Postmortem Redistribution of Tramadol and O-Desmethyltramadol

Tramadol is a widely used analgesic opioid for moderate-to-severe pain due to its efficacy and safety. Although tramadol induces less adverse effects compared with other opioids, an increased number of documented cases of dependence, abuse, intentional overdose or intoxication have been described. I...

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Bibliographic Details
Published in:Journal of analytical toxicology 2013-11, Vol.37 (9), p.670-675
Main Authors: Costa, Isabel, Oliveira, Ana, Guedes de Pinho, Paula, Teixeira, Helena Maria, Moreira, Roxana, Carvalho, Félix, Jorge Dinis-Oliveira, Ricardo
Format: Article
Language:English
Subjects:
Analgesics, Opioid - blood
Analgesics, Opioid - metabolism
Analgesics, Opioid - poisoning
Drug Overdose
Gas Chromatography-Mass Spectrometry
Humans
Indicators and Reagents
Myocardium - chemistry
Myocardium - metabolism
Postmortem Changes
Reference Standards
Reproducibility of Results
Spectrometry, Mass, Electrospray Ionization
Tissue Distribution
Tramadol - analogs & derivatives
Tramadol - blood
Tramadol - metabolism
Tramadol - poisoning
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Summary:Tramadol is a widely used analgesic opioid for moderate-to-severe pain due to its efficacy and safety. Although tramadol induces less adverse effects compared with other opioids, an increased number of documented cases of dependence, abuse, intentional overdose or intoxication have been described. In fatal intoxication, the interpretation of the probable cause of death often relies on the measurement of the tramadol concentration in blood. However, postmortem redistribution (PMR) may affect the results and therefore bias the autopsy report. In the present study, the postmortem cardiac and femoral blood samples from 15 cases of fatal tramadol intoxication were obtained to assess the PMR of tramadol and its main active metabolite, O-desmethyltramadol (M1). Toxicological analysis was performed by the gas chromatography-electron impact-mass spectrometry (GC-EI-MS) method, previously developed and validated for the quantification of both analytes. The cardiac-to-femoral blood ratios of 1.40 and 1.28 were obtained for tramadol and M1, respectively. Results were compared with those in the literature and it was possible to conclude that femoral blood should be considered for quantitative interpretations in fatal cases of tramadol intoxication.
ISSN:0146-4760
1945-2403
DOI:10.1093/jat/bkt084