Journal of The Korean Society of Clinical Toxicology

Serotonin Syndrome After an Overdose of Dextromethorphan and Chlorpeniramine: Two Case Reports: Kwang Yul Jung, Sung Hyun Yun, Hyun Min Jung, Ji Hye Kim, Seung Baik Han, Jun Sig Kim, Jin Hui Paik; J Korean Soc Clin Toxicol. 2013;11(1):19-22. Published online June 30, 2013

Abstract PDF: Dextromethorphan and chlorpeniramine are common ingredients of over-the-counter (OTC) cough pills. They are known to be safe when used alone, however, combination with other serotonergic drugs or use of an overdose can cause serotonergic toxicity. We report on a 43-year-old male and a 57-year-old female who ingested an overdose of antitussive drugs containing dextromethorphan and chlorpeniramine. They commonly presented with altered mentality and hyperreflexia on both upper and lower extremities. After conservative therapies, they were discharged with alert mentality. These cases are meaningful in that there are few cases of serotonin syndrome with an overdose of a combination of dextromethorphan and chlorpeniramine. Careful use with medication counseling for OTC cough pills is needed in order to prevent overdose of these ingredients.

Postmortem Blood and Tissue Concentration of Carisoprodol and Meprobamate: Hye Young Choi, Hwa Kyung Choi, Ju Seon Lee, Sang Hee Woo, Han Sun Lee, Yoo Sin Park, Hee Sun Chung; J Korean Soc Clin Toxicol. 2003;1(1):34-39. Published online June 30, 2003

Abstract PDF: Carisoprodol (CSP) is commonly prescribed as a skeletal muscle relaxant. Recently, we encountered 7 suicidal cases in which carisoprodol was detected. We developed a rugged, sensitive, and specific method for the determination of CSP and meprobamate (MPB) by GC and GC/MS. Postmortem blood concentrations of CSP and MPB ranged 22.9-124.4 ,$mu$g/ml and its metabolite, 26.8-144.5 ,$mu$g/ml respectively. Among 7 cases studied, Only CSP was ingested in 4 cases and combination of CSP and dextromethorphan was ingested in 2 cases according to the case history and one case was with ethanol. The order of the tissue concentration of CSP and MPB was liver> kidney > brain, and the concentration of MPB was higher than that of CSP in all tissues. The MPB /CSP concentration ratios of urine, bile juice, liver, kidney, brain and blood were 15.7, 4.0, 1.2, 1.4, 1.4 and 1.0 respectively. There was a big difference in concentration of CSP and MPB in 7 cases due to differences in the amount of dose administered and time to death after dosing.

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