Postmortem Tissue Concentrations of Olanzapine

Abstract

Twenty-eight cases from 2004-2007 involving olanzapine were analyzed at the San Diego County Medical Examiner's Office. Olanzapine was initially detected by gas chromatography coupled with mass spectrometry (GC-MS), and then confirmed by GC with a nitrogen-phosphorus detector. In cases where olanzapine was detected, concentrations in peripheral blood (PB), central blood (CB), liver, and vitreous were determined if available. In the six olanzapine-only deaths, average olanzapine concentrations (mean+/-standard deviation) were 3.2+/-2.0 mg/L (PB), 4.5+/-2.6 mg/L (CB), 40+/-29 mg/kg (liver), and 1.6+/-0.50 mg/L (vitreous). This was compared to the 10 non-olanzapine-related deaths, which showed average olanzapine concentrations of 0.26+/-0.13 mg/L (PB), 0.29+/-0.17 mg/L (CB), 5.6+/-5.6 mg/kg (liver), and 0.24+/-0.38 mg/L (vitreous). The remaining 10 multi-drug deaths had average concentrations of 0.59+/-0.33 mg/L (PB), 0.64+/-0.60 mg/L (CB), 5.9+/-4.3 mg/kg (liver), and 0.78+/-0.91 mg/L (vitreous). Concentrations of olanzapine associated with toxicity were found to be in the range of 1.4-6.2 mg/L (PB), 1.1-7.4 mg/L (CB), 14-88 mg/kg (liver), and 1.1-2.1 mg/L (vitreous). Concentrations associated with therapeutic use were found to be in the range of 0.11-0.43 mg/L (PB), 0-0.53 mg/L (CB), 0-8.6 mg/kg (liver), and 0-0.98 mg/L (vitreous). Deaths attributed solely to olanzapine were distinguished by a 10-fold or more increase in tissue concentrations over those found in the non-olanzapine-related deaths.