Evidence of repeated mirtazapine poisoning in children by hair analysis

Abstract

Mirtazapine is an antidepressant drug, used to treat depression, but also, in some specific conditions, to treat obsessive-compulsive disorder and anxiety. Although mirtazapine is not a hypnotic, it can make the subject feel drowsy. Children under the age of 18 should not take mirtazapine, but for some very special diseases, a physician can prescribe it for a limited period of time. The authors report a case involving 2 children (7-and 9-year-old) who were administered mirtazapine without consent by the mother, who was under daily therapy with this antidepressant. Hair specimens, collected from the children were tested by liquid chromatography coupled to tandem mass spectrometry for mirtazapine and its metabolite, N-desmethylmirtazapine, on 3 × 1 cm segments. The hair test results (3 × 1 cm segments) have demonstrated that both children have been repetitively exposed to mirtazapine for approximately the last 3 months before hair collection, with concentrations in the range 1.32-3.79 and 0.64-2.54 ng/mg for mirtazapine and N-desmethylmirtazapine, respectively.Environmental contamination was ruled out as the measured concentrations are highly variable according to the pattern of drug distribution and the washes were negative. Hair testing for drugs appears as an excellent diagnostic tool for child protection toward drug exposure.

Withdrawn: Liquid chromatography–tandem mass spectrometry and confirmation by liquid chromatography–high‐resolution mass spectrometry hair tests to evidence use of tizanidine by racing cyclists

“…The whole hair strand was first decontaminated by two baths of 5‐mL dichloromethane for 2 min and then cut into small pieces (<1 mm) with small scissors. Tizanidine was extracted from 20‐mg decontaminated cut hair in the presence of 500 pg of diazepam‐ d 5 used as internal standard, after overnight incubation in 1 mL of pH 9.5 borate buffer at 40°C, according to our procedure devoted to pharmaceuticals 15 . After cooling, 5 mL of diethyl ether/dichloromethane/hexane/isoamylic alcohol (50/30/20/0.5, v/v) were added, and the vials were horizontally shaken for 15 min.…”

“…Tizanidine was extracted from 20-mg decontaminated cut hair in the presence of 500 pg of diazepam-d 5 used as internal standard, after overnight incubation in 1 mL of pH 9.5 borate buffer at 40 C, according to our procedure devoted to pharmaceuticals. 15 After cooling, 5 mL of diethyl ether/dichloromethane/hexane/isoamylic alcohol (50/30/20/0.5, v/v) were added, and the vials were horizontally shaken for 15 min. After centrifugation, collection of the supernatant, and its evaporation to dryness, the residue was reconstituted in 30 μL of 5-mM ammonium formate buffer adjusted at pH 3.…”