Fatalities attributed to normal dose fluoxetine?

[ReverbAndBeer]

Hello - I am new here, and not sure where this post belongs. Can anyone direct me to articles published in peer reviewed professional journals regarding fatalities attributed to a normal 20mg dose of fluoxetine?

I have been researching this subject for over 10 years (for personal reasons). Patient was a previously healthy female in her 30's. I am familiar with the "slow metabolizer" effect of abnormalities in CYP450, but this patient was never tested for this genetic abnormality. The central and peripheral blood samples that were used to measure the blood levels of fluoxetine were mishandled by the coroner (samples were not obtained until 36 hours after death and were not stored properly). Regardless, the levels of peripheral norfluoxetine were only slightly elevated, and an internal memo to the coroner's office from the lab director doubted that it had anything to due with the patient's death. The sheriff/coroner still, however, classified the death as "Accidental", the result of a "Seizure" which was attributed to the "Combined effects of fluoxetine and norfluoxetine". Her stomach contents contained "a single pill fragment, less than 5mg" of fluoxetine. Thee was no concomitant ingestion. Based on this information, I disagree with the coroner's findings.

The coroner stated that based on the position of the limbs, which were turned inward slightly, they believed that she had suffered a seizure. I saw the patient where she died, and she most definitely did not have any signs of having a seizure. No buccal trauma, no incontinence, and no history of seizures. The position of the extremities was more consistent with decorticate posturing due to anoxia. A fundoscopic exam was not performed.

My supposition at this point is that the SSRI caused a prolonged QT causing sudden cardiac death, but I have not been able to find anything specific about fluoxetine in the literature that supports this. She did also take St.John's Wort, but it is unknown if she had taken this within the previous 48 hours. She had never had an electrocardiogram.

My reasons for wanting to know are strictly for my own peace of mind. No lawsuits, etc (the statute of limitations passed long ago). Thank you in advance.

 

[Bob Loblaw]

~~> od

 

[alexvolume2]

Move this to advanced drug discussion, or N&P

First off I have to disagree with Señor Boblaw, OP may have a better response in ADD.....I mean Neuroscience and Pharm.

I have an interest in this subject and also am curious about the prolonged QT intervals causing sudden death...however, my knowledge is insufficient to answer OP.

 

[Hammilton]

How do you know she used no other drugs? What was tested for? Perhaps tramadol or DXM or something that wouldn't automatically be tested for.

 

[Kittycat5]

I read a case study of a woman who had repeated episodes of torsades de pointes due to fluoxetine. She was, however elderly, had left bundle branch block, and survived when fluoxetine was withdrawn. I guess it shows it is at least feasible.

 

[ReverbAndBeer]

Hi - The county sheriff's officers and coroner's deputy all immediately considered her death to be a suicide based on the full bottle of fluoxetine at the bedside. The coroner's deputy was clueless. Weeks later, when the peripheral norfluoxetine levels came back as "slightly elevated", I asked him how that could happen. He said, "You take too much of it". When I pointed out that there was only a pill fragment consisting of less than 5mg in her stomach at autopsy, which means she did NOT take too much of it, he said he would call me back. That was the last I heard from him, but they did go back and test for everything from benzo's to LSD. I'm in the "biz" and I wrote a 5 page letter detailing every mistake they made. The sheriff/coroner sent back a ½ page reply stating that their office had multiple meetings about her case and she had the most extensive toxicology testing of any case that year. I asked for a biopsy of her liver to check for genetic defects of CYP450. The letter stated that their findings were an "opinion", and that they were not mandated to provide proof. You can imagine how I felt about that, and still do.