DRUG (Reference)

ASSAY

THERAPEUTIC (mg/L)

TOXIC  (mg/L)

LETHAL  (mg/L)

COMMENTS/ADDITIONAL INFORMATION

Acetaminophen (1,2,3,5)

N

1-52

30-300

90-320 (170)

The toxic effects of acetaminophen are often seen 2-4 days after ingestion and blood levels may not be extremely high at time of death.

Alprazolam (1,2,4,5)

E/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 (1,3,5)

B

0.1-1.0

1-5

21-48 (33)

Amitriptyline (1,2,3,5,6)

B

0.01-0.25

>0.5

>2

Significant postmortem redistribution can occur with all tricyclics.  PB and LVR may be required to resolve difficult cases.

Amoxapine (1,5,6)

B

0.01-0.6

0.3-3

0.9-20 (6.9)

Significant postmortem redistribution can occur with this drug.  PB and LVR may be required to resolve difficult cases.

Amphetamine (1,3,4,5,6)

B

0.05-2.0

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)

0.039 - 0.452

0.063-1.42

unknown

Arsenic (1,3,6)

S

0.002-0.062;         0.27 (herbicide workers)

>0.023

>0.6-9.3 (oral);        >0.1 (arsine)

Detection of chronic arsenic poisoning is complex.  Blood specimens alone are insufficient.  Tissues and/or hair are usually required.

Benztropine (1,5,6)

B

0.005-0.18

>0.05

0.2-1.1 (0.5)

Bupropion (1,5,7)

B

 0.05-0.4

0.19-0.22

4-13 (7.3)

Postmortem redistribution can occur with this drug.  PB and LVR may be required to resolve difficult cases.

Buspirone (1,4,5)

B

0.0005-0.003

>0.25

0.44

Butalbital (1,3,4,5,6)

A

1-10

0.1-28 (8.5)

13-30

Butorphanol (1,3,5,7)

S

<0.004

0.005

Caffeine (1,2,3,4,5)

B

12-36

50-400

79-344 (183)

Carbamazepine (1,2,3,5, 7)

N

2-12

3-77

35-120

Carbon Monoxide (1,3,5,6)

S

<10 % SAT

15-25 % SAT

50 % SAT

smokers:5-6%

Carisoprodol (1,2,3,5,6)

N/B

2.6-30

2.6-40

>30

Tolerance is important to consider when evaluating the toxicity of this drug. The concentrations listed as toxic are from driving under the influence (DUID) cases.

Chlordiazepoxide (1,2,3,4,5,6)

B

0.4-3.0

1-66

>20

Chlorpheniramine (1,5)

B

0.003-0.02

0.5

>0.5

Significant postmortem redistribution can occur with this drug.  PB and LVR may be required to resolve difficult cases.

Chlorpromazine (1,2,3,5)

B

0.02-0.30 low dose      0.75 high dose

0.5-3.0

1-35(mean= 17)

Liver levels can usually differentiate high chronic vs. fatal cases.Significant postmortem redistribution can occur with this drug.  PB and LVR may be required to resolve difficult cases.

Citalopram (1,2,5)

B

<1

1.0-4.0

>3.4

Significant postmortem redistribution can occur with all SSRI's.  PB and LVR may be required to resolve difficult cases. The concentrations listed as toxic are from driving under the influence (DUID) cases.

Clomipramine (1,2,3,5)

B

<0.3

>0.75

>0.54

Significant postmortem redistribution can occur with all tricyclics.  PB and LVR may be required to resolve difficult cases.

Clonazepam (1,3,4,5)

E

0.01-0.2

>0.1

>0.3-10 (+mtb.)

Usually present as mtb. only. The concentrations listed as toxic are from driving under the influence cases.

Clorazepate (1,3,4,5)

B

0.12-2.0 (nordiazepam)

>5

Prodrug for nordiazepam. No reported OD for this drug taken alone.

Clozapine (1,2,4,5)

B

0.06-1.0

0.6-9.5

1.2-13

Significant postmortem redistribution can occur with this drug.  PB and LVR may be required to resolve difficult cases.

Cocaine (1,3,4,5)

E

0.1-1.0

0.1-5

>0.9

Concentrations listed include the cocaine metabolites

 benzoylecgonine and ecgonine methyl ester.

