Postmortem forensic toxicology of trazodone
Goeringer, KE
Washington State Toxicology Laboratory, Department of Laboratory Medicine, Seattle, WA., United States Air Force Academy, Colorado Springs, CO.

Raymon, L
Toxicology Laboratory, Pathology Department, University of Miami, Miami, FL.

Logan, BK
Washington State Toxicology Laboratory, Department of Laboratory Medicine, Seattle, WA.


Abstract
Trazodone is a popular antidepressant medication that has been available for approximately 30 years. It has a reputation as a safe drug with relatively few reported fatalities attributed solely to it. We review the pharmacology and forensic toxicology of trazodone and report toxicology and cause and manner of death in a series of 37 deaths in which trazodone was detected.
Although the normal upper therapeutic blood concentration for trazodone is about 2 mg/L, fatalities are rarely attributed solely to it at blood concentrations below 9 mg/L. Considering the pharmacology of the drug, potential interactions between other drugs with serotonin reuptake properties need to be considered, as does the increased susceptibility to the toxic effects in patients with pre-existing heart disease.
In the cases reviewed, none were attributed solely to trazodone, although trazodone was frequently present together with other serotonergic drugs, such as the selective serotonin reuptake inhibitors like fluoxetine and sertraline. Ten cases had blood trazodone concentrations above 2 mg/L. Of these cases, trazodone played a primary role in the death of three subjects, with blood concentrations all greater than 9 mg/L.
We confirm the conclusions of others that trazodone is a relatively safe drug except in massive overdose, although its toxicity may be influenced by the presence of other drugs and underlying pathophysiology.

Keywords:
forensic science, forensic toxicology, serotonin syndrome, trazodone

Paper ID: JFS4540850

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Author Ying, BW Affiliation Institute of Forensic Medicine, Sichuan University (West China University
of Medical Sciences), Chengdu 610041, Sichuan, P. R. China. Author Chen, JH Affiliation Public Security Bureau of Wenling, Zhejiang, P. R. China. Author Wang, JP Affiliation Panzhihua Central Hospital, Sichuan, P. R. China. Author Shi, MS Affiliation Author Deng, JQ Affiliation Author Li, YB Affiliation Author Wu, J Affiliation Author Zhang, J Affiliation Author Yan, J Affiliation Author Lin, W Affiliation The PeopleÆs Procuratorate of Chengdu, Chengdu 610041, Sichuan, P. R.
China. Author Hou, BS Affiliation Author Goeringer KE, Raymon L, Logan BK Title Postmortem forensic toxicology of trazodone Symposium , Committee on