Analysis of Sertraline in Postmortem Fluids and Tissues in 11 Aviation Accident Victims
FEDERAL AVIATION ADMINISTRATION OKLAHOMA CITY OK CIVIL AEROSPACE MEDICAL INST
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Sertraline Zoloft R 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 pilots 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 andor 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 GCMS. Whole blood sertraline concentrations obtained from these 11 cases ranged from 0.005 to 0.392 micgmL. The distribution of sertraline, expressed as specimenblood ratio, was as follows urine 0.47 -0.39 n6, vitreous humor 0.02 - 0.01 n4, liver 74 - 59 n11, lung 67 - 45 n11, kidney 7.4 - 5 n11, spleen 46 - 45 n10, muscle 2.1 - 1.3 n8, brain 22 - 14 n10, heart 9 - 7 n11, and bile 36 - 26 n8.