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Published:
Journal of Analytical Toxicology,
ISSN 0146-4760,
Volume 27, Number 8, November/December,
pp. 595-599
CASE REPORT: Fatal Propafenone Overdoses: Case Reports
and A Review of the Literature
Franck Clarot[1], Jean Pierre Goullé[2], Marlène
Horst[1], Emmanuelle
Vaz[1], Christian Lacroix[2], and Bernard Proust[1]
[1]Medical Forensic Institute, Rouen University Hospital Charles Nicolle, Rouen,
France and
[2]Pharmacokinetic and Toxicology Laboratory, Jacques Monod Hospital,
76083 Le Havre, France
First synthesized in 1970, propafenone is a frequently used 1C
antiarrhythmic drug metabolized into two major metabolites, 5-hydroxypropafenone
and norpropafenone. Paradoxically, fatal intoxication is rarely described,
and only six cases have been reported in the literature. We report our experience
with two patients found dead of self-inflicted poisoning where the propafenone
blood concentration was very high (one concentration to our knowledge is one
of the highest reported in the literature). At autopsy, no evidence of significant
pathological disease were found. Propafenone was detected in blood by gas chromatography–mass
spectrometry and by high-performance liquid chromatography using a diode-array
detector, respectively, as propafenone artifact and propafenone. Blood propafenone
concentrations were 4180 ng/mL and 9123 ng/mL. The literature regarding propafenone
pharmacokinetic and intoxication is reviewed, and we discuss the low death
rate attributed to this drug in contrast to its frequent use. Reproduction
of editorial content of this journal is prohibited without publisher’s
permission.
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