Fatal acute intoxication after snorting cocaine and fluoxetine

A case report of a fatal acute intoxication following cocaine and fluoxetine snorting is described here. A 44-year-old woman with an history of drug abuse was found dead at home. On-site evaluation conducted by police highlighted evidence of recent cocaine consumption whereas no tablets or drug blisters were spotted. In the hypothesis of a drug-related crime the local Prosecutor ordered a judicial autopsy. Pathological findings were consistent with an acute cardiac failure while toxicological analysis conducted on blood revealed the presence of fluoxetine and cocaine in reportedly fatal concentrations. A blood alcohol concentration of 1.9 g/L was also detected. Nasal swabs were positive for both fluoxetine and cocaine whereas no sign of tablets was spotted in the stomach, which appeared empty. Death was hence ascribed to an acute cardiac failure secondary to fluoxetine and cocaine intoxication. To the best of the authors knowledge, this is the first post-mortem report of fluoxetine and its active metabolite norfluoxetine in fatal concentrations following intake by snorting.