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Toxicology

The Toxicology Laboratory located at the Office of the Chief Medical Examiner in Raleigh is nationally accredited by the American Board of Forensic Toxicology, Inc. and serves all 100 counties of the North Carolina Medical Examiner System by providing forensic analytical testing of specimens and evidence from medical examiner cases. The laboratory is responsible for analytical testing, records maintenance and review of analytical testing and interpretation of results for more than 10,000 medical examiner cases annually. The staff which consists of toxicologists, chemists, laboratory technicians and administrative technicians performs more than 36,000 analytical tests each year.

Note: Toxicologists at the North Carolina Office of the Chief Medical Examiner (NC-OCME) are limited to interpreting information for our own cases.

Interpretation of Toxicology Results

The following table is provided only as a guide. The data have been compiled from previously published scientific literature and from prior OCME experience; hence these concentrations cannot be regarded as complete for all therapeutic and poisoning situations. When available, references are included for a drug. Also, the appropriate screening assay is designated for each drug. Average concentrations are given in parenthetical form when available. Many of the concentrations listed as toxic are from driving under the influence of drugs (DUID) data and are referenced as such in the comments column. The proper interpretation of postmortem drug concentrations is complex and complicated by many factors including individual variations in response to drugs, tolerance, physical stature, and disease states; the presence of other drugs, and the potential for postmortem changes in blood-drug concentrations. If a toxicological agent is suspected in a case, additional specimens including peripheral blood (PB) and liver (LVR) should be submitted for a more complete investigation. Normal and lethal liver concentrations where available have been added for clarity.

Last Revision: August 18, 2015

Drug (Reference) Assay Therapeutic (mg/L) Toxic (mg/L) Lethal (mg/L) Additional Information
Acetaminophen (1,4,24,25) A 1-52 30-300 50-320 (170) The toxic effects of acetaminophen are often seen 2-4 days after ingestion and blood levels may be extremely low at time of death.
Alprazolam (1,4,22,24) L/B 0.005-0.11 0.008-0.64 0.12-2.1 (0.55) The concentrations listed as toxic are from driving under the influence (DUID) cases. Only 30% of those arrested had concentrations greater than 0.10 mg/L.
Amantadine (1,24,25) B 0.1-1.0 1-5 21-48 (34)  
Amitriptyline (1,4,7,13,17,24,25) B

0.01-0.50;

Liver: 0.4-17 mg/kg

> 0.5;

Liver: > 50 mg/kg

0.6-27;

LVR: 50-420 mg/kg

Postmortem normal concentrations often exceed 0.5 mg/L. Significant postmortem redistribution (PMRD) can occur with all tricyclics. PB and LVR may be required to resolve difficult cases
Amlodipine (1,14,17,24) B 0.001-0.024 0.067-0.39 0.9-2.7 Significant PMRD can occur with this drug. PB and LVR may be required to resolve difficult cases.
Amoxapine (1,7,17,24) B 0.01-0.6 0.31-2.90

0.9-20 (6.9);

LVR: 50-348 mg/kg

Significant PMRD can occur with this drug. PB and LVR may be required to resolve difficult cases.
Amphetamine (1,7,22,24,25) B 0.02-2.0 0.2-3 0.5-41 (8.6) Tolerance is important to consider when evaluating the toxicity of this drug. Cardiotoxic with ethanol consumption.
Aripiprazole (1,24) S 0.039 - 0.5 0.063-1.42 Unknown  
Arsenic (1,7,24,25) S

0.002-0.07;

0.27 (herbicide workers)

0.05-12.7*

0.6-9.3 (3.3) oral;

0.1-0.6 (0.4) arsine fumes

Detection of chronic arsenic poisoning is complex. Blood specimens alone are insufficient. Tissues and/or hair are usually required. *Subacute poisoning incident from contaminated well water (nausea, emesis, diarrhea, abdominal pain).
Asenapine  (15,24) S 0.002-0.005 >0.01 Unknown  
Benztropine (1,7,24) B 0.005-0.18 >0.05 0.2-1.1 (0.5)  
Buprenorphine (1,10,24) L 0.5-5 ng/mL*  

1-29 ng/mL (8)**

1-15 ng / mL ****

*Note units change (ng/mL = ug/L). Tolerance and route of administration is important to consider when evaluating the toxicity of this drug. Significant PMRD can occur.