Codeine (1,2,3,4,5)

E

0.03-0.4

0.2

1-8.8 (2.8)

Cyanide (1,3,5,6)

S

<0.06

0.02-5.9

1.1-5.3 (oral);

1-15 (inhalation)

Includes both smokers and non-smokers

Cyclizine (1,3,5)

B

0.01-0.3

0.75-1

15-80 (oral)           1.5 (IV)

Cyclobenzaprine (1)

B

<0.1

0.03-0.35

>0.5

Significant postmortem redistribution can occur with all tricyclics.  PB and LVR may be required to resolve difficult cases.

Desipramine (1,2,3,5,6,7)

B

0.1-0.8

0.3-2.0

3-16.8 (10.8)

Significant postmortem redistribution can occur with all tricyclics.  PB and LVR may be required to resolve difficult cases.

Dextromethorphan (1,4,5)

B

0.01-0.04

0.1

1.1-18 (3.5)

May exhibit PMRD; PB and LVR may be required to resolve difficult cases.

Diazepam (1,2,3,4,5,6,7)

B

0.2-1.5 (low dose); 2-4 (high dose)

2-5

>5

Diazepam only deaths are infrequent. Toxic concentrations include DUID.

Diethylpropion (1,3)

B

<0.2

2

5

Diflunisal (1)

S

40

>260

Digoxin (1,3,4,5,6,7)

S

 0.0004-0.003

0.0014-0.007

0.0015-0.03

Blood should be taken from a peripheral source. Vitreous is also acceptable

Diltiazem (1,2,4,5,6)

B

0.1-0.4

>0.8

2-33

PMRD may occur, PB and LVR excellent complementary specimens to resolve difficult cases.

Diphenhydramine (1,3,5,6,7)

B

 0.02-1

.1-10

1.1-31

Lethal concentrations include infant reported deaths. Significant postmortem redistribution can occur.  PB and LVR excellent complementary specimens to resolve difficult cases.

Donepezil (1)

B

0.02

unknown

unknown

Doxepin (1,3,5,6,7)

B

<0.25

>0.14

0.7-29

Significant postmortem redistribution can occur with all tricyclics.  PB and LVR excellent complementary specimens to resolve difficult cases.

Doxylamine (1,5)

B

0.05-0.8

0.2-7.5

0.7-140

Duloxetine (1)

S

0.03

>1

Ephedrine (1,2,5)

B

0.018-0.6

>2.7

Eszopiclone (1)

S

< 0.087

unknown

unknown

Ethchlorvynol (1,3,5,6,7)

S

0.5-20

18-280

14-400 (115)

Ethylene glycol (1,3,5,6,7)

S

na

94-500

>300

Fenfluramine (1,3,4,5,7)

B

0.03-0.3

0.5-2.5

6-16

Fentanyl (1,4,5,6)

E/B

0.001-0.0038

0.003

0.002(IV);

>0.007(patch)

Tolerance is important to consider when evaluating the toxicity of this drug.

Flunitrazepam (1,5)

S

0.005-0.015

.01-.05

0.01-1.6

Toxic concentrations listed are for DUID. Parent drug is rarely detected. Values given are for the 7-amino flunitrazeapm metabolite

Fluoxetine (1,4,5,6,7)

B

<1.4 (parent + mtb)

0.2-3 (parent + mtb)

2-6

Significant postmortem redistribution can occur with all SSRIs.  PB and LVR excellent complementary specimens to resolve difficult cases. The concentrations listed as toxic are from driving under the influence (DUID) cases.

Fluphenazine (1,5, 7)

S

0.02

0.05-0.1

0.1

Fluvoxamine (1,2,5)

B

<0.9

0.3-0.75

2.8-16

Significant postmortem redistribution can occur with all SSRIs.  PB and LVR excellent complementary specimen to resolve difficult cases. The concentration listed as toxic is from a driving under the influence (DUID) case.

Gabapentin (1,5)

S

<21

45

>250

Gammahydroxybutyrate (1,5,7)

S

20-120

52-551

>400

Lethal levels lower with concomitant use of ethanol.

Guaifenesin (1,5)

N

0.3-1.5

14

A lethal conc. of hydrocodone was also detected

Haloperidol (1,3,5,6,7)

S

<0.1

0.04-0.5

0.2-1

Heroin (1,3)

E

0.1 (morphine in chronic user)

>0.1 (morphine)

Tolerance is important to consider when evaluating the toxicity of this drug. Urine or bile are elecellent complimetary specimens to use in distinguishing between morphine and heroin use.

