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Published:
Journal of Analytical Toxicology,
ISSN 0146-4760,
Volume 25, Number 7, October, pp. 641-644
Citalopram Distribution in Postmortem Cases
Barry Levine, Xiang Zhang, and John E. Smialek
Office of the Chief Medical Examiner, State of Maryland, 111 Penn Street, Baltimore,
Maryland
Gary W. Kunsman and Michael E. Frontz
Bexar County Medical Examiner’s Office, 7337 Louis Pasteur Drive, San Antonio,
Texas 78229
This is a report of the analytical findings in 13 cases investigated
by either the Office of the Chief Medical Examiner, State of Maryland or the
Bexar County (San Antonio, TX) Medical Examiner’s Office in which citalopram,
a highly selective serotonin reuptake inhibitor used therapeutically as an antidepressant,
was identified. In 8 of the 9 cases in which both blood and urine specimens
were received, the urine citalopram concentration exceeded the blood concentration,
indicating that urine is an appropriate specimen for screening citalopram use.
The average liver to blood citalopram concentration ratio was 6.5 (range 3.1–13,
n = 6). Three cases had blood concentrations less than 0.24 mg/L, which is in
the reported antemortem therapeutic range of the drug. Eleven cases had blood
concentrations less than 1.3 mg/L; in each of these cases, citalopram was determined
to be an incidental finding to the ultimate cause of death. Quantitation of
citalopram and the metabolite desmethylcitalopram in these cases yielded an
average parent-to-metabolite ratio of 6.4.
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