A fatal case of amoxapine poisoning under the influence of chronic use of psychotropic drugs

A 43-year-old woman was found dead in a car in the supine position. She had been suffering from depression for 2 years and hesitation wounds on the left forearm and wrist were observed. On microscopic examination, pulmonary congestion and edema were observed with heart failure cells in many alveoli, thereby suggesting not only acute but also chronic heart failure. Drug screening in the blood by gas chromatography–mass spectrometry (GC–MS) revealed the presence of amoxapine and levomepromazine, and their concentrations in tissues were determined by GC–MS with three-step solvent extraction followed by acetylation. The concentration of amoxapine in the blood and liver was 0.86–1.77 and 18.76 μg/ml, respectively; the levels were much higher than the therapeutic level but did not reach the lethal level. The concentrations of levomepromazine in tissues were within the therapeutic level. Based on the pathological and toxicological findings, the cause of death was determined to be amoxapine poisoning on the basis of chronic heart failure due to the chronic use of psychotropic drugs.