**Postmortem blood concentrations following intravenous administration.

****Postmortem blood concentrations  following oral administration

Bupropion (1,3,13,17,24) B 0.01-0.4 1.2-2 4-13 (6.6);
LVR: 8.7-14 mg/kg
PMRD can occur with this drug. PB may be required to resolve difficult cases. Bupropion is unstable in whole blood and liver at room temperature.
Buspirone (1,22,24) B 0.0005-0.004 >0.008 0.44  
Butalbital (1,7,22,24,25) A 1-10 0.1-28 (8.5) 13-30 The concentrations listed as toxic are from DUID cases.
Butorphanol (1,3,13,24,25) S 0.0006-0.002 Unknown 0.005  
Caffeine (1,4,13,22,24,25) B 4-36 50-400 79-567 (204)  
Carbamazepine (1,4,13,24,25) N 2-12 3-77 35-70 (45)  
Carbon Monoxide (1,7,24,25) S <10% SAT 15-25% SAT 48-93% (72) Smokers: 5-6%
Carisoprodol (1,4,7,24,25) N/B 2.6-30 2.6-40 >30; 39,110 Tolerance is important to consider when evaluating the toxicity of this drug. The concentrations listed as toxic are from DUID cases.
Chlordiazepoxide (1,6,7,10,20,22,25) B 0.1-3.0 1-66

26*

20**

*Death attributed solely to chlordiazepoxide

**Death attributed to chlordiazepoxide and amitriptyline

Chlorpheniramine (1,234 B 0.003-0.017 0.5 >0.5; 0.069 and 0.08* Postmortem normal concentrations often exceed 0.25 mg/L. Significant PMRD can occur with this drug. PB and LVR may be required to resolve difficult cases. *Observed in two infant deaths.
Chlorpromazine (1,4,13,24,25) B 0.02-0.30 low dose; 0.75 high dose 0.5-3.0 1-35 (17) Liver levels can usually differentiate high chronic vs. fatal cases. Significant PMRD can occur with this drug. PB and LVR may be required to resolve difficult cases.
Citalopram (1,4,17,24) B

0.05- 0.11

LVR: 1.0-5.7 mg/kg

1.0-4.0

3.4-49

LVR: 24-55 mg/kg

Postmortem normal concentrations often exceed 0.5 mg/L. Significant PMRD can occur with all SSRI's. PB and LVR may be required to resolve difficult cases. The concentrations listed as toxic are from DUID cases.
Clobazam (1,24) B 0.03-0.3 >0.5 1.5* 3.9** *Intentional overdose of clobazam and diazepam.
**Only significant finding at autopsy.
Clomipramine (1,4,17,24,25) B

0.09-0.25

LVR: 7-20 mg/kg

>0.4-0.6

0.54-3.

3LVR: 90-320 mg/kg

Significant PMRD can occur with all tricyclics. PB and LVR may be required to resolve difficult cases.
Clonazepam (1,13, 22,24,25) L 0.02-0.2 >0.08 >0.3-10 (+mtb) Acute OD: 1.4* Clonazepam is unstable in whole blood. Usually present as metabolite (mtb) only. The concentrations listed as toxic are from DUID cases. *With 0.6 mg/L of oxycodone present.
Clonidine (1,11,24) S 0.001-0.002 >0.025-0.05 0.023*; 0.047** Significant PMRD can occur with clonidine. *PM level in 43 year old woman who died from OD. **PM level in 23 month old.
Clozapine (1,4,13,17,22,24) B 0.06-1.0 0.6-9.5

1.2-13 (5.2)

