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Acute Intoxication Caused by Overdose of Flunitrazepam and Triazolam: High Concentration of Metabolites Detected at Autopsy Examination

Namera, Akira PhD; Makita, Ryosuke PhD; Saruwatari, Tatsuro BSc; Hatano, Aiko MD; Shiraishi, Hiroaki MD, PhD; Nagao, Masataka MD, PhD

The American Journal of Forensic Medicine and Pathology: December 2012 - Volume 33 - Issue 4 - p 293–296
doi: 10.1097/PAF.0b013e31820f1514
Case Reports

A 52-year-old woman was found dead on the floor of the living room on the first floor of a house, which belonged to the man with whom she shared the house. On visiting the site, her clothes were found to be undisturbed. Packages of flunitrazepam (Silece, 2 mg/tablet) and triazolam (Halcion, 0.25 mg/tablet) were found strewn around the victim. Toxicological analysis was performed, and the concentrations of flunitrazepam, triazolam, and their metabolites in the victim’s blood and urine were measured by high-performance liquid chromatography coupled with photodiode array and mass spectrometry. A high blood concentration of 7-aminoflunitrazepam was detected (1,270 ng/g), and further metabolites such as 7-acetamidoflunitrazepam, 7-acetamidodesmethylflunitrazepam, and 7-aminodesmethylflunitrazepam were detected in the blood and urine samples. In addition, 4-hydroxytriazolam and α-hydroxytriazolam were detected in her urine at a concentration of 950 and 12,100 ng/mL, respectively.

On the basis of the autopsy findings and toxicology results of high concentrations of both flunitrazepam and triazolam derivatives, the cause of death was determined to be acute intoxication from flunitrazepam and triazolam.

From the Department of Forensic Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.

Manuscript received August 25, 2010; accepted December 21, 2010.

The authors report no conflicts of interest.

This work was supported by F. Hoffmann-La Roche for donating flunitrazepam metabolites and Eisai Co. for providing information on flunitrazepam.

Reprints: Akira Namera, PhD, Department of Forensic Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8551, Japan. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.