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14 results on '"toxic concentration"'

1. The analysis of ramipril/ramiprilat concentration in human serum with liquid chromatography-tandem mass spectrometry – interpretation of high concentrations for the purposes of forensic toxicology.

Author

Dziadosz, Marek, Rosenberger, Wolfgang, Klintschar, Michael, and Teske, Jörg

Subjects
*LIQUID chromatography-mass spectrometry, *DRUGGED driving, *FORENSIC toxicology, *RAMIPRIL, *ACE inhibitors
Abstract

Ramipril is a popular angiotensin-converting enzyme inhibitor applied in the treatment of hypertension. Its therapeutic effect is oriented on the concentration of the active metabolite ramiprilat. The information about toxic drug levels is missing in the literature. Therefore, the aim of this work was an indication of possible toxic ranges based on the analysis of real samples with high ramiprilat concentrations. For these purposes, an appropriate analytical LC–MS/MS method was developed and validated according to forensic guidelines and applied in the routine. Most real samples targeted for ramipril/ramiprilat were associated with the typical therapeutic drug range of 1–40 ng/mL described in the literature. However, higher drug levels with ramiprilat concentrations above 100 ng/mL could also be observed infrequently in cases of driving under the influence of drugs or attempted suicides. To the best of the author's knowledge, this is the first time antemortem ramipril and ramiprilat concentrations associated with driving under the influence of drugs and suicide attempts were discussed from a forensic point of view. The collected data enabled an indication of the ramiprilat toxic concentration range from about 600 ng/mL to at least 3500 ng/mL. The toxic concentration range discussed can be applied in the forensic practice as a reference for future cases. [ABSTRACT FROM AUTHOR]

Published
2024
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2. Evaluation of therapeutic and toxic levels of serum digoxin concentration: a cross-sectional study from a tertiary hospital.

Author

KOCA, H. B., ONCU, S., BECIT-KIZILKAYA, M., and GOKASLAN, S.

Abstract

OBJECTIVE: Digoxin is a cardiac glycoside for treating heart failure and atrial fibrillation. Despite its limited therapeutic range and complex pharmacokinetic properties, this medication continues to be frequently prescribed. This study aimed to evaluate the serum digoxin concentration (SDC) at therapeutic, subtherapeutic, and toxic levels and explore the factors affecting these levels in patients receiving digoxin therapy for heart failure. PATIENTS AND METHODS: In this descriptive and cross-sectional study, the data were obtained from the electronic system of patients who presented to Afyonkarahisar Health Sciences University. For the SDC, the reference range was accepted as 0.5-0.9 ng/mL, and the upper limit was 2.0 ng/mL. The patient's demographic characteristics, comorbidities, and laboratory findings were evaluated. The Mann-Whitney U test, Chi-square test, and logistic regression analysis were used. p<0.05 was considered statistically significant. RESULTS: The data of 419 patients (mean age: 65.9±16.1 years, 68.5% women) were evaluated. The mean SDC was 1.11±1.01 ng/mL, and it was below 0.5 ng/mL in 24.3% of the patients, 0.5-0.9 ng/mL in 23.4%, 0.9-2 ng/mL in 41.3%, and over 2 ng/mL in 11.1%. Age, male gender, the presence of diabetes mellitus, and high HbA1c values were found to be associated with greater SDC levels, but this was not statistically significant. The presence of renal failure, elevated creatinine and magnesium levels, and potassium, sodium, and calcium levels outside the normal limits significantly increased the SDC. High creatinine and low/high potassium values significantly affected the detection of SDC at the toxic level. CONCLUSIONS: The measurement of SDC levels holds significance not only in the monitoring of toxicity but also in ensuring adherence to the recommended therapeutic range during therapy. It is recommended to exercise caution in terms of risk factors such as age, kidney function test results, and blood electrolyte levels. [ABSTRACT FROM AUTHOR]

Published
2024

4. Determining the Population Doubling Time of HepG2 and Huh-7 Cells and the Toxic Effect of Dimethyl Sulfoxide (DMSO)

Author

Fazleen Haslinda Mohd Hatta, Ruhil Nadirah Che Omar, Mohd Ikhwan Ismail, Rosmadi Mohd Yusoff, and Mohd Shihabuddin Ahmad Noorden