LVR: 19-85 mg/kg

Significant PMRD can occur with this drug. PB and LVR may be required to resolve difficult cases.
Cocaine (1,13,17,22,24,25) L/B 0.05-1 0.1-5 >0.9 Concentrations vary greatly depending on the dosage, route of administration, period of survival and manner of storage of the specimens.
Codeine (1,4,22,24,25) L/B 0.03-0.4 0.2 1-8.8 (2.8); 0.49* The concentrations listed as toxic are from impaired driving cases. *Postmortem concentration found in 3 year old.
Cyanide (1,7,24,25) S <0.06 0.02-5.9 1.1-53 (oral); 1-15 (inhalation); seen as low as 0.17 in fire victims Includes both smokers and non-smokers.
Cyclizine (1,22,25) B 0.01-0.3 0.75-1 15-80 (oral); 1.5* *Postmortem overdose concomitantly with dipipanone.
Cyclobenzaprine (1) B 0.003-0.04 0.03-0.35

>0.3 with other drugs present

LVR: 25mg/kg

Postmortem normal concentrations often exceed 0.25 mg/L. Significant PMRD can occur with all tricyclics. PB and LVR may be required to resolve difficult cases.
Desipramine (1,3,4,7,17,23,24) B 0.01-0.8 0.3-2.0

3-15 (9.8)

LVR: 50-294 mg/kg

Significant PMRD can occur with all tricyclics. PB and LVR may be required to resolve difficult cases.
Dextromethorphan (1,17,21,23) B 0.01-0.04 0.1

1-18

LVR: 31-230 mg/kg

May exhibit PMRD; PB and LVR may be required to resolve difficult cases.
Diazepam (1,4,7,13,22,24,25) B 0.1-2 (low dose); 2-4 (high dose) 2-5 >5 Diazepam only deaths are infrequent. Toxic concentrations include DUID.
Diethylpropion (1,25) B 0.003-0.007 2 5  
Diflunisal (1,24) S 40-100 >300-500 >260-600  
Digoxin (1,3,7,13,22,24,25) S 0.0004-0.003; HF:0.0005-0.0009 0.0014-0.007 0.0015-0.03; 0.00035-0.2 Blood should be taken from a peripheral source. Vitreous is also acceptable. Do not measure in heart blood.
Diltiazem (1,4,7,17,22,24) B 0.03-0.4 >0.8

2-33 (15)

LVR: 41-380 mg/kg

PMRD may occur, PB and LVR excellent complementary specimens to resolve difficult cases.
Diphenhydramine (1,3,7,17,24,25) B 0.02-1 >1-2

1.1-31

LVR: 23->160 mg/kg

Lethal concentrations include infant reported deaths. Significant PMRD can occur. PB and LVR excellent complementary specimens to resolve difficult cases.
Donepezil (1) B appr. 0.03-0.075 >0.075 0.210* PMRD may occur. * Level is from an OD and is from when patient was still alive.
Doxepin (1,3,7,13,17,24,25) B 0.01-0.25 >0.5-1

0.7-29 (9.3)

LVR: 50-320 mg/kg

Postmortem normal concentrations often exceed 0.5 mg/L. Significant PMRD can occur with all tricyclics. PB and LVR excellent complementary specimens to resolve difficult cases.
Doxylamine (1,17,24) B 0.05-0.8 0.2-7.5

0.7-140

LVR: 80-300 mg/kg

Significant PMRD can occur.
Duloxetine (1) B 0.03-0.12 >0.24 >1; 0.910; 2.5* Significant PMRD can occur. *OD concomitantly with baclofen.
Ephedrine (1,4,24) B 0.018-0.6 >1 >2.7  
Eszopiclone (1,9) S <0.07 0.07 0.20-3.9 This analyte is unstable. Please ship specimens frozen. The concentrations listed as toxic are from impaired driving cases.
Ethchlorvynol (1,3,7,13,24,25) S 0.5-20 18-280 14-400 (119)  
Ethylene glycol (1,3,7,13,24,25) S Not listed 94-500 300-4300 (2400)  
Fenfluramine (1,13, 21,24,25) B 0.03-0.3 0.5-2.5 6.5-16* *Data includes children aged 2-6 and a 13 year old, as well as a 36 and 25 year old woman.
Fentanyl (1,7,17,22,24) L/B 1-5 ng/mL* 3 ng/mL

