Skip to main content Accessibility help

Post-Mortem Antipsychotic Drug Concentrations and Unexplained Deaths

  • Nedzara Jusic (a1) and Malcolm Lader (a2)



The relationship between antipsychotic drug treatment and sudden unexplained death remains unclear. The estimation of post-mortem blood drug concentrations should be helpful.


Eight medico-legal cases were reviewed with respect to behaviour of patient, type and dosage of drug treatment, mode of death, post-mortem findings and drug concentrations.


The problems of evaluating such drug levels are discussed. Five of the eight patients had probably toxic concentrations of antipsychotic and/or antidepressants, which caused death, usually involving cardiac arrhythmias.


In cases of sudden unexpected death, a sample of blood from a peripheral vein should be obtained immediately death is pronounced or the body discovered, and sent for analysis. To minimise such fatalities, the patient should be monitored carefully, with ECG if feasible, and electrolyte balance checked. The drug regimen used should be kept simple and large doses of antipsychotics and/or antidepressants avoided wherever possible.


Corresponding author

Professor M. Lader, Institute of Psychiatry, London SE5 8AF


Hide All
Balant-Gorgia, A. E., Balant, L. P. & Andreoli, A. (1993) Pharmacokinetic optimisation of the treatment of psychosis. Clinical Pharmacokinetics, 25, 217236.
Brown, R. P. & Kocsis, J. H. (1984) Sudden death and antipsychotic drugs. Hospital and Community Psychiatry, 35, 486491.
Cassem, N. (1982) Cardiovascular effects of antidepressants. Journal of Clinical Psychiatry, 43, 2228.
Fowler, N. O., McCall, D., Chuan, T., et al (1976) Electrocardiographic changes and cardiac arrhythmias in patients receiving psychotropic drugs. American Journal of Cardiology, 37, 223230.
Fulop, G., Phillips, R. A., Shapiro, A. K., et al (1987) ECG changes during haloperidol and pimozide treatment of Tourette's disorder. American Journal of Psychiatry, 144, 673675.
Hirsch, C. S. & Martin, D. K. (1971) Unexpected death in young epileptics. Neurology, 21, 682.
Jackman, W. N., Friday, K. J., Anderson, J. L., et al (1988) The long QT syndromes: a critical review, new clinical observations and a unifying hypothesis. Progress in Cardiovascular Disease, 31, 115172.
Jones, G. R. & Pounder, D. J. (1987) Site dependence of drug concentrations in postmortem blood – a case study. Journal of Analytical Toxicology, 11, 186190.
Kannel, W. B. & Thomas, H. E. (1982) Sudden coronary death: the Framingham study. Annals of the New York Academy of Science, 382, 321.
Kemper, A. J., Dunlap, R. & Pietro, D. A. (1983) Thioridazineinduced torsades de pointes: successful therapy with isoproterenol. Journal of the American Medical Association, 249, 29312934.
Kuller, L., Lilienfeld, A. & Fisher, R. (1967) An epidemiological study of sudden and unexpected deaths in adults. Medicine, 46, 341361.
Loga, S., Curry, S. & Lader, M. (1981) Interaction of chlorpromazine and nortriptyline in patients with schizophrenia. Clinical Pharmacokinetics, 6, 456462.
Lown, B. (1987) Sudden cardiac death and behavioral perspectives. Circulation, 76, 186196.
Mehtonen, O.-P., Aranko, K., Mälkonen, L., et al (1991) A survey of sudden death associated with the use of antipsychotic or antidepressant drugs. Acta Psychiatrica Scandinavica, 84, 5864.
Moss, A. J. & Schwartz, P. J. (1982) Delayed repolarisation (QT or QTU prolongation) and malignant ventricular arrhythmias. Journal of the American Heart Association, 51, 8590.
Pilowski, L. S., Ring, H., Shine, P. J., et al (1992) Rapid tranquillisation. A survey of emergency prescribing in a general psychiatric hospital. British Journal of Psychiatry, 160, 831835.
Pounder, D. J. & Jones, G. R. (1990) Post-mortem drug redistribution – a toxicological nightmare. Forensic Science International, 45, 253263.
Prouty, R. W. & Anderson, W. H. (1990) The forensic science implications of site and temporal influences on postmortem blood-drug concentrations. Journal of Forensic Sciences, 35, 243270.
Task Force Report (1988) Sudden death in psychiatric patients: the role of neuroleptic drugs. American Psychiatric Association Report No. 27, Washington, DC: APA.
Ungvari, G. (1980) Neuroleptic related sudden death: proven or a mere hypothesis? Pharmacopsychiatry, 13, 29.
Vale, J. A. & Meredith, T. J. (1985) A Concise Guide to the Management of Poisoning (3rd edn). Edinburgh: Churchill Livingstone.
Zipes, D. P. (1987) Proarrhythmic effects of antiarrhythmic drugs. American Journal of Cardiology, 59, 26E31E.

Post-Mortem Antipsychotic Drug Concentrations and Unexplained Deaths

  • Nedzara Jusic (a1) and Malcolm Lader (a2)


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Post-Mortem Antipsychotic Drug Concentrations and Unexplained Deaths

  • Nedzara Jusic (a1) and Malcolm Lader (a2)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *