Drug and chemical blood-level data 2001

Abstract

Current blood-level data are presented for drugs and chemicals of toxicologic interest. The data represent an update of previously published compilations of therapeutic, toxic and lethal blood-levels.

Introduction

Since first publishing a tabulation of therapeutic, toxic or lethal drug and chemical blood-level concentrations in the early 1970s [1], the data has been published in revised form numerous times in journals and in reference books [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]. The first published form was done by Fisher Scientific and consisted of one page of levels. There have been other authors that have published tables dealing with drug levels, but these have disappeared and have not been updated [13], [14], [15]. With the addition of new drug entities on an annual basis, it is now necessary to update and revise the blood-level data more frequently.

The same cautions that have been indicated in earlier publications still apply to the interpretation of the information of blood-levels contained in Table 1. Post-mortem redistribution is a more recent factor that must be taken into consideration. The first published paper dealing with post-mortem redistribution was published in 1971 [16]. At the time, the authors referred to post-mortem redistribution as post-mortem diffusion.

It should also be noted that this table does not apply to infants and children. The levels for infants and children can be calculated from the data using any one of the rules for calculation of dosage such as Young’s, Cowling’s, Fried’s or Clark’s. The method based on surface area as related to weight can also be used [17]. The surface area calculation is the one generally used.

The values in the table are not considered absolute, but are to be used as a guideline in evaluating a given case. The values can be affected by dose, route of administration, absorption differences, age, sex, tolerance, pathology or disease state, method of analysis, post-mortem redistribution, protein binding, active metabolites, total or free drug, etc. Users of the table are referred to Winek’s Toxicology Annual [7] or Chapter 72 in Forensic Medicine [8]. For other tissue levels and pharmacokinetic data users are referred to Baselt’s reference [18]. An important caution is that ante-mortem pharmacokinetics does not apply to the post-mortem state. There have been attempts to apply pharmacokinetics using a one compartment or two compartment system to consider the dose taken. Such pharmacokinetic methods do not apply to the morbid state.