2(IV); >7(patch);
Oral abuse of patch: 6.1-97;
IV: 3-383;
Patch: 12-41

LVR:
IV: 5.9-78 ng/g;
Patch: 79-203 ng/g

*Note units change (ng/mL = ug/L). Tolerance and route of administration is important to consider when evaluating the toxicity of this drug. Significant PMRD can occur. Peripheral blood and liver should be collected in cases suspicious for fentanyl toxicity.
Flunitrazepam (1,24) S 0.005-0.015 >0.01-0.05 0.01-1.6 Toxic concentrations listed are for DUID. Parent drug is rarely detected. Values given are for the 7-amino flunitrazepam metabolite.
Fluoxetine (1,3,7,13,22,24) B < 0.12-0.8 0.2-3 (parent + mtb)

2-6 1.3-6.8 (3.8)

LVR: 29-128 mg/kg

Postmortem normal concentrations often exceed 1 mg/L. Significant PMRD can occur with all SSRIs. PB and LVR excellent complementary specimens to resolve difficult cases. The concentrations listed as toxic are from DUID cases.
Fluphenazine (1,3,13,24) S 0.0003-0.02 0.05-0.1 0.1  
Fluvoxamine (1,4,24) B 0.06-0.23 0.3-0.75 2.8-16; 3.4-11 (5.0) Significant PMRD can occur with all SSRIs. PB and LVR excellent complementary specimen to resolve difficult cases. The concentration listed as toxic is from a DUID case.
Gabapentin (1,16,23,24) L appr. 0.5-6 <2.0-25 (8.4) >80* Toxic concentrations are from impaired driving cases. Concentrations > 6.0 may be necessary to control seizures in refractory patients. Tolerance and indication for use (e.g. chronic pain vs. seizure) should be considered when evaluating the toxicity of this drug. *Lethal concentrations may be lower if used with other CNS depressants.
Gamma-hydroxybutyrate (1,3,24) S 20-120 8-551 27-4400 Lethal levels lower with concomitant use of ethanol. The concentrations listed as toxic are from impaired driving cases.
Guaifenesin (1,24) N 0.3-1.5 Not available 14* 27** *A lethal conc. of hydrocodone was also detected. **In combination with diphenhydramine and chlorpheniramine.
Haloperidol (1,3,7,13,24,25) S 0.005-0.017 0.04-0.5 0.2-1 PMRD can occur.  
Heroin (1,25) L 0.1 (morphine in chronic user) Unknown >0.1 (morphine); 0.05-2.1*; No recent usage: 0.38-0.41 Tolerance is important to consider when evaluating the toxicity of this drug and survival time of victims. Urine, bile or vitreous are excellent complimentary specimens to use in distinguishing between morphine and heroin use. Concentrations reported as morphine. *Postmortem concentrations from 42 young adults dying rapidly after injection.
Hydrocodone (1,7,22,24,25) L/B 0.01-0.05 0.1-0.2 0.12-7 Tolerance and route of administration is important to consider when evaluating the toxicity of this drug. May exhibit PMRD.
Hydromorphone (1,7,22,24,25) L 0.005-0.015 >0.1 0.07-2.7 Tolerance is important to consider when evaluating the toxicity of this drug.
Hydroxyzine (1,4,7,24,25) B 0.01-1 >0.17 1.1-39 The concentrations listed as toxic are from impaired driving cases. Significant PMRD can occur. Peripheral blood is required for accurate interpretation.
Ibuprofen (1,7,13,24,25) S 15-30 100-400 185-680; 518  
Imipramine (1,5,6,7,10,1722,25) B 0.05-0.35 0.25-4.9