Subjects
dmso concentration, hepatocytes, hepg2, huh7, toxic concentration, cell doubling, Mathematics, QA1-939, Physics, QC1-999, Medicine (General), R5-920, Engineering (General). Civil engineering (General), TA1-2040, Agriculture (General), S1-972
Abstract

Developing cell lines that carry promising qualities closest to human hepatocytes in drug studies is a dream of many research laboratories. About 90% of drugs are metabolised by the liver. Therefore, most drug discovery studies utilise hepatocytes to understand the basic mechanism of the drug’s breakdown. To assure hepatocytes survival, various solvents were tested for their cytotoxicity on the cell line. Since most drugs are weakly soluble in water, they can be dissolved in an aprotic solvent. To obtain accurate results, the requirements of these solvents are biocompatible and non-toxic to the cells. One of the most commonly used solvents is dimethyl sulfoxide (DMSO). This study aims to understand the cell characteristic of cells doubling time and investigate the toxic effect of DMSO using the cell proliferation measurement technique. The toxicity was measured on liver-derived cell lines HepG2 and Huh-7. Cell growth and morphology were observed with an inverted phase microscope while cell viability was counted using Vi-Call XR 2.03. Results showed that a doubling time of 32 hours would be best for treatments on both cells. A concentration of more than 0.40% DMSO has significant toxicity and caused inhibition of proliferation on both cell lines, resulting in low cell count and higher cell death. Ethanol and methanol were observed as good solvents since they have low toxicity. However, drugs that were only dissolved in a low concentration of DMSO (0.05-0.2%) gave the best result without any harmful effect on cell proliferation.

Published
2022
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5. Kinetics and toxicity of an environmentally relevant mixture of halogenated organic compounds in zebrafish embryo

Author

Lindqvist, Dennis, Wincent, E., Lindqvist, Dennis, and Wincent, E.

Abstract

Persistent and semi-persistent halogenated compounds cause health problems for the animals occupying the upper level of the food web in the Baltic Sea. Atlantic salmon (Salmo salar), being a top piscivore in the Baltic Sea, has been observed to carry a large body burden of halogenated toxins. Here, a mixture of nine halogenated compounds belonging to different groups was created, based on the observed composition of halogenated toxins in salmon serum. The toxicokinetic properties of the compounds were studied in zebrafish (Danio rerio) embryos to achieve the same proportions between the internal doses of the compounds in the zebrafish as in the salmon. Toxicity was evaluated for the compounds dosed individually as well as in a mixture. Perfluorooctanesulfonic acid (PFOS) was the dominant compound in the salmon and was observed to be the driving force for effects on swimbladder inflation caused by the mixture with a 50% effect concentration of 4.8 µM nominal dose, or 1300 µMD based on the area under the internal concentration-time curve (AUC). The driving compound for other severe effects caused by the mixture, including lethality, spinal deformity, and edemas, was the hydroxylated polybrominated diphenyl ether 6-OH-BDE47, which was observed to have a 50% lethality concentration of 93 nM, corresponding to 94 µMD based on internal dose (AUC). The individual compounds were observed to act additively on most of the documented outcomes when dosed as a mixture.

Published
2022
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6. Prenatal metal mixture concentrations and reward motivation in children

Author

de Water, E., Curtin, P., Gennings, C., Chelonis, J. J., Paule, M., Bixby, M., McRae, N., Svensson, Katherine, Schnaas, L., Pantic, I., Téllez-Rojo, M. M., Wright, R. O., Horton, M. K., de Water, E., Curtin, P., Gennings, C., Chelonis, J. J., Paule, M., Bixby, M., McRae, N., Svensson, Katherine, Schnaas, L., Pantic, I., Téllez-Rojo, M. M., Wright, R. O., and Horton, M. K.

