Alcohol and Benzodiazepines in Fatal Poisonings

Background Postmortem forensic toxicology frequently finds alcohol both alone and in combination with drugs. Although benzodiazepines are generally considered safe, they are considered dangerous with alcohol. Methods A retrospective statistical analysis of alcohol and benzodiazepine concentrations in postmortem blood samples included 808 cases diagnosed as fatal alcohol or drug intoxication involving (1) ethanol alone; (2) ethanol with temazepam; or (3) ethanol with any combination of diazepam, chlordiazepoxide, and nordazepam. Results The median concentration of ethanol was 3.3‰ in cases with ethanol alone and 3.5‰ when diazepam was present, but it was significantly lower, only 2.5‰, when temazepam was present in the blood. Furthermore, the median concentration of ethanol was 2.2‰ in cases with high concentrations (>0.9 mg/liter) of temazepam and 2.7‰ in cases with therapeutic (≤0.9 mg/liter) concentrations. Conclusions Diazepam and chlordiazepoxide pose a smaller risk of death by poisoning than does temazepam when given as a hypnotic to patients suffering from alcoholism.