Eine tödlich verlaufene Monointoxikation mit Flurazepam (Dalmadorm®)

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Abstract
A death case following a suicidal overdose of flurazepam (Dalmadorm®) is reported. The body was found after 3 month near a highway. The course of the intoxication is in question as benzodiazepines are believed to be relatively save drugs. The death might have occured rapidly because of the acute toxic actions of the drug overdose as well as after a protracted course involving additional complications like inflammatory alteration of the myocard or hypothermia during a coma. Flurazepam and its major metabolites were analysed in blood and urine. The toxic levels of flurazepam (0,51 mg/l), N1-desalkylflurazepam (0,14 mg/l) and N1-hydroxyethylflurazepam (9,0 mg/l) in the blood amounted to 20–50 times higher than therapeutic levels, with flurazepam and metabolites being in only slighty altered relation to each other. The overdose is considered to have been above 2,4 g (80 tablets). The resorption of the drug was complete. The analytical findings in blood and urine as well as in the GI-tract are in satisfactory agreement. The analytical data of flurazepam and its metabolites are discussed in detail, taking metabolic and pharmacokinetic parameters, autopsy findings and case circumstances into consideration. A final decision about the course of the intoxication is not possible. This case shows however the fatal consequences of a flurazepam overdose although alcohol or other drugs were not involved. Es wird ein Fall einer tödlich verlaufenen Vergiftung nach Flurazepam (Dalmadorm®)-Überdosierung in suicidaler Absicht beschrieben. Auf der Basis von chemisch-toxikologischen Analysen, pharmakokinetischen Überlegungen, Sektionsbefunden und Fallumständen wird der mögliche Vergiftungsverlauf diskutiert. Es wird die Frage erörtert, ob sich der Todeseintritt als indirekte Folge bei protrahiertem Verlauf oder als direkte Folge der akuten Arzneimittelwirkung ableiten läßt. Die Leiche wurde erst nach 3 Monaten aufgefunden.