Association between sexual activity-related death and non-prescription use of phosphodiesterase type 5 inhibitors
Association between sexual activity-related death and non-prescription use of phosphodiesterase type 5 inhibitors
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DOI：
10.1016/j.legalmed.2020.101815
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发表时间：
2021-02-01
期刊：
影响因子：
1.5
通讯作者：
Iwase, Hirotaro
中科院分区：
文献类型：
--
作者：
Nagasawa, Sayaka;Saka, Kanju;Iwase, Hirotaro
近年来，通过互联网或其他方式从国外购买未经医生诊断的5型磷酸二酯酶抑制剂（PDE5i）的使用有所增加。我们报告了六例非处方使用 PDE5i 可能导致死亡的病例。在被认为经历过心源性猝死的四名死者中，三人（病例1-3）有心血管疾病史，这是禁忌症，其余病例（病例4）涉及联合使用多种PDE5i。 4例心源性猝死病例中，有2例检出西地那非（0.063μg/mL、0.087μg/mL）。其余两例中，其中一例检出他达拉非（0.096μg/mL），另一例检出他达拉非（0.197μg/mL）和伐地那非（0.011μg/mL）。 1例有禁忌史的交通事故病例中检出西地那非（0.032μg/mL）、他达拉非（0.062μg/mL）、乙醇。在因呕吐物吸入而窒息的一例中，尸检显示冠状动脉前降支狭窄90%，并检出了西地那非（0.063μg/mL）。据我们所知，这是第一份关于他达拉非和伐地那非死后血液浓度可能导致死亡的报告。尽管有很多关于使用 PDE5 抑制剂危险的警告，但在尸检过程中仍然发现了 PDE5i 导致死亡的病例。因此，提高公众对个人使用进口药品相关风险的认识是必要的。
In recent years, there has been an increase in the use of phosphodiesterase type 5 inhibitors (PDE5i) that are purchased from abroad without a doctor's diagnosis via the Internet or other means. We report six cases in which nonprescription use of PDE5i may have led to death. Among the four deceased individuals who were believed to have experienced sudden cardiac death, three (cases 1-3) had a history of cardiovascular disease, which is a contraindication, and the remaining case (case 4) involved combined use of multiple PDE5i. Sildenafil (0.063 mu g/mL, 0.087 mu g/mL) was detected in two of the four cases of sudden cardiac death. Tadalafil (0.096 mu g/mL) was detected in one of the remaining two cases, and tadalafil (0.197 mu g/mL) and vardenafil (0.011 mu g/mL) were detected in the other case. Sildenafil (0.032 mu g/mL), tadalafil (0.062 mu g/mL), and ethanol were detected in a traffic accident case with a history of contraindications. In a case of asphyxiation by vomit aspiration, autopsy showed 90% stenosis in the anterior descending branch of the coronary artery, and sildenafil (0.063 mu g/mL) was detected. To the best of our knowledge, this is the first report of postmortem blood levels of tadalafil and vardenafil likely contributing to the cause of death. Despite all the warnings about the dangers of using PDE5 inhibitors, cases of PDE5i contributing to death are still identified during autopsies. Therefore, raising public awareness of the risks of the risks associated with the imported drug use by individuals is necessary.