Abstract

Reward motivation is a complex umbrella term encompassing the cognitions, emotions, and behaviors involved in the activation, execution, and persistence of goal-directed behavior. Altered reward motivation in children is characteristic of many neurodevelopmental and psychiatric disorders. Previously difficult to operationalize, the Progressive Ratio (PR) task has been widely used to assess reward motivation in animal and human studies, including children. Because the neural circuitry supporting reward motivation starts developing during pregnancy, and is sensitive to disruption by environmental toxicants, including metals, the goal of this study was to examine the association between prenatal concentrations of a mixture of neurotoxic metals and reward motivation in children. We measured reward motivation by administering a PR test to 373 children ages 6–8 years enrolled in the Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) Study in Mexico City. Children were asked to press a response lever for a token reward; one press on the response lever was required to earn the first token and each subsequent token required an additional 10 lever presses. Maternal blood concentrations of lead, manganese, zinc, arsenic, cadmium, and selenium were measured using inductively-coupled plasma mass spectrometry during the 2nd and 3rd trimesters of pregnancy. We performed generalized Weighted Quantile Sum (gWQS) regression analyses to examine associations between the prenatal metal mixture and reward motivation; adjusting for child sex, birthweight and age; and maternal IQ, education, and socioeconomic status. The prenatal metal mixture was significantly associated with higher motivation as indicated by more lever presses (ß = 0.02, p < 0.001) and a shorter time between receiving the reinforcer and the first press (ß = 0.23, p = 0.01), and between subsequent presses (ß = 0.07, p = 0.005). Contributions of different metals to this association diff

Published
2022
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7. Seedling response of three Eucalyptus species to copper and zinc toxic concentrations

Author

Assareh, M.H.

Subjects
Toxic concentration, E. occidentalis, E. microtheca, Eucalyptus camaldulensis, Heavy Metals, Environmental sciences, GE1-350, Science
Abstract

Human activities have continuously increased the level of heavy metal ions circulating in the environment. It is important to understand the tolerance of plant species to high concentrations of heavy metals. Very little is known on the response of Eucalyptus species to Zn and Cu toxic concentrations Eucalyptus camaldulensis, E. microtheca, and E. occidentalis seeds were grown in silt and irrigated by nutrient solution. Forty two days old seedlings were exposed to ten Zn and Cu treatments for ten months. The tolerance order of the species to toxic concentrations of Cu was Eucalyptus camaldulensis> E. occidentalis> E. microtheca and the tolerance order of the species to toxic concentrations of Zn was E. occidentalis> E. microtheca> E. camaldulensis. Tissue concentration increased as Zn and Cu concentration increased for the species. Root tissue concentrations regards to Zn and Cu concentrations were higher than shoot tissue concentration at all solution. These results provided the first quantified metals in Eucalyptus species and the second explored relationships between concentrations of metals in nutrient solution and plant organs.

Published
2008

9. Performance of Chlorella Vulgaris Exposed to Heavy Metal Mixtures: Linking Measured Endpoints and Mechanisms

Author

Universitat Rovira i Virgili, Exposito, Nora; Carafa, Roberta; Kumar, Vikas; Sierra, Jordi; Schuhmacher, Marta; Gimenez Papiol, Gemma, Universitat Rovira i Virgili, and Exposito, Nora; Carafa, Roberta; Kumar, Vikas; Sierra, Jordi; Schuhmacher, Marta; Gimenez Papiol, Gemma

Abstract

Microalgae growth inhibition assays are candidates for referent ecotoxicology as a fundamental part of the strategy to reduce the use of fish and other animal models in aquatic toxicology. In the present work, the performance of Chlorella vulgaris exposed to heavy metals following standardized growth and photosynthesis inhibition assays was assessed in two different scenarios: (1) dilutions of single heavy metals and (2) an artificial mixture of heavy metals at similar levels as those found in natural rivers. Chemical speciation of heavy metals was estimated with Visual MINTEQ software; free heavy metal ion concentrations were used as input data, together with microalgae growth and photosynthesis inhibition, to compare different effects and explain possible toxicity mechanisms. The final goal was to assess the suitability of the ecotoxicological test based on the growth and photosynthesis inhibition of microalgae cultures, supported by mathematic models for regulatory and decision-making purposes. The C. vulgaris algae growth inhibition test was more sensitive for As, Zn, and Pb exposure whereas the photosynthesis inhibition test was more sensitive for Cu and Ni exposure. The effects on growth and photosynthesis were not related. C. vulgaris evidenced the formation of mucilaginous aggregations at lower copper concentrations. We found that the toxicity of a given heavy metal is not only determined by its chemical speciation; other chemical compounds (as nutrient loads) and biological interactions play an important role in the final toxicity. Predictive mixture effect models tend to overestimate the effects of metal mixtures in C. vulgaris for both growth and photosynthesis inhibition tests. Growth and photosynthesis inhibition tests give complementary information, and bo

