Cardiac Arrest Following Drug Abuse with Intravenous Tapentadol: Case Report and Literature Review

Patient: Female, 32 Final Diagnosis: Cardiac arrest after intravenous tapentadol abuse Symptoms: Headache Medication: — Clinical Procedure: Tapentadol drug levels in serum Specialty: Forensic Medicine OBJECTIVE: Rare disease BACKGROUND: Tapentadol is a centrally acting opioid analgesic, with a dual mode of action, as a norepinephrine reuptake inhibitor and an agonist of the μ-opioid receptor (MOR). Tapentadol is used for the management of musculoskeletal pain, and neuropathic pain associated with diabetic peripheral neuropathy. CASE REPORT: A 32-year-old woman attended hospital for evaluation of an intractable headache. Computed tomography and magnetic resonance imaging of the brain were negative. She was found unresponsive in the bathroom on the day following hospital admission, and despite resuscitative measures, the patient died following cardiac arrest. Autopsy toxicology revealed significantly elevated levels of tapentadol, and bedside evidence suggested that the patient had self-administered this medication intravenously before her death. CONCLUSIONS: We report a rare adverse effect of tapentadol causing respiratory depression leading to cardiac arrest. Medical examiners and forensic toxicologists should be aware of the toxicity of this novel opiate drug.