Aerospace Medicine Technical Reports
FAA Office of Aerospace Medicine
Civil Aerospace Medical Institute
Report No: DOT/FAA/AM-12/17
Title and Subtitle: Analysis of Sertraline in Postmortem Fluids and Tissues in 11 Aviation Accident Victims
Report Date: November 2012
Authors: Lewis RJ, Angier MK, Williamson KS, Johnson RD
Abstract: Sertraline (Zoloft) is a selective serotonin reuptake inhibitor that is a commonly prescribed drug for the treatment of depression, as well as obsessive-compulsive disorder, panic disorder, social anxiety disorder, premenstrual dysphoric disorder, and post-traumatic stress disorder.
While the use of sertraline is relatively safe, certain side effects could negatively affect a pilot's performance and become a factor in an aviation accident. The adverse side effects associated with this medication include: sleepiness, nervousness, insomnia, headaches, tremors, and dizziness. The nature of aviation accidents often precludes the availability of blood from accident victims; therefore, tissues must be relied upon for analysis. Understanding the distribution of a drug throughout postmortem fluids and tissues is important when trying to interpret drug impairment and/or intoxication.
Our laboratory investigated the distribution of sertraline and its primary metabolite, desmethylsertraline, in various postmortem tissues and fluids obtained from 11 fatal aviation accident cases between 2001-2004. The gender of the pilots was male and their ages ranged from 31 - 66. When available, 11 specimen types were analyzed for each case, including blood, urine, vitreous humor, liver, lung, kidney, spleen, muscle, brain, heart, and bile. Human specimens were processed utilizing solid-phase extraction, followed by characterization and quantitation employing GC/MS.
Whole blood sertraline concentrations obtained from these 11 cases ranged from 0.005 to 0.392 ug/mL. The distribution of sertraline, expressed as specimen/blood ratio, was as follows: urine 0.47 +- 0.39 (n=6), vitreous humor 0.02 +- 0.01 (n=4), liver 74 +- 59 (n=11), lung 67 +- 45 (n=11), kidney 7.4 +- 5 (n=11), spleen 46 +- 45 (n=10), muscle 2.1 +- 1.3 (n=8), brain 22 +- 14 (n=10), heart 9 +- 7 (n=11), and bile 36 +- 26 (n=8).
Postmortem distribution coefficients obtained for sertraline had coefficient of variations (CV) ranging from 47 - 99%. With such large CVs, the distribution coefficients have very little use in aiding in the interpretation of sertraline-positive tissue specimens. Furthermore, no consistent desmethylsertraline/sertraline ratio was identified within any specimen group. This study suggests that sertraline likely undergoes significant postmortem redistribution.
Key Words: Forensic Toxicology, Sertraline, Norsertraline, Desmethylsertraline, Postmortem Distribution, GC/MS, Selective Serotonin Reuptake Inhibitor
No. of Pages: 16
Civil Aerospace Medical Institute
Report No: DOT/FAA/AM-12/17
Title and Subtitle: Analysis of Sertraline in Postmortem Fluids and Tissues in 11 Aviation Accident Victims
Report Date: November 2012
Authors: Lewis RJ, Angier MK, Williamson KS, Johnson RD
Abstract: Sertraline (Zoloft) is a selective serotonin reuptake inhibitor that is a commonly prescribed drug for the treatment of depression, as well as obsessive-compulsive disorder, panic disorder, social anxiety disorder, premenstrual dysphoric disorder, and post-traumatic stress disorder.
While the use of sertraline is relatively safe, certain side effects could negatively affect a pilot's performance and become a factor in an aviation accident. The adverse side effects associated with this medication include: sleepiness, nervousness, insomnia, headaches, tremors, and dizziness. The nature of aviation accidents often precludes the availability of blood from accident victims; therefore, tissues must be relied upon for analysis. Understanding the distribution of a drug throughout postmortem fluids and tissues is important when trying to interpret drug impairment and/or intoxication.
Our laboratory investigated the distribution of sertraline and its primary metabolite, desmethylsertraline, in various postmortem tissues and fluids obtained from 11 fatal aviation accident cases between 2001-2004. The gender of the pilots was male and their ages ranged from 31 - 66. When available, 11 specimen types were analyzed for each case, including blood, urine, vitreous humor, liver, lung, kidney, spleen, muscle, brain, heart, and bile. Human specimens were processed utilizing solid-phase extraction, followed by characterization and quantitation employing GC/MS.
Whole blood sertraline concentrations obtained from these 11 cases ranged from 0.005 to 0.392 ug/mL. The distribution of sertraline, expressed as specimen/blood ratio, was as follows: urine 0.47 +- 0.39 (n=6), vitreous humor 0.02 +- 0.01 (n=4), liver 74 +- 59 (n=11), lung 67 +- 45 (n=11), kidney 7.4 +- 5 (n=11), spleen 46 +- 45 (n=10), muscle 2.1 +- 1.3 (n=8), brain 22 +- 14 (n=10), heart 9 +- 7 (n=11), and bile 36 +- 26 (n=8).
Postmortem distribution coefficients obtained for sertraline had coefficient of variations (CV) ranging from 47 - 99%. With such large CVs, the distribution coefficients have very little use in aiding in the interpretation of sertraline-positive tissue specimens. Furthermore, no consistent desmethylsertraline/sertraline ratio was identified within any specimen group. This study suggests that sertraline likely undergoes significant postmortem redistribution.
Key Words: Forensic Toxicology, Sertraline, Norsertraline, Desmethylsertraline, Postmortem Distribution, GC/MS, Selective Serotonin Reuptake Inhibitor
No. of Pages: 16
Last updated: Tuesday, February 9, 2016