Two cases involving clomipramine intoxication

Abstract

Clomipramine and its active metabolite norclomipramine were identified and quantitated in multiple tissues recovered from two postmortem cases using liquid chromatography-mass spectrometry. In both cases clomipramine toxicity was assessed primarily upon levels determined from brain samples. This communication supplements the database on clomipramine and norclomipramine by providing quantitative determinations of both parent drug and metabolite in multiple tissues. A literature search revealed a paucity of data on clomipramine and norclomipramine levels in general and a total absence of documented brain levels. In patients who have undergone long-term tricyclic antidepressant (TCA) therapy, blood and liver analysis alone may not be sufficient to establish toxicity. Such patients can sequester substantial amounts in liver, a concern because the TCAs are subject to significant postmortem redistribution. When conducting postmortem investigations, the inclusion of brain determination provides valuable information in assessing the magnitude of toxicity in cases involving clomipramine and its active metabolite norclomipramine.