Published
2021

10. Heavy Metal Bioaccumulation, Oxidative Stress And Genotoxicity In African Catfishclarias Gariepinusfrom Orontes River

Author

Serpil Karan, Gul Ozyilmaz, Funda Turan, Haluk Uluca, Meltem Eken, Deniz Bilimleri ve Teknolojisi Fakültesi -- Su Ürünleri Yetiştiriciliği Bölümü, Deniz Bilimleri ve Teknolojisi Fakültesi -- Deniz Bilimleri Bölümü, Turan, Funda, Eken, Meltem, and Karan, Serpil

Subjects
0106 biological sciences, Chromium, Veterinary medicine, Physiology, Health, Toxicology and Mutagenesis, Seasonal variation, Anguilla-anguilla, 010501 environmental sciences, medicine.disease_cause, Toxicology, Muscle tissue, 01 natural sciences, Animal tissue, Liver cell, Clarias gariepinus, African catfish, Liver tissue, Water pollutant, Catfishes, Priority journal, biology, Ecology, Chemistry, Environmental monitoring, General Medicine, Water sampling, Toxic concentration, Bioaccumulation, Damage, Heavy metals, European eel, DNA strand-breakage, Bioassay, Animal cell, Catfish, Cadmium, DNA damage, Iron, Principal component analysis, Management, Monitoring, Policy and Law, Exposure, Rivers, Metals, Heavy, River ecosystem, medicine, Animals, Ecotoxicology, Comet assay, 0105 earth and related environmental sciences, Manganese, Animal, Antioxidant response, Biomarker, DNA, biology.organism_classification, Concentration (composition), Nonhuman, 010602 entomology, Fish, Correlation coefficient, Metabolism, Oxidative stress, Fish culture, Physiological stress, Comet Assay | Micronucleus Tests | Genotoxicity, Africa, Clarias-gariepinus, Genotoxicity, Controlled study, Water Pollutants, Chemical, Environmental Sciences, Biomarkers, Copper
Abstract

One of the major problems affecting the ecosystem health is the exposure of heavy metals due to anthropogenic activities. These exposures may induce toxiogenetic damage and carcinogenesis in aquatic organism. DNA damage biomarkers for fish species detect genotoxic parameters for ecological risk assessment. In the present study, the effect of heavy metals (Cr, Cd, Cu, Fe and Mn) on DNA damage and oxidative stress of Clarias gariepinus was examined by Comet assay at Reference site and two different sampling sites of the Orontes River. Moreover, the relationship between DNA damage and physiological response to oxidative stress caused in C. gariepinus was investigated by sampling seasonal water and fish samples for one year. In this study, Cr, Cd and Cu in water column of Orontes River and the concentrations of Fe and Mn in liver tissue of C. gariepinus were highly exceed the maximum permissible limit set by EPA (1999, 2016) WHO (1989) and TEG (2012) that can cause adverse effects on environment health. SOD activities in liver tissues were significantly higher than those in muscle tissues. SOD, CAT activity and MDA levels of both Site 1 and Site 2 at Orontes River were higher than those of the Reference site. In result of the COMET analysis, the highest levels of DNA damage were found at gill and liver tissues in Site 2 (17.746 ± 1.072% T-DNA; 16.014 ± 0.710% T-DNA respectively) at Orontes river. A higher level of DNA damage in gill cells compared to liver cells was observed in all regions of the Orontes River. In Principal component analysis (PCA), the heavy metals Cd, Cr and Cu (in the water column) and MDA in liver and muscle revealed strong contribution to the observed DNA damage that were scattered opposite to each other's along the principal components. Moreover, correlations between parameters revealed a positive significant relationship between Cd, Cr and Cu in water and DNA damage levels in C. gariepinus. Pearson correlation analysis detected a positive relationship between MDA, CAT and SOD and DNA damage levels in African catfish. Consequently, this study exposed genotoxic damage and oxidative stress of C. gariepinus due to metal pollution in Orontes River and lead to the better understanding of genotoxicty, oxidative stress and heavy metal relationships.