Hydrocodone (1,3,4,5,6)

E/B

<0.1

0.1-0.2

0.1-7

Tolerance is important to consider when evaluating the toxicity of this drug.

Hydromorphone (1,3,4,5,6)

E

<0.05

0.1

0.07-2.7

Tolerance is important to consider when evaluating the toxicity of this drug.

Hydroxyzine (1,2,3,5,6)

B

 0.01-1

>1.1

Ibuprofen (1,3,5,6,7)

S

<50

100-400

185-680

Imipramine (1,2,3,5,6,7)

B

< 0.5 (parent + mtb)

0.5-4.9

1.0-30

Significant postmortem redistribution can occur with all tricyclics.  PB and LVR excellent complementary specimen to resolve difficult cases.

Ketamine (1,2,3,5)

B

<6

7

7-10

Nonmedical IV use can be lethal at conc. as low as 2.0 mg/L

Lamotrigene (1,5,7)

A

1-5 (monotherapy) 3-29.1 (combo therapy)

15-30

52

Levetiracetam (1,5)

N

<37

400

unknown

Lidocaine (1,2,5,6,7)

B

0.08-6

1.5-19

6-92

Lithium (1,3,5,6)

S

<1.3 mEq/L

2.0 mEq/L

2.4-14.0  mEq/L

Lorazepam (1,5,6,7)

S

<0.25

0.3-0.6

0.52-2.8

Lower toxic concentrations are found in cases of ingestion of multiple respiratory depressants.

Loxapine (1,3,5,6)

B

<0.1

0.2-0.72

2-9.5

Significant postmortem redistribution can occur. PB and LVR excellent complementary specimens to resolve difficult cases.

Memantine (1, 10)

0.039-0.082

unknown

Meperidine (1,4,5,6,7)

B

0.06-1.84

>1

8 (oral); 1-8 (IV)

Meprobamate (1,2,3,4,5,6,7)

N

<27

10-60

30-240

Tolerance is important to consider when evaluating the toxicity of this drug. DUID cases reported to have meprobamate concentrations of 35-96 mg/L.

Methadone (1,2,3,4,5,6,7)

B

0.01-1.06

0.2

0.06-3.1(0.28)

Significant postmortem redistribution 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 (1,3,5,6)

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.

Methanol (1,3,5,6,7)

S

>25

200-900 mg/dL

Methylenedioxymethamphetamine (1,5,7)

B

0.02-0.35

0.05-1.9

0.6-2.8 (1.8)

 The concentration listed as toxic is an average value from driving under the influence (DUID) cases.

Metoprolol (1,3,4,5,6)

B

 0.03-0.5

0.65-18

4.7-142

Midazolam (1,2,4,5,6)

E

0.008-0.6

0.03-1.5

0.07-2.8

Mirtazapine (1,5)

B

0.1-0.3

0.1-2

 1-12

The concentration listed as toxic is from a driving under the influence (DUID) case.

Morphine (1,3,4,5,6,7)

E

0.01-0.3

0.04-5

 0.1-4

Higher doses in caner patients

Naproxen (1,3,4,5)

S

<120

200-840

Nefazadone (1,5)

B

0.01-2

5

>7

Nicotine (1,3,5)

B

0.005-0.044

0.09-0.4

1.4-63

Lower toxic concentrations are associated with transdermal patch use.

Nifedipine (1,5,6)

S

<0.1

0.12-0.2

0.15-5.4

Nortriptyline (1,2,3,5,6,7)

B

0.01-0.37

>0.2

1-26

Significant postmortem redistribution can occur with all tricyclics.  Liver is excellent complementary specimen to resolve difficult cases.

O-desmethylvenlafaxine (1,5)

0.069-0.3

1-5.1

unknown

Significant postmortem redistribution can occur with all tricyclics.  Liver is excellent complementary specimen to resolve difficult cases.

Olanzapine (1,5)

B

0.02-0.4

0.01-1.0

0.8-4.9

Freeze specimen to prevent analyte degradation:

Oxazepam (1,2,3,4.5,6,7)

E

0.1-1.5

0.2-8.0

3-6.1

The concentrations listed as toxic are from driving under the influence (DUID) cases.

Oxcarbazepine (1,5)

N

8-12 (mtb)

46

2.5 (parent)                          92 (mtb)

10-OH carbazepine metabolite (mtb) accumlates with chronic dosing, whereas, parent analyte does not.

Oxycodone (1,3,4,5,6)

B

0.01-0.1

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 driving under the influence (DUID) cases.