0.3-30

LVR: 33-381 mg/kg

Significant PMRD can occur with all tricyclics. PB and LVR excellent complementary specimen to resolve difficult cases.
Ketamine (1,4,24,25) B 1-6 >7 (abuse) 7-10; 3.8, 6.9 Nonmedical IV use can be lethal at conc. as low as 2.0 mg/L. May exhibit PMRD.
Lacosomide (24) A 1-12 >20 120* *High levels of guaifenesin and topiramate present.
Lamotrigine (1,3,24) A 1-5 (monotherapy) 3-9.1 (combo therapy) 15-30 20-60*; 20-38** *5 victims of overdose ranging from 2 wks old to 42. **2 patients concomitantly with valproic acid.
Levetiracetam (1,2,24) N 10-40 70 35*, 190** *multi-drug intoxication. ** single drug intoxication Tolerance should be considered when evaluating the toxicity of this drug.
Lidocaine (1,4,7,13,24) B 0.08-6 1.5-19 6-92 Route of administration is important to consider when evaluating the toxicity of this drug.
Lithium (1,7,13,24,25) S <1.3 mEq/L >1.5 mEq/L 2.4-14.0; 0.3-4.6 mEq/L  
Loperamide (1) B 0.0002-0.003 Not listed 0.084-1.2 May exhibit PMRD.
Lorazepam (1,3,7,13,24) L 0.05-0.24 0.3-0.6 0.28-2.8* Lower toxic concentrations are found in cases of ingestion of multiple respiratory depressants.
Loxapine (1,7,24,25) B 0.01-0.03 0.2-0.72 2-9.5 (heart blood) Significant PMRD can occur. PB and LVR excellent complementary specimens to resolve difficult cases.
Memantine (1,21) B 0.039-0.15 >0.3 >1  
Meperidine (1,3,7,17,22,24) B 0.06-1.84 >1

8-20 (oral); 1-8 (IV)

LVR: PO:5-10 mg/kg IV: 2-16 mg/kg

May exhibit PMRD.
Meprobamate (1,3,4,7,13,21,23,24) N 5-12 >10-25 35-240 Tolerance is important to consider when evaluating the toxicity of this drug. DUID cases reported to have meprobamate concentrations of 35-96 mg/L.
Metaxalone (1,26) N <2.0-8.6 20 20-63* The concentration listed as toxic is from an impaired driving case. *Most deaths attributed to metaxalone are multiple drug intoxications.
Methadone (1,3,4,7,13,17,22,24,25) B 0.01-1.06 >0.2

0.06-3.1 (0.28); Maintenance patients OD: 0.18-4.0 (1.3)

LVR: 1.8 - 9 mg/kg

Significant PMRD can occur. Liver is an excellent complementary specimen to resolve difficult cases. Tolerance is important to consider when evaluating the toxicity of this drug. Toxic concentration listed reflects DUID.  
Methamphetamine (1,7,24,25) B 0.01-0.3 0.12-5 0.09-64 DUID cases reported to have methamphetamine concentrations of 0.05-2.6 mg/L. May exhibit PMRD.
Methanol (1,3,7,24,25) S <2 >25 50-5430  
Methylenedioxy-methamphetamine (MDMA) (1,3,22) B 0.02-0.35 0.05-1.9 0.5-7.3 (2.7) The concentration listed as toxic is an average value from DUID cases. May exhibit PMRD.
Metoprolol (1,7,22,24,25) B 0.035-0.5 0.65-18 4.7-142 May exhibit PMRD.
Midazolam (1,4,7,22,24) L 0.008-0.6 0.03-1.5 0.07-2.8 May exhibit PMRD.
Mirtazapine (1,24) B 0.03-0.3 0.1-2

1-12

LVR: >14mg/kg*

The concentrations listed as toxic are from DUID cases. * Seen with other drugs concomitantly
Mitragynine (1,18) B Unknown Urine 0.050* 0.60** Ingredient of Kratom. *Level in man who experienced seizures. **Death was deemed “possible kratom toxicity.”
Morphine (1,3,7,21,24,25) L 0.01-0.3* 0.04-5 0.1-4 Tolerance is important to consider when evaluating the toxicity of this drug. *Higher doses in cancer patients. May exhibit PMRD. 
Naproxen (1,22,24,25) S 20-50 200-840 Unknown May exhibit PMRD.
Nefazadone (1,24) B 0.01-2 5 >7  
Nicotine (1,24,25) B 0.005-0.044 0.09-0.4 1.4-63 Lower toxic concentrations are associated with transdermal patch use. May exhibit PMRD.
Nifedipine (1,7,24) S 0.025-0.15 0.12-0.2 0.15-5.4  
Nortriptyline (1,4,7,13,17,24,25) B

