Post‐mortem clinical pharmacology

Clinical pharmacology assumes that deductions can be made about the concentrations of drugs from a knowledge of the pharmacokinetic parameters in an individual; and that the effects are related to the measured concentration. Post‐mortem changes render the assumptions of clinical pharmacology largely invalid, and make the interpretation of concentrations measured in post‐mortem samples difficult or impossible. Qualitative tests can show the presence of substances that were not present in life, and can fail to detect substances that led to death. Quantitative analysis is subject to error in itself, and because post‐mortem concentrations vary in largely unpredictable ways with the site and time of sampling, as a result of the phenomenon of post‐mortem redistribution. Consequently, compilations of ‘lethal concentrations’ are misleading. There is a lack of adequate studies of the true relationship between fatal events and the concentrations that can be measured subsequently, but without such studies, clinical pharmacologists and others should be wary of interpreting post‐mortem measurements.