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Fatality following a suicidal overdose with varenicline

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Abstract

The smoking cessation agent varenicline acts as a partial agonist on α4β2 nicotinic acetylcholine receptors. Although debated, several reports have linked varenicline therapy to an increased risk of suicidal thoughts and/or suicide. In addition, several non-fatal overdose cases have been reported. In this report, we utilised a sample preparation procedure suitable for postmortem samples and gas chromatography coupled to mass spectrometry to analyse samples obtained from a suicidal case in which ingestion of an overdose of varenicline had occurred. Extremely high concentrations of varenicline (>250 ng/ml) were detected in the blood of the deceased, in addition to high concentrations in urine and vitreous humour. To the best of our knowledge, similar high concentrations have not been reported yet. Although, with respect to the mechanism of death in this case, confounding factors were concomitant ethanol consumption and, importantly, potentially fatal hypothermia, this is the first report of a fatality associated with the ingestion of an overdose of varenicline.

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Acknowledgments

We wish to acknowledge Prof. Dr. Dr. h. c. Hans Maurer for kindly providing us with an extract from the ‘Mass Spectral and GC Data of Drugs, Poisons, Pesticides, Pollutants and their Metabolites 2011’ before it was published.

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Authors and Affiliations

  1. Department of Toxicology, Forensic Institute—Ghent University, Harelbekestraat 72, 9000, Ghent, Belgium

    Christophe P. Stove & Willy E. Lambert

  2. Department of Forensic Medicine, Forensic Institute—Ghent University, Jozef Kluyskensstraat 29, 9000, Ghent, Belgium

    Els A. De Letter & Michel H. Piette

Authors
  1. Christophe P. Stove
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  2. Els A. De Letter
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  3. Michel H. Piette
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  4. Willy E. Lambert
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Corresponding author

Correspondence to Christophe P. Stove.

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Stove, C.P., De Letter, E.A., Piette, M.H. et al. Fatality following a suicidal overdose with varenicline. Int J Legal Med 127, 85–91 (2013). https://doi.org/10.1007/s00414-012-0695-5

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  • DOI: https://doi.org/10.1007/s00414-012-0695-5

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