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Case study: two fatal case reports of acute yohimbine intoxication.

Abstract

Yohimbine is an alkaloid that has been encountered on the streets as an aphrodisiac, hallucinogen, dietary supplement and erectile dysfunction drug. Yohimbine hydrochloride is an alpha 2-adrenoreceptor antagonist, blocking the pre- and postsynaptic alpha-2 adrenoreceptors and causing an increased release of noradrenaline and dopamine. An average oral dose of 5-15 mg produces a therapeutic whole blood level range of 40-400 ng/mL. Overdoses leading to neurotoxic effects have been seen with blood concentrations up to 5,000 ng/mL. The laboratories from the Maricopa County Medical Examiner and the Los Angeles County Department of Coroner each encountered a case in which yohimbine was identified in whole blood by means of a liquid-liquid basic drug extraction with detection on a GC-MS. Because validated quantitative methods for yohimbine did not exist at either facility, both agencies referred the blood specimens to NMS Labs, Inc. The reference laboratory analyzed the blood specimens with an LC-MS-MS and determined the quantitative values of yohimbine to be 7,400 and 5,400 ng/mL. Given the absence of other significant positive findings and the substantial yohimbine blood concentrations cited, the respective Medical Examiners determined the cause of death to be acute yohimbine intoxication with the mode being an accident. Yohimbine is a rarely encountered drug in medical examiner casework, and interpretation of the results is difficult to assess toward the cause and manner of death without such case studies being described.

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  • Authors+Show Affiliations

    ,

    1Forensic Science Center, Maricopa County Office of the Medical Examiner, 701 West Jefferson, Phoenix, AZ 85007, USA.

    , ,

    Source

    Journal of analytical toxicology 37:8 2013 Oct pg 611-4

    MeSH

    Adult
    Enzyme-Linked Immunosorbent Assay
    Fatal Outcome
    Gas Chromatography-Mass Spectrometry
    Humans
    Male
    Street Drugs
    Substance Abuse Detection
    Substance-Related Disorders
    Yohimbine
    Young Adult

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng

    PubMed ID

    23846025

    Citation

    Anderson, Colin, et al. "Case Study: Two Fatal Case Reports of Acute Yohimbine Intoxication." Journal of Analytical Toxicology, vol. 37, no. 8, 2013, pp. 611-4.
    Anderson C, Anderson D, Harre N, et al. Case study: two fatal case reports of acute yohimbine intoxication. J Anal Toxicol. 2013;37(8):611-4.
    Anderson, C., Anderson, D., Harre, N., & Wade, N. (2013). Case study: two fatal case reports of acute yohimbine intoxication. Journal of Analytical Toxicology, 37(8), pp. 611-4. doi:10.1093/jat/bkt057.
    Anderson C, et al. Case Study: Two Fatal Case Reports of Acute Yohimbine Intoxication. J Anal Toxicol. 2013;37(8):611-4. PubMed PMID: 23846025.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Case study: two fatal case reports of acute yohimbine intoxication. AU - Anderson,Colin, AU - Anderson,Dan, AU - Harre,Nicole, AU - Wade,Norman, Y1 - 2013/07/11/ PY - 2013/7/13/entrez PY - 2013/7/13/pubmed PY - 2014/4/15/medline SP - 611 EP - 4 JF - Journal of analytical toxicology JO - J Anal Toxicol VL - 37 IS - 8 N2 - Yohimbine is an alkaloid that has been encountered on the streets as an aphrodisiac, hallucinogen, dietary supplement and erectile dysfunction drug. Yohimbine hydrochloride is an alpha 2-adrenoreceptor antagonist, blocking the pre- and postsynaptic alpha-2 adrenoreceptors and causing an increased release of noradrenaline and dopamine. An average oral dose of 5-15 mg produces a therapeutic whole blood level range of 40-400 ng/mL. Overdoses leading to neurotoxic effects have been seen with blood concentrations up to 5,000 ng/mL. The laboratories from the Maricopa County Medical Examiner and the Los Angeles County Department of Coroner each encountered a case in which yohimbine was identified in whole blood by means of a liquid-liquid basic drug extraction with detection on a GC-MS. Because validated quantitative methods for yohimbine did not exist at either facility, both agencies referred the blood specimens to NMS Labs, Inc. The reference laboratory analyzed the blood specimens with an LC-MS-MS and determined the quantitative values of yohimbine to be 7,400 and 5,400 ng/mL. Given the absence of other significant positive findings and the substantial yohimbine blood concentrations cited, the respective Medical Examiners determined the cause of death to be acute yohimbine intoxication with the mode being an accident. Yohimbine is a rarely encountered drug in medical examiner casework, and interpretation of the results is difficult to assess toward the cause and manner of death without such case studies being described. SN - 1945-2403 UR - https://www.unboundmedicine.com/medline/citation/23846025/full_citation L2 - https://academic.oup.com/jat/article-lookup/doi/10.1093/jat/bkt057 DB - PRIME DP - Unbound Medicine ER -