Death Following Moclobemide and Venlafaxine Overdose

Interpretation of toxicological findings following the identification of multiple compounds at concentrations suggestive of overdose can be complicated. How these compounds interact and may create additive toxicity needs to be considered prior to concluding a death investigation. In the case of serotonergic compounds, excessive serotonin toxicity, frequently described as serotonin syndrome, can be diagnosed based on the observation of specific symptoms combined with the identification of at least one serotonergic compound. We present a case of suspected serotonin toxicity causing death following the ingestion of moclobemide and venlafaxine. Post-mortem blood concentrations of venlafaxine and moclobemide were 9.4 mg/L and 30 mg/L respectively. Trimipramine and bupropion were also identified at near therapeutic concentrations. The decedent experienced diaphoresis, diarrhea and labored breathing immediately prior to death. To our knowledge, this is only the second reported fatality following venlafaxine and moclobemide overdose.