Analysis of 2-hydroxyimipramine in an imipramine-related fatality

A fatality following ingestion of the tricyclic antidepressant imipramine (Novopramine®), acetaminophen, and ethyl alcohol is described. Imipramine, desipramine, acetaminophen, and 2-hydroxyimipramine were quantitated by high performance liquid chromatography, and ethyl alcohol by gas liquid chromatography. Concentrations of imipramine, desipramine, 2-hydroxyimipramine, and acetaminophen were: in blood - 9.0, 1.1, 3.9 and 11 mg/L; in urine - 92, 14, and 42 mg/L (acetaminophen not quantitated in urine). Ethyl alcohol concentration in blood was < 10 mg/dL and 105 mg/dL in the urine by headspace gass chromatography. These findings are compared to previous reports of imipramine-related fatalities. To our knowledge, this is the first fatality reported involving imipramine where analysis included quantitation of 2-hydroxyimipramine in blood and urine.