Differences in amiodarone,digoxin,flecainide and sotalol concentrations between antemortem serum and femoral postmortem blood

Abstract

1 The concentrations of amiodarone/desethylamiodarone, digoxin, flecainide and sotalol were measured in serum collected immediately prior to death and in postmortem blood collected from the femoral vein and artery of an 18-year-old male with congenital heart disease who developed a fatal arrhythmia.

2 The concentrations of all four drugs in the sample col lected during life were consistent with the dosage given and in the range accepted for normal therapy.

3 There were no differences in amiodarone/desethylamio darone, flecainide and sotalol concentrations in arterial or venous postmortem blood.

4 The concentrations of desethylamiodarone, digoxin, fle cainide and sotalol but not amiodarone, were higher in postmortem blood than in antemortem serum. The flecainide concentration was significantly greater than the upper limit associated with toxicity in life. Without knowledge of the true concentration measured in life, this apparently high, toxic concentration would have suggested that death could have resulted from arrhyth mogenic/proarrhythmic effects of the drug in excess.

5 These results further demonstrate the hazards in inter preting postmortem blood concentrations following suspected drug intoxication.