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International Journal of Legal Medicine
Published in: International Journal of Legal Medicine 5/2020

Open Access 01-09-2020 | Intoxication | Case Report

The adulterated XANAX pill: a fatal intoxication with etizolam and caffeine

Authors: V. Kolbe, D. Rentsch, D. Boy, B. Schmidt, R. Kegler, A. Büttner

Published in: International Journal of Legal Medicine | Issue 5/2020

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Abstract

A 49-year old man was found dead at home next to a glass containing a dried, white, crystalline substance and near a bag containing pills with the imprint XANAX, the trade name of alprazolam. A comprehensive screening of material collected during the autopsy revealed the presence of etizolam and caffeine in lethal concentrations (0.77 μg/mL and 190 μg/mL) but no trace of alprazolam. Benzodiazepine analogue etizolam is rarely prescribed in Germany, and as a result there are not many reports about fatal cases. It has anxiolytic, hypnotic, sedative and muscle-relaxant properties and is used for the short-term treatment of anxiety and panic attacks. The purine alkaloid caffeine, conversely, is the most widely used central nervous system stimulant. The following report outlines potentially the first reported case of a lethal combination of the downer etizolam and the upper caffeine in medical literature.
Literature
1.
Pariante F, Caddeo S, Ecari U (1989) Etizolam in the treatment of generalized anxiety disorder associated with depressive symptoms. Curr Med Res Opin 11(9):543–549PubMedCrossRef
2.
Casacchia M, Bolino F, Ecari U (1990) Etizolam in the treatment of generalized anxiety disorder: a double-blind study versus placebo. Curr Med Res Opin 12:215–223PubMedCrossRef
3.
Fracasso C, Confalonieri S, Garattini S, Caccia S (1990) Single and multiple dose pharmacokinetics of etizolam in healthy subjects. Eur J Clin Pharmacol 40:181–185
4.
Kawajiri M, Ohyagi Y, Furuyua H, Araki T, Inoue N, Esaki S, Yamada T, Kira J (2002) A patient with Parkinson's disease complicated by hypothyroidism who developed malignant syndrome after discontinuation of etizolam. Rinsho Shinkeigaku 42(2):136–139PubMed
5.
Kuroda K, Yabunami H, Hisanaga Y (2002) Etizolam-induced auperficial erythema annulare centrifugum. Clin Exp Dermatol 27:34–36PubMedCrossRef
6.
Nakamae T, Shinozuka T, Sasaki C, Ogamo A, Murakami-Hashimoto C, Irie W, Terada M, Nakamura S, Furukawa M, Kurihara (2008) Case report: Etizolam and its major metabolites in two unnatural death cases. Forensic Sci Int 182: e1 – e6
7.
National Research Institute of Police Science (2005) Annual case reports of drug and toxic poisoning in Japan 47
8.
Pohler H (2010) Caffeine intoxication and addiction. J Nurse Pract 6(1):49–52CrossRef
9.
Kerrigan S, Lindsey T (2005) Fatal caffeine overdose: two case reports. For Sci Int 153(1):67–69
10.
Mackey TK, Liang BA, York P, Kubic T (2015) Counterfeit drug penetration into global legitimate medicine supply chains: a global assessment. Am J Trop Med Hyg 92(6):59–67PubMedPubMedCentralCrossRef
11.
Maurer HH, Pfleger K, Weber AA (2017) Mass spectral library of drugs, poisons, pesticides, pollutants and their metabolites. WILEY-VCH, Weinheim
12.
Pragst F, Herzler M, Herre S, Erxleben B-T, Rothe M (2007) Supplement: UV spectra of toxic compounds. Toxicological Chemistry, Berlin
13.
O’Connell CW, Sadler CA, Tolia VM, Ly BT, Saitman AM, Fitzgerald RL (2015) Overdose of etizolam: the abuse and rise of a benzodiazepine analog. Letter to the editor. Ann Emerg Med 65(4):456–466CrossRef
14.
Magdalan J, Zawadzki M, Skowronek R, Czuba M, Porebska B, Sozanski T, Szpot P (2017) Nonfatal and fatal intoxications with pure caffeine—report of three different cases. Forensic Sci Med Pathol 13:355–358PubMedCrossRef
15.
16.
Banerjee P, Ali Z, Levine B, Fowler D (2014) Fatal caffeine intoxication: a series of eight cases from 1999 to 2009. J Forensic Sci 59(3):865–868PubMedCrossRef
17.
Riesselmann B, Rosenbaum F, Roscher S, Schneider V (1999) Fatal caffeine intoxication. For Sci Int 103:49–52
18.
19.
Rudolph T, Knudsen K (2010) A case of fatal caffeine poisoning. Acta Anaesthesiol Scand 54:521–523PubMedCrossRef
20.
Verster CJ, Volkerts ER (2004) Clinical pharmacology, clinical efficacy, and behavioural toxicity of alprazolam: a review of the literature. CNS Drug Rev 10(1):45–76PubMedPubMedCentralCrossRef
21.
Arens AM, van Wijk XMR, Vo KT, Lynch KL, Wu AHB, Smollin CG (2016) Adverse effects from counterfeit alprazolam tablets. JAMA Intern Med 176(10):1554–1555PubMedCrossRef
22.
Rentsch D, Einsle R, Nowotnik J, Büttner A, Rücker G, Kegler R (2014) High incidence of the designer drug methylone in partiticipants of a music festival in summer 2013. Toxichem Krimtech 81(2):65–68
23.
Brunt TM, Nagy C, Bücheli A, Martins D, Ugarte M, Beduwe C, Ventura Vilamala M (2016) Drug testing in Europe: monitoring results of the Trans European Drug Information (TEDI) project. Drug Test Anal 9:188–198PubMedCrossRef
Metadata
Title
The adulterated XANAX pill: a fatal intoxication with etizolam and caffeine
Authors
V. Kolbe
D. Rentsch
D. Boy
B. Schmidt
R. Kegler
A. Büttner
Publication date
01-09-2020
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Legal Medicine / Issue 5/2020
Print ISSN: 0937-9827
Electronic ISSN: 1437-1596
DOI
https://doi.org/10.1007/s00414-020-02352-7

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