Coroner's Finding: KALME Dearne Lee

51y · Female·undetermined - either citalopram toxicity or ischaemic heart disease

A 51-year-old woman died at home on 15 October 2013 while on home detention bail. She had been hospitalized in July 2013 following suspected drug overdose/withdrawal, during which she developed secondary kidney and heart complications. She was discharged in good health on 26 August 2013 with prescriptions for citalopram 40mg daily and alprazolam 2mg for anxiety. Post-mortem toxicology revealed a potentially lethal citalopram level, and autopsy showed significant atherosclerotic coronary artery disease. The cause of death was undetermined, as either citalopram toxicity or ischaemic heart disease could have been fatal. Clinical considerations include: the appropriate monitoring of psychiatric medications following discharge, baseline cardiac assessment given her risk factors, and consideration of drug interactions between citalopram and benzodiazepines in vulnerable patients with substance use history.