0.01-0.37

LVR: 0.3-2.8

>0.2

1-26

LVR: 8-253 mg/kg

Postmortem normal concentrations often exceed 0.5 mg/L. Significant postmortem redistribution (PMRD) can occur with all tricyclics. PB and LVR may be required to resolve difficult cases. Toxic liver concentrations from nortriptyline ingestion > 50 mg/kg. Concentrations may be lower if ingestion was amitriptyline.
O-desmethylvenlafaxine* (1,24) B 0.069-0.3 1-5.1 Unknown *Also called desvenlafaxine (Pristiq®). Significant PMRD can occur. Liver is excellent complementary specimen to resolve difficult cases.
Olanzapine (1,24) B 0.02-0.4 0.01-1.0 0.8-4.9 Freeze specimen to prevent analyte degradation. May exhibit PMRD.
Oxazepam (1,3,4,7,22,24,25) L 0.1-1.5 0.2-8.0 3-6.1 The concentrations listed as toxic are from DUID cases. May exhibit PMRD.
Oxcarbazepine (1,24) N 8-12 (mtb) >45 2.5 (parent) 92 (mtb) 10-OH carbazepine metabolite accumulates with chronic dosing, whereas, parent analyte does not.
Oxycodone (1,7,22,24,25) B/L 0.005-0.1 0.01-0.5 (0.24) 0.12-14 Tolerance is important to consider when evaluating the toxicity of this drug. The concentrations listed as toxic are from DUID cases. May exhibit PMRD.
Oxymorphone (1,8) L 0.003-0.005 Unknown 0.010-0.15 Tolerance is important to consider when evaluating the toxicity of this drug. May exhibit significant PMRD.
Paroxetine (1,4,17,24) B 0.1-0.6 >0.35-0.4

0.7-4.6

LVR: 15-113 mg/kg*

Significant PMRD can occur with all SSRIs. Liver is excellent complementary specimen to resolve difficult cases. *With co-ingestion of other drugs.
Pentobarbital (1,3,4,7,13,22,24,25) A Sedation Target 1-5; Coma or ICP Target: 30-40 >10-19 5-169  
Phencyclidine (1,7,24,25) B 0.01-0.2 0.007-0.8 0.3-25 May exhibit PMRD.
Phenobarbital (1,6,7,10,20,22) A 6-48 >30-40 >50  
Phentermine (1,22,24,25) B 0.03-0.51 0.2 1-7.6 May exhibit PMRD.
Phenylpropanolamine (1,4,24,25) B 0.1-0.5 0.3-2 >2 May exhibit PMRD.
Phenytoin (1,4,13,24,25) A 5-20 >20-50 43-94 May exhibit PMRD.
Pregabalin (1) L 1.3-4.9 >10 25 and 180* 50** *Found in 2 deaths with at least one other drug. **Found with other drugs in suspected heroin suicide.
Primidone (1,3,7,13,24,25) A <5 y/o: 7-10; Adults: 5-12 9-50 65  
Procainamide (1,7,13,24,25) S 4-10 10-16 17-260 (100)  
Promethazine (1,4,7,17,22,24) B 0.05-0.2 0.17-1

0.16-12

LVR: 23-180 mg/kg

Will exhibit PMRD, peripheral blood and liver should be collected in cases suspicious for promethazine OD.
Propoxyphene (1,3,4,7) B 0.13-1.0 >0.5 1.0-17 Will exhibit PMRD, peripheral blood and liver should be collected in cases suspicious for propoxyphene OD.
Propranolol (1-7,13,22,24) B 0.02-0.3 1-4.5 2-29 May exhibit PMRD.
Pseudoephedrine (1,24,25) B 0.5-0.8 Unknown 10-66 May exhibit PMRD.
Quetiapine (1,17) B 0.1-1 1.1-8.8

