Analysis of phenazepam and 3-hydroxyphenazepam in post-mortem fluids and tissues

摘要

Phenazepam is a benzodiazepine that is predominantly used clinically in the former Soviet\udstates but throughout the wider world is being abused. This study reports the tissue\uddistribution and concentration of both phenazepam and 3-hydroxyphenazepam in 29 cases\udquantitated by LC-MS/MS in a variety of postmortem fluids (subclavian blood, femoral\udblood, cardiac blood, urine, vitreous humor) and tissues (thalamus, liver and psoas\udmuscle). In 27 cases the cause of death was not directly related to phenazepam (preserved\ud(fluoride/oxalate) femoral blood phenazepam concentrations 0.007 mg/L to 0.360 mg/L\ud(median 0.097 mg/L)). In two cases phenazepam was either a contributing factor to, or the\udcertified cause of death (preserved (fluoride/oxalate) femoral blood 0.97 mg/L and 1.64\udmg/L). The analysis of phenazepam and 3-hydroxyphenazepam in this study suggests that\udthey are unlikely to be subject to large postmortem redistribution and that there is no direct\udcorrelation between tissues/fluid and femoral blood concentrations. Preliminary\udinvestigations of phenazepam stability comparing femoral blood phenazepam\udconcentrations in paired preserved (2.5% fluoride/oxalate) and unpreserved blood show\udthat unpreserved samples show on average a 14% lower concentration of phenazepam\udand we recommend that phenazepam quantitation is carried out using preserved samples\udwherever possible.