Oxymorphone (1,11)

0.003-0.005

0.010-0.15

Tolerance is important to consider when evaluating the toxicity of this drug.

Paroxetine (1,2,5)

B

0.1-0.6

0.35-0.4

 0.7-4.6

Significant postmortem redistribution can occur with all SSRIs  Liver is excellent complementary specimen to resolve difficult cases.

Pentobarbital (1,2,3,4,5,6,7)

A

1-10

>10

5-169

Phencyclidine (1,3,5,6)

S

na

.007-0.8

0.3-25

Phenobarbital (1,2,4,5,6)

A

6-48

30

>50

Phentermine (1,3,4,5)

B

0.03-0.51

0.2

1-7.6

Phenylpropanolamine (1,2,3,5)

B

0.1-0.5

0.3-2

>2

Phenytoin (1,2,3,5)

A

5-20

20-50

 >43

Pregabalin (1)

S

1.3-4.9

unknown

unknown

Primidone (1,3,5,6,7)

A

4-20

>9

65

Procainamide (1,3,5,6,7)

S

4-10

10-16

17-260 (100)

Promethazine (1,2,4,5,6)

B

<0.5

0.17-1

0.16-12

Propoxyphene (1,2,6,7)

B

0.13-1.0

>0.5

>2 (parent only)

Propanolol (1,2,4,5,6,7)

B

<0.34

1-4.5

2-29

Pseudoephedrine (1,3,5)

B

<1

unknown

10-66

Quetiapine (1)

B

<1

1.1-8.8

5-49

PMRD may occur, PB and LVR excellent complementary specimens to resolve difficult cases.

Quinidine (1,3,4,5,6, 7)

B

<6

6-10

10-45

Quinine (1,3,5,7)

B

0.22-15

>10

6-24 (13)

Risperidone (1,5)

S

0.006-0.11

1.1

1.8

Salicylate (1,2,3,5,6,7)

S

10-300

>200

400-7300 (600)

Higher conc. are with arthritic patients that have been titrated to this level (44-330).

Sertraline (1,5)

B

<0.5

>0.2

>1.5 (parent only)

PMRD may occur, PB and LVR excellent complementary specimens to resolve difficult cases.

Temazepam (1,3,4,5,7)

E

0.2-1.1

1

3-14

Theophylline (1,2,3,5,6,7)

N

4.0-20

>20

25-250

Thioridazine (1,2,5,6,7)

B

0.14-2.6

1.1-14

1-18 (5.4)

PMRD may occur, PB and LVR excellent complementary specimen to resolve difficult cases.

Topiramate

A

2.4-8.0

5.9

>49

The concentration listed as toxic are from driving under the influence (DUID) cases.

Tramadol (1,5,7)

B

0.1-1

0.01-5.3

1.1-23

The concentrations listed as toxic are from driving under the influence (DUID) cases.

Trazodone (1,3,5,6,7)

B

<2.5

4-26

9.4-34

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 (1,3,5,6)

E

<0.004

0.004-0.04

0.01-0.22

The concentrations listed as toxic are from driving under the influence (DUID) cases.

Trichlorethanol (1,2,5)

S

2-27

40-330

20-640 (250)

Mtb. of chloral hydrate. Significant postmortem redistribution can occur.  PB and LVR may be required to resolve difficult cases.

Trimipramine (1,2,3,5)

B

0.011-0.241

0.5-1.0

0.4-12

PMRD may occur, PB and LVR excellent complementary specimens to resolve difficult cases.

Valproic acid (1,3,5,6,7)

S

40-125 (plasma)     27-50 (whole blood)

52-148 (hepatotoxic); 482-2120 (coma)

269-2204

Venlafaxine (1,5)

B

<1

6-24

6.6-89 (56)

PMRD may occur, PB and LVR excellent complementary specimens to resolve difficult cases.

Verapamil (1,2,4,5,6,7)

B

0.03-1

1-4

0.9-85 (11)

Zaleplon (7)

S

0.015-0.3

0.037-0.1

>2.2

Ziprasidone (1)

S

0.045-0.14

unknown

unknown

Zonisamide (1,5,8,9)

N

10.0 - 30

> 30

44

Zolpidem (1,2,4,5,7)

B

<0.3

0.07-0.7

>1

The concentrations listed as toxic are from driving under the influence (DUID) cases. Tolerance should be considered when evaluating the toxicity of this drug.