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- Title
Fatal Intoxications Due to Administration of Isosorbide Tablets Contaminated with Pyrimethamine.
- Authors
Imran, Muhammad; Shafi, Humera; Mahmood, Zahid; Sarwar, Mohammad; Usman, Hafiz Faisal; Tahir, Mohammad Ashraf; Ashiq, Muhammad Zar
- Abstract
In January 2012, 664 cases of pyrimethamine toxicity and 151 deaths were reported among cardiac patients that had recently received free medicines from pharmacy of Punjab Institute of Cardiology, Lahore, Pakistan. These patients, ages ranged from 58 to 75 years, were prescribed simvastatin, clopidogrel, aspirin soluble, isosorbide mononitrate, and amlodipine. On examination of medications being given to them, it was found that a particular batch of isosorbide mononitrate tablets was contaminated with 50 mg pyrimethamine. Cardiac patients were taking isosorbide contaminated with pyrimethamine twice daily (100 mg pyrimethamine/day), whereas therapeutic dose of pyrimethamine for malaria is 25 mg/week. Postmortem urine, cardiac blood, and femoral blood specimens of three deceased males were submitted to author's laboratory for analysis. Postmortem toxicological analysis revealed that pyrimethamine concentration fell within the range of 1-10 μg/mL by liquid chromatography. Clinical, autopsy, histopathological, and toxicological findings strongly suggested toxicity due to pyrimethamine accumulation that resulted in deaths of these cardiac patients.
- Subjects
ISOSORBIDE dinitrate (Drug); FORENSIC sciences; CARDIAC patients; LIQUID chromatography; DOSE-effect relationship in pharmacology; AUTOPSY
- Publication
Journal of Forensic Sciences, 2016, Vol 61, Issue 5, p1382
- ISSN
0022-1198
- Publication type
Article
- DOI
10.1111/1556-4029.13125