Cuyahoga County Coroner's Office, 2121 Adelbert Road, Cleveland, OH 44106 U.S.A.

We report 2 postmortem cases in which mirtazapine was detected in heart blood specimens: Case #1- An 82 year old white female was found by nursing staff on the floor of her bedroom at a nursing care facility. Her medications included diet supplements, albuterol, donepezil and mirtazapine. An autopsy was not performed but heart blood was submitted for toxicological analysis. Case #2- A 70 year old white male was found by nursing staff on the bathroom floor at a nursing facility. Medications included alprazolam, diltiazem and mirtazapine. An autopsy was not performed but heart blood was submitted for toxicological analysis.

Mirtazapine was identified by dual column (RTx-50 and RTx-200) gas chromatography with nitrogen phosphorus detection (HP 6890 GC) after a basic liquid-liquid extraction. Promazine was utilized as the internal standard. Quantitation was achieved by assaying calibrators (200-2000 ng/ml) concurrently with case specimens (r > 0.999). Confirmation was achieved by full scan electron impact gas chromatography/mass spectrometry using an HP 5970 MSD with a DB-5 column.

Mirtazapine chromatographed well on the RTx-50 column, with a relative retention time of 0.978 min, eluting near benztropine. By GC/MS, the base peak of mirtazapine was m/z 195, with a molecular ion of m/z 265, and other prominent ions at m/z194, 208 and 43. The heart blood specimens from each case were subjected to comprehensive toxicological analysis. Mirtazapine was the only drug detected. The mirtazapine blood concentration in case #1 was 280 ng/ml and for case #2, 100 ng/ml. Although the mirtazapine concentration in case #1, was slightly higher than previously reported therapeutic levels, the cause of death was determined to be atherosclerotic heart disease, and the manner, natural.