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An acute gabapentin fatality: a case report with postmortem concentrations

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Abstract

Gabapentin (GBP) (Neurontin®, Horizant®, Gralise®) is a widely prescribed medication used primarily for the treatment of epilepsy and neuropathic pain. GBP has a favorable adverse effect profile in therapeutic dosing with the most common reported effects being dizziness, fatigue, drowsiness, weight gain, and peripheral edema. Even with intentional GBP self-poisonings, serious effects are rare. A 47-year-old female was found dead at work with her daughter’s bottle of GBP 600 mg. There were 26 tablets missing and the decedent’s only known medication was hydrocodone/acetaminophen. Following initial detection by an alkaline drug screen (GC-MS), analysis utilizing specific liquid chromatography–mass spectrometry revealed an elevated postmortem GBP peripheral blood concentration of 37 mg/L, central blood 32 mg/L, liver 26 mg/kg, vitreous 32 mg/L, and gastric contents 6 mg. Screening for volatiles, drugs of abuse, alkaline compounds, and acid/neutral compounds was negative with the exception of ibuprofen (<2 mg/L) detected in peripheral blood. This report presents a fatality that appears to be associated with an isolated and acute GBP ingestion.

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Acknowledgments

The authors would like to thank the San Diego County Chief Medical Examiner, Dr. Glenn Wagner, for making available case details described in this manuscript.

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Authors and Affiliations

  1. California Poison Control System, San Diego Division, 200 W. Arbor Dr., San Diego, CA, 92103-8925, USA

    F. Lee Cantrell

  2. School of Pharmacy, University of California San Francisco, San Francisco, CA, USA

    F. Lee Cantrell

  3. County of San Diego Medical Examiner’s Office, 5570 Overland Ave., Suite 101, San Diego, CA, 92123, USA

    Othon Mena, Ray D. Gary & Iain M. McIntyre

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  1. F. Lee Cantrell
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  2. Othon Mena
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  3. Ray D. Gary
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  4. Iain M. McIntyre
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Correspondence to F. Lee Cantrell.

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Cantrell, F.L., Mena, O., Gary, R.D. et al. An acute gabapentin fatality: a case report with postmortem concentrations. Int J Legal Med 129, 771–775 (2015). https://doi.org/10.1007/s00414-015-1193-3

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  • DOI: https://doi.org/10.1007/s00414-015-1193-3

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