Ropinirole involved in a fatal case: blood and urinary concentrations
Ropinirole involved in a fatal case: blood and urinary concentrations
复制标题
罗匹尼罗涉及致命病例：血液和尿液浓度
DOI：
10.1007/s11419-021-00593-8
复制
发表时间：
2022
影响因子：
2.2
通讯作者：
Iwase Hirotaro
中科院分区：
文献类型：
--
作者：
Nagasawa Sayaka;Yamaguchi Rutsuko;Saka Kanju;Torimitsu Suguru;Chiba Fumiko;Yajima Daisuke;Inokuchi Go;Motomura Ayumi;Kira Kei;Yamagishi Yoshikazu;Ogra Yasumitsu;Iwase Hirotaro
目的：安非他命是一种抗帕金森病药物，最近被认为对肌萎缩性侧索硬化有效。预计在不久的将来，罗匹尼罗的处方将会增加。然而，目前还不清楚血液中的致命浓度。因此，我们报告了一个涉及罗匹尼罗中毒的致命病例，并参考几个涉及罗匹尼罗的尸检病例讨论了致命浓度。方法采用药物筛选法对5例尸检患者的股静脉血、心脏血和尿液中罗匹尼罗进行定量分析。1例为罗匹尼罗中毒病例（本报告），其余为非中毒病例。比较并讨论了它们的罗匹尼罗浓度。结果患者股血、心血、尿中罗匹尼罗浓度分别为100 ng/mL、160 ng/mL和1840 ng/mL。4例非罗匹尼罗中毒患者的血药浓度分别为：股血7 ~ 35 ng/mL（平均24 ng/mL），心血13 ~ 100 ng/mL（平均60 ng/mL），尿140 ~ 1090 ng/mL（平均640 ng/mL）。心脏/外周比值在1.6-2.1之间（平均1.8）。结论无明显用药过量迹象，心脏/外周血比值高提示死后可能发生了再分布，但外周血罗匹尼罗浓度（100 ng/mL）明显高于既往罗匹尼罗中毒致死病例（64 ng/mL）。根据这些结果，本病例的死亡原因被认为是由于罗匹尼罗中毒引起的休克和致命性心律失常。本病例提供了死后血液和尿液中罗匹尼罗中毒水平的重要数据。
PurposeRopinirole is an antiparkinsonian drug and has recently been suggested to be effective in amyotrophic lateral sclerosis. It is expected that ropinirole prescriptions will increase in the near future. However, the fatal concentration in blood is unclear at this time. Therefore, we report a fatal case involving ropinirole intoxication and discuss the fatal concentrations with reference to several autopsy cases involving ropinirole.MethodsRopinirole was quantified in femoral vein blood, cardiac blood, and urine from five autopsy cases in which ropinirole was detected by drug screening in our laboratory. One is a ropinirole intoxication case (this report) and the others were non-intoxication cases. Their ropinirole concentrations were compared and discussed.ResultsThe ropinirole concentration in this case was 100 ng/mL in femoral blood, 160 ng/mL in cardiac blood, and 1840 ng/mL in urine. The ropinirole concentrations in the four non-ropinirole poisoning cases were 7–35 ng/mL (mean: 24 ng/mL) in femoral blood, 13–100 ng/mL (mean: 60 ng/mL) in cardiac blood, and 140–1090 ng/mL (mean: 640 ng/mL) in urine. Cardiac/peripheral ratios were in the range of 1.6–2.1 (mean 1.8).ConclusionsThere were no obvious signs of overdose, and the high cardiac/peripheral blood ratio suggested that postmortem redistribution may have occurred, but the peripheral blood ropinirole concentration (100 ng/mL) was obviously higher than that reported in the previous fatal case of ropinirole poisoning (64 ng/mL). Based on these results, the cause of death in this case was considered to be shock and fatal arrhythmia due to ropinirole poisoning. This case provides important data on postmortem blood and urinary levels of ropinirole poisoning.