Published
2020

11. Границы всхожести семян фитомелиорантов в присутствии токсичных концентраций тяжелых металлов

Subjects
heavy metals, soil pollution, pollutants, phytomeliorants, clover seeds, alfalfa seeds, germination en- ergy, laboratory germination, phytotoxicity, toxic concentration, threshold concentration, optimal concentration, zinc, copper, cadmium, lead, stability limits, тяжелые металлы, почвенное загрязнение, поллютанты, фитомелиоранты, семена донника, семена люцерны, энергия прорастания, лабораторная всхожесть, фитотоксичность, токсичная концентрация, пороговая концентрация, оптимальная концентрация, цинк, медь, кадмий, свинец, границы устойчивости
Abstract

Цель исследования заключается в проведении биологического тестирования на начальных стадиях жизнеспособности растительных объектов в модельных условиях загрязнения тяжелыми металлами. В статье представлены результаты лабораторных опытов по оценке влияния различных концентраций солей тяжелых металлов на жизнеспособность семян донника желтого и люцерны посевной. Проведенными экспериментальными исследованиями установлена прямая зависимость уменьшения показателей энергии прорастания и лабораторной всхожести семян при повышении концентрации солей фитотоксикантов, определены критическая (пороговая) концентрация изучаемых элементов и содержание металла, при котором процессы роста и развития семян сохраняются. Оптимальной для всхожести семян донника является концентрация 0,01% по кадмию, цинку, свинцу и меди, где всхожесть составила 80%, 74%, 69% и 64% соответственно. Для семян люцерны высокие показатели всхожести отмечены в 0,01% загрязнении свинцом, цинком, кадмием и медью – 82%, 80%, 77% и 76% соответственно, а также в 0,1% растворе соли свинца, меди и цинка зафиксировано 75%, 74% и 72% проростков. Цинк в концентрации 0,01% на начальных этапах всхожести семян фитомелиорантов оказывал стимулирование энергии прорастания. Отмечена тенденция устойчивости к загрязнению свинцом, цинком и медью у всходов люцерны посевной, к загрязнению кадмием наибольшую устойчивость проявил донник желтый. Определение границ всхожести семян бобовых растений в присутствии токсичных агентов позволит проводить научные разработки по биологической рекультивации загрязненных почв и может быть использовано на техногенно-нарушенных территориях., The aim of the study is to conduct biological testing at the initial stages of plant objects viability in the model conditions of heavy metal pollution. The paper presents the results of laboratory experiments to assess the impact of different concentrations of heavy metal salts on the viability of yellow melilot and great trefoil seeds. In the course of the conducted experimental studies the author has been established a direct dependence of the decrease in the indices of germination energy and laboratory germination of seeds with an increase in the concentration of phytotoxicant salts, determined the critical (threshold) concentration of the studied elements and the metal content, in which the processes of growth and development of seeds remain. The concentration of 0,01% cadmium, zinc, lead and copper was optimal for germination of melilot seeds, where germination was equal to 80%, 74%, 69% and 64%, respectively. For great trefoil seeds, high germination rates were noted in case of 0,01% contamination with lead, zinc, cadmium and copper – 82%, 80%, 77% and 76%, respectively, and in 0,1% salt solution of lead, copper and zinc there were recorded 75%, 74% and 72% of seedlings. Zinc in the concentration of 0,01% at the initial stages of germination of phytomeliorant seeds stimulated germination energy. The tendency of resistance to pollution by lead, zinc and copper was observed at sprouts of a great trefoil, and to pollution by cadmium the greatest resistance was shown by a melilot yellow. Defining the limits of the leguminous plant seeds germination in the presence of a toxic agent will allow research and development in respect of biological restoration of contaminated soils and can be used in technologically disturbed lands.

Published
2019
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12. Acute and Chronic Effects of Three Pharmaceutical Drugs on the Tropical Freshwater Cladoceran Ceriodaphnia silvestrii

Author

Bruno Nunes, Odete Rocha, Laira Lúcia Damasceno de Oliveira, Raphael Campitelli-Ramos, Sara C. Antunes, and CIIMAR - Centro Interdisciplinar de Investigação Marinha e Ambiental

