. Department of Medical Sciences, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-cho, Miyazaki 889-1692, Japan;5. Frontier Science Research Center, University of Miyazaki, 5200 Kihara, Kiyotake-cho, Miyazaki 889-1692, Japan;1. Guilloz Imaging Department, Central Hospital, CHRU Nancy, F-54000, France;2. Forensic Institute, Brabois Adultes Hospital, CHRU Nancy, F-54000, France;3. Lorraine University, Inserm, IADI, F-54000 Nancy, France |
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| Abstract: | A man in his forties was found dead in his friend’s home, with moderate putrefaction. Quantitative toxicological analysis showed that concentrations of caffeine, chlorpheniramine, dihydrocodeine, and methylephedrine were 183.3 µg/mL, 0.533 µg/mL, 2.469 µg/mL and 8.336 µg/mL, respectively. Ephedrine, amitriptyline, nortriptyline, etizolam, fluvoxamine and 7-aminoflunitrazepam were detected in an aortic blood sample. Caffeine, chlorpheniramine, dihydrocodeine and methylephedrine are the main components of BRONTM, an over-the-counter antitussive sold in Japan. Those concentrations in blood were within fatal ranges. Caffeine is classified as a methylxanthine and is mainly metabolized by cytochrome P450 (CYP)1A2. Fluvoxamine is a potent CYP1A2 inhibitor. Blood fluvoxamine concentration was within the therapeutic range, but would have increased blood caffeine level by the inhibition of caffeine metabolism. The conclusion was that his death was caused by BRONTM overdose. Inhibition of caffeine metabolism may increase blood caffeine concentrations. This suggests that more attention should be paid to potential interactions between multiple drugs. |
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| Keywords: | Overdose Caffeine Drug interaction |
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