Fatal Oral Methylphenidate Intoxication with Postmortem Concentrations

Abstract

Methylphenidate (MPD) is a widely prescribed stimulant used primarily for the treatment for attention-deficit/hyperactivity disorder (ADHD). Suicide attempts involving MPD ingestion have been well described; however, deaths attributed solely to MPD ingestion have not been reported. A 62-year-old woman was found dead on her floor. The only discrepancy in among her medication quantities was that >three hundred 10 mg MPD tablets were missing. Analysis utilizing gas chromatography-mass spectrometry revealed elevated postmortem MPD peripheral and central blood, liver and vitreous humor concentrations. Considering both the central blood to peripheral blood ratio (0.89) and the liver to peripheral blood ratio (3.3), MPD does not appear subject to significant postmortem redistribution. With no other identifiable cause of death, we report what appears to be the first isolated MPD ingestion associated with a fatality.

First Death Involving 4-Fluoroethylphenidate (4F-EPH): Case Report, User Experiences, and Review of the Related Literature

“…The blood level of 4F-EPH in the death described here was 4F-EPH 0.078 mg/L. This compares with methylphenidate blood levels >0.050 mg/L being considered toxic, and levels of central and peripheral blood levels of 0.980 and 1.100 mg/L reported by Cantrell et al (49). The present case is higher than the toxic level for methylphenidate but lower than lethal levels.…”

“…Methylphenidate blood levels >50 ng/mL are considered toxic (47,48). The first death involving the ingestion of methylphenidate reported central and peripheral blood levels of 980 and 1100 ng/mL, respectively (49).…”

Age, Sex and Strain Respond Differently to Acute Ritalin (Methylphenidate) Exposure

“…MPD is among the first line medications when it comes to treating social behavioral disorders such as ADHD [45,46,47] . Unfortunately, there has been an increase in the use of MPD in people without ADHD and the number of fatalities associated with its misuse has risen to a record level [48,49,50,51,52,3,53,27] . Currently, there is widespread prescription and illicit use of methylphenidate (MPD) in persons without ADHD of all ages and both sexes across the world.…”

Methylphenidate Intoxication: Somnolence as an Uncommon Clinical Symptom and Proof of Overdosing by Increased Serum Levels of Ritalinic Acid

“…The literature provides only few case reports that provide measurements of MPH serum levels in patients with MPH intoxications. Postmortem measures of MPH serum concentration in a 62-year-old woman who committed suicide by ingestion of an unknown quantity of MPH tablets were 1 100 μg/l (peripheral blood) and 980 μg/l (central blood) [ 33 ] . MPH serum concentration in a patient who died subsequent to an accidental overdose resulting from intravenous injection of crushed MPH were 2 800 μg/l [ 42 ] .…”