Fatal acute intoxication after snorting cocaine and fluoxetine.

A 44-year-old woman with a history of drug abuse was found dead in her home, prompting an on-site evaluation by police. The initial investigation revealed evidence of recent cocaine consumption, but no other drugs or tablets were found. Given the circumstances, the local Prosecutor ordered a judicial autopsy to determine the cause of death. The autopsy revealed that the woman had suffered from acute cardiac failure, which was likely related to her drug use. Toxicological analysis of her blood confirmed the presence of cocaine and fluoxetine, a prescription antidepressant, in concentrations that were reportedly fatal. The presence of fluoxetine in the woman's system was particularly noteworthy, as it is not typically associated with fatal overdoses when taken orally. However, in this case, the woman had snorted the drug, which can lead to much higher concentrations in the bloodstream. Nasal swabs also tested positive for both fluoxetine and cocaine, suggesting that she had indeed snorted these substances. The absence of tablets or other drug packaging in her stomach, which was found to be empty, further supported this theory. The combination of fluoxetine and cocaine in her system, along with a blood alcohol concentration of 1.9 g/L, ultimately led to her death from acute cardiac failure. This case report is significant, as it is the first documented instance of fatal fluoxetine and norfluoxetine concentrations following snorting, highlighting the dangers of this mode of ingestion and the potential for lethal interactions between different substances. Link: https://pubmed.ncbi.nlm.nih.gov/40188637/