Subjects
0301 basic medicine, toxicity test, paracetamol, environmental exposure, 010501 environmental sciences, acute toxicity, 01 natural sciences, Toxicology, brachiopod, Crustacea, Bioassay, Chronic toxicity, Water Science and Technology, fertility, ecotoxicity, Ecological Modeling, drug, risk assessment, Tropical crustacean, Environmental exposure, Pollution, 3. Good health, EC50, Aquatic organisms, bioassay, Toxicity, toxic concentration, Ceriodaphnia silvestrii, Environmental Engineering, Diclofenac, Ecotoxicological effects, Biology, Article, ecotoxicology, freshwater ecosystem, 03 medical and health sciences, toxicity testing, tropical environment, Environmental Chemistry, Ecotoxicology, controlled study, propranolol, 0105 earth and related environmental sciences, Acetaminophen, Ceriodaphnia, nonhuman, physicochemical property, Tropics, Acute toxicity, 030104 developmental biology, 13. Climate action, biomonitoring, Ecotoxicity, pollution effect, chronic toxicity
Abstract

Among emerging contaminants, pharmaceuticals are one of the most relevant groups of substances found in aquatic environment, due to their universal use, specific physical-chemical properties, and mode of action in aquatic organisms at low concentrations. Considering the magnitude of concentrations and the considerable small amount of information about their potential ecotoxicological effects on wildlife (especially towards organisms from tropical areas), the present study intended to assess the acute and chronic effects of three pharmaceuticals (the analgesic acetaminophen, the anti-inflammatory diclofenac, and the antihypertensive propranolol) in the tropical crustacean species Ceriodaphnia silvestrii. Results of acute exposures showed a considerable variation in toxicity among pharmaceuticals: acetaminophen (EC50 = 40.3 mg L−1) < diclofenac (EC50 = 37.9 mg L−1) < propranolol (EC50 = 3.17 mg L−1), C. silvestrii being more sensitive to the drug propranolol. Data of chronic toxicity tests showed the occurrence of reproductive adverse effects, but also stimulatory phenomena. Propranolol caused a significant increase in fecundity for the concentrations up to 0.0313 mg L−1, and the rate of population increase was significantly augmented from the lower concentration tested. Considering these results and the wide distribution of C. silvestrii in tropical regions, we suggest the use of this species to be used as test organism in ecotoxicity assays performed in such areas, especially for biomonitoring and/or the determination of effects of pharmaceutical drugs. © 2018, Springer International Publishing AG, part of Springer Nature. Acknowledgments We are grateful to the Brazilian Research Council (CNPq) for the financial support provided for this research project (No. 142131/2010-5). Bruno Nunes was hired under the program Investigador FCT, co-funded by the Human Potential Operational Program (National Strategic Reference Framework 2007–2013) and European Social Fund (EU). Sara Antunes was funded by a post-doctoral fellowship (SFRH/BPD/109951/2015) by Fundação para a Ciência e Tecnologia (Government of Portugal).

Published
2018
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14. A fatal intoxication case involving topiramate

Author

Beer, Beate, Libiseller, Kathrin, Oberacher, Herbert, and Pavlic, Marion

Subjects
*TEMPERANCE, *CASE studies, *TOPIRAMATE, *ANTICONVULSANTS, *TREATMENT of epilepsy, *MIGRAINE, *HEADACHE treatment, *PHARMACOLOGY, *PHARMACODYNAMICS, *AUTOPSY
Abstract

Abstract: Topiramate belongs to a new group of anticonvulsive drugs primarily applied in treatment of epilepsy and in preventive therapy of migraines. Topiramate is structurally unrelated to other antiepileptic drugs and acts by multiple neurostabilizing mechanisms. However, the pharmacology of topiramate appears to be complex and some of its pharmacodynamic actions still remain to be elucidated. This case report documents a fatal intoxication involving topiramate. A 41-year old woman with a known history of psychiatric disorder was found unresponsive by her husband. Resuscitation efforts did not succeed and the woman was pronounced dead at the intensive care unit four hours later. At the scene, drug packages of topiramate, citalopram and flunitrazepam were found. Autopsy including histological examination revealed morphological signs of an acute intoxication and shock. A comprehensive toxicological analysis with GC–MS was performed on the deceased''s autopsy samples (femoral blood, bile, kidney, gastric content). The results revealed the presence of topiramate at a concentration of 49mg/L in the femoral blood sample, thus clearly exceeding the therapeutic range. Additionally, citalopram (0.85mg/L) and flunitrazepam in traces (<2μg/L) were detected in peripheral blood. Based on the autopsy findings and toxicological results, the cause of death was primarily attributed to an intoxication with topiramate in combination with citalopram. [Copyright &y& Elsevier]

Published
2010
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