SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists
SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists
SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists
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PIS <br />
LEVELS OF LEVETIRACETAM IN POSTMORTEM BLOOD<br />
Ashraf Mozayani* and Terry J. Danielson. Harris County Medical Examiner, 1885 Old Spanish Trail,<br />
Houston, Texas, 77054<br />
Levetiracetam (LEV) is a recently introduced anticonvulsant agent and little information is available to<br />
assist in the interpretation <strong>of</strong> levels seen in post-mortem cases. Our objective is to report our observations<br />
from three Medical Examiner cases in which LEV was detected.<br />
LEV is said to have "ideal" pharmacokinetic characteristics for clinical application. It is well absorbed after<br />
oral administration and is distributed approximately into body water. It is not appreciably bound to plasma<br />
protein and its apparent plasma elimination half-life is near to 6 hours.<br />
LEV was extracted from acidified blood into dichloromethane and was assayed by gas chromatography I<br />
mass spectrometry using hexobarbital as internal standard. The retention factor, relative to hexobarbital,<br />
was 0.79 on a HP-5 column (initial temp, 50 ·C; time 1, 1 min; ramp 1,50 ·C Imin to 100 ·C; ramp 2, 20<br />
·C/min to 285 "C). The electron impact mass spectrum contained an intense ion at mlz 126, minor ions at<br />
mlz 170 (m*), 98 and 69.<br />
Case summaries and levels <strong>of</strong> LEV in postmortem blood are reported in Table 1. The data suggest that<br />
postmortem levels <strong>of</strong> LEV near 60 mgIL may be within the normal therapeutic range, and might be<br />
encountered, without toxicological consequence. A lower level, near 10 mgIL as seen in case number 3,<br />
may be sub-therapeutic.<br />
Table 1: Levels <strong>of</strong> Levetiracetam (LEV) in postmortem blood, Case 1, femoral. Cases 2 and 3, source not<br />
indicated<br />
Case # Age Sex LEV Other drugs<br />
Cause <strong>of</strong>Death<br />
Manner<br />
(mg/L) (mg/L blood)<br />
1 22 M 60 None detected Idiopathic epilepsy, Natural<br />
cerebral sclerosis<br />
2 58 M 61 Hydrocodone, 0.25 Hypertensive<br />
Natural<br />
Metoprolol, 1.4<br />
Amitriptyline, 0.38<br />
Nortriptyline, 0.57<br />
Paroxetine, 0.33<br />
cardiovascular disease<br />
Post -cerebral vascular<br />
infarct seizure disorder<br />
I<br />
Trazadone, 0.93<br />
Phenobarbital, < 10<br />
3 35 M 11 None detected Drowning,<br />
Accident<br />
Seizure due to remote<br />
leptomeningitis<br />
Keywords: Levetiracetam, blood, postmortem<br />
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