A fatal case due to combined toxicity of psychotropic drugs

Blood concentration of 7-AF in this case was about one-third of fatal levels previously reported [6]. Since drug metabolism in a state of shock seems to be slower with a longer elimination half-life [7], forensic estimation of trazodone and paroxetine levels in the blood of the deceased when she was found unconscious, was quite difficult using pharmacokinetic parameters. Taking these factors into consideration, blood concentrations of the drugs at the time of hospital admission may have been higher than those of the postmortem samples. [...]as the trazodone is metabolized by cytochrome P450 2D6 (CYP2D6) [5], which is strongly inhibited by paroxetine [4], estimation of antemortem blood concentration is difficult to determine.