Reactions 1489, p15-16 - 22 Feb 2014

O X SDextropropoxyphene/paracetamol/prazepam overdose

Acute respiratory distress and liver failure: casereport

A 17-year-old boy died from acute respiratory distress aftermultiple poisoning with dextropropoxyphene/paracetamol[Di-antalvic] and prazepam [Lysanxia]; a drug interactionbetween these three drugs and/or massive liver failure causedby paracetamol [acetaminophen] may have occurred.

The boy, who had a history of depressive syndrome with aprevious suicide attempt, reported feeling ill and listless upongetting up one morning. A few moments later, he was foundlying on the floor with breathing difficulties that rapidlydeveloped into acute asphyxia. Two hours after the onset ofsymptoms, he died. While receiving medical care, emptyblister packs of prazepam and dextropropoxyphene/paracetamol were found. The amounts of active ingredientsingested were estimated from counting the tablets asprazepam 110mg, paracetamol 8g and dextropropoxyphene750mg [time to onset not stated].

Full toxicological analysis determined peripheral bloodconcentrations of dextropropoxyphene and paracetamol at6420 µg/L and 342 µg/L, respectively. Prazepam was alsodetected at 178 µg/L. The autopsy report concluded that theboy’s death was caused by toxic factors and acute respiratorydistress following a massive intake of dextropropoxypheneand paracetamol. The detection of prazepam in the bloodsuggested that its metabolism had been inhibited by a druginteraction with dextropropoxyphene and paracetamolinvolving the cytochrome oxidase system. Additionally, thefailure of prazepam metabolism may have been due to massiveand rapid liver failure caused by paracetamol; however, thishypothesis could not be confirmed.

Author comment: We present a case of death by multiplepoisoning with dextropropoxyphene, paracetamol andprazepam, for which toxicological expertise has enabled theidentification of prazepam in the blood post mortem linkedto a failure to metabolise this product.Mathiaux F, et al. Prazepam detection in post-mortem blood after acetaminophen,dextropropoxyphene and prazepam poisoning. Annales de Toxicologie Analytique25: 75-78, No. 2, 27 Sep 2013. Available from: URL: http://doi.org/10.1051/ata/2013042 [French; summarised from a translation] - France 803099443

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Reactions 22 Feb 2014 No. 14890114-9954/14/1489-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved