Problems of Forensic Sciences 2020 Vol. 121 (CXXI) 51-63
FATAL TAPENTADOL POISONING – CASE STUDY AND LITERATURE REVIEW
Joanna GIEROŃ, Piotr ADAMOWICZ
Institute of Forensic Research, Kraków, Poland
Streszczenie
Tapentadol is a new opioid drug with a dual mechanism of action. It acts agonistically on the µ opioid receptor and as a norepinephrine reuptake inhibitor. It has been used in Poland since 2017 in the treatment of pain of various origins, including postoperative and cancer pain. Literature reports of cases of death in which this drug was detected in biological material are few, which also attests to the fact that it is a relatively safe drug compared to other strong opioids. It is structurally similar to tramadol, but it interacts pharmacokinetically and pharmacodynamically with other drugs much less frequently than tramadol.
This paper is dedicated to a discussion of a case of suicidal poisoning with tapentadol against the background of other cases in the literature. In autopsy material taken from a 27-year-old woman, tapentadol was detected at concentrations of 6.8 µg/ml in blood and 7.3 µg/ml in urine. The presence of ethyl alcohol at concentrations of 1.48‰ and 3.46‰, respectively, was also demonstrated.
The autopsy report did not show the presence of any pathological or injury-related changes. Liquid-liquid extraction and liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) were used as the method of determination. This is the first case in Poland, and so far the only one in the literature, where fatal poisoning was caused by the interaction of tapentadol and ethanol.
Słowa kluczowe
Tapentadol; Ethyl alcohol; New opioids; Fatal intoxication; LC-MS/MS.