POSTMORTEM CLOMIPRAMINE - THERAPEUTIC OR TOXIC CONCENTRATIONS

Postmortem blood and liver concentrations of clomipramine were determi ned in ten cases by high performance liquid chromatography (HPLC). Blo od concentrations ranged from 0.21 to 4.9 mg/L, and liver concentratio ns from 7.0 to 320 mg/kg. Two cases associated with clomipramine toxic ity were clearly differentiated from other cases by the analysis of li ver. The concentrations of clomipramine in these two cases were 3.3 an d 1.8 mg/L in blood, and 280 and 320 mg/kg in liver. The liver concent rations were 10 to 30 fold greater in the deaths associated with drug toxicity compared with the other cases. One case, where cardiac blood was collected in place of femoral blood, showed a high blood concentra tion (4.9 mg/L), but an arguably therapeutic liver concentration (13 m g/kg). The analysis of femoral blood together with liver provides the best guide as to the significance of postmortem clomipramine concentra tions.