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Fatal toxicity index of medicinal drugs based on a comprehensive toxicology database

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Abstract

The fatal toxicity index (FTI) is the absolute number of fatal poisonings caused by a particular drug divided by its consumption figure. Consequently, it is a useful measure in evaluating toxicity of the drug and its relevance in fatal poisonings. In this study, we assessed the FTI of medicinal drugs in 3 years (2005, 2009, and 2013) in Finland. As the measure of drug consumption, we used the number of defined daily doses (DDD) per population in each year. There were 70 medicinal drugs in Finland for which the mean FTI expressed as the number of deaths per million DDD over the three study years was higher or equal to 0.1. The Anatomical Therapeutic Chemical (ATC) classification system was used for the classification of the active ingredients of medicinal drugs according to the organ or system which they act on. Of these 70 drugs, 55 drugs (78.6 %) acted on the nervous system (denoted by ATC code N), 11 (15.7 %) on the cardiovascular system (C), three (4.3 %) on the alimentary tract and metabolism (A), and one (1.4 %) on the musculoskeletal system (M). The nervous system drugs consisted of 20 psycholeptics, (ATC code N05), 20 psychoanaleptics (N06), eight analgesics (N02), six antiepileptics (N03), and one other nervous system drug (N07). The highest individual FTIs were associated with the opioids methadone, dextropropoxyphene, oxycodone, tramadol, and morphine; the antipsychotics levomepromazine and chlorprothixene; and the antidepressants doxepin, amitriptyline, trimipramine, and bupropion. Buprenorphine was not included in the study, because most of the fatal buprenorphine poisonings were due to smuggled tablets. A clearly increasing trend in FTI was observed with pregabalin and possibly with bupropion, both drugs emerging as abused substances.

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Authors and Affiliations

  1. Department of Forensic Medicine, University of Helsinki, PO Box 40, Kytösuontie 11, FI-00014, Helsinki, Finland

    Ilkka Ojanperä, Pirkko Kriikku & Erkki Vuori

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  1. Ilkka Ojanperä
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  2. Pirkko Kriikku
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  3. Erkki Vuori
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Correspondence to Pirkko Kriikku.

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The study was conducted in accordance with all applicable local and international laws and regulations. For this type of study, formal consent is not required.

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The authors declare that they have no conflict of interest.

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Ojanperä, I., Kriikku, P. & Vuori, E. Fatal toxicity index of medicinal drugs based on a comprehensive toxicology database. Int J Legal Med 130, 1209–1216 (2016). https://doi.org/10.1007/s00414-016-1358-8

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