5-49; Acute OD: 7.2-25; Psychiatric patient OD: 170

LVR: 34-200 mg/kg

PMRD may occur, PB and LVR excellent complementary specimens to resolve difficult cases.
Quinidine (1,7,13,22,24,25) B Naïve: 2-5 Dependent: 3-6 6-10 10-45  
Quinine (1,3,24,25) B 0.22-15 >10 6-24 (13)  
Risperidone (1,24) S 0.006-0.11 >0.12 1.8 May exhibit PMRD.
Rufinamide (1,24) A 3.0-30 >40 Unknown  
Salicylate (1,3,4,7,13,24,25) S 10-300 >200 400-7300 (600) Higher conc. are with arthritic patients that have been titrated to this level (44-330).
Sertraline (1,24) B 0.05-0.25 >0.2 >1.5 (parent only) Normal postmortem concentration often exceeds 0.75 mg/L. PMRD may occur, PB and LVR excellent complementary specimens to resolve difficult cases.
Tapentadol (1,15,24,27) B 0.05-0.13 >1 >2*; 0.3** Tolerance is important to consider when evaluating the toxicity of this drug. *Without the presence of other significant CNS depressant drugs. ** With ethanol and several other drugs.
Temazepam (1,3,22,24,25) L 0.02-1.1 >1 0.9-14*; 3.8-10.0** May exhibit PMRD. *With other drugs present. **Only temazepam.
Theophylline (1,4,7,13,23,24) N Children: 5-10; Adults 5-15 >20 25-250  
Thioridazine (1,4,7,13,17,24) B

0.14-2.6

LVR: 1-12 mg/kg

1.1-14

1-18 (5.4)

LVR: 25-513 mg/kg

PMRD may occur, PB and LVR excellent complementary specimen to resolve difficult cases.
Topiramate (1,22) A 2-10 >5.9-16 >49 43* The concentrations listed as toxic are from DUID cases.   *With 2 other drugs present.
Tramadol (1,3,13,24) B 0.1-1 0.01-5.3 1.1*-23; Avg 6.1** The concentrations listed as toxic are from DUID cases. *With other drugs present. **Only tramadol.
Trazodone (1,7,13,24,25) B 0.5-2.5 >4-26

9.4-34

LVR: 57-82 mg/kg

PMRD may occur, PB and LVR excellent complementary specimens to resolve difficult case. The concentrations listed as toxic are from overdose cases in which the patient survived with supportive therapy.
Triazolam (1,7,24,25) L 0.002-0.02 >0.004-0.04 0.01-0.22 The concentrations listed as toxic are from DUID cases. May exhibit PMRD.
Trichlorethanol (1,4,24) S 2-27 >40-330 20-640 (250) Mtb. of chloral hydrate. Significant PMRD can occur. PB and LVR may be required to resolve difficult cases.
Trimipramine (1,4,17,24,25) B 0.011-0.3 0.5-1.0

0.4-12

LVR: 42-544 mg/kg

PMRD may occur, PB and LVR excellent complementary specimens to resolve difficult cases.
Valproic acid (1,3,7,13,24,25) S 40-125 (plasma); 27-50 (whole blood); Epilepsy: 50-100; Mania: 50-125 52-148 (hepatotoxic)  482-2120 (coma) 166*; 269**-2204 * 3 pediatric patients who developed fatal hepatitis. **OD level in a one month old.
Venlafaxine (1,17,24) B 0.1-0.4 1-24

6.6-95 (61)

LVR: 21-430 mg/kg

PMRD may occur, PB and LVR excellent complementary specimens to resolve difficult cases.
Verapamil (1,3,4,7,17,22, 24) B 0.02-1 >1-4

0.9-85 (11)

LVR: 3-280 mg/kg

May exhibit PMRD.
Vilazodone(1) S 0.028-0.063 Unknown Unknown  
Zaleplon (1,24) S 0.001-0.03 0.037-0.13 >2.2; 0.870* The concentrations listed as toxic are from DUID cases. May exhibit PMRD. *With other drugs present.
Ziprasidone (1,6) S 0.045-0.2 >0.4 2.0  
Zolpidem (1,3,4,9,22,24) B 0.08-0.15 0.07-0.7 >1; >0.8*; Avg 1.9** The concentrations listed as toxic are from DUID cases. Tolerance should be considered when evaluating the toxicity of this drug. *With ethanol. **11 adults following acute OD with only zolpidem.
Zonisamide (1,12,19,24) N 10-40 >30-70 44* *Blood specimen at time of death from ingesting 4.8g

*Assay Interpretation

A=Acids
B=Bases
N=Neutrals
E=Immunoassay
S=Special

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Last Modified: August 19, 2015