Winek's Drug & Chemical Blood-Level Data 2001 - abmdi.org

1 Winek's Drug & ChemicalBlood-Level data 2001 Prepared by: Charles L. winek , , Wagdy W. Wahba, ,Charles L. winek , Jr., (Pharm.), , and Tracey winek (Pharm.), have gathered the data in the table from the literatureand from personal experience. The values are not consid-ered absolute, but are to be used as a guide in evaluat-ing a given case. The values can be affected by dose,route of administration, absorption differences, age andsex, tolerance, method of analysis, pathological or dis-ease state, postmortem redistribution, etc. Users of thetable are referred to Winek's Toxicology Annualand Chapter 72 in Forensic Medicine, Volume III, byTedeschi, Eckert and Tedeschi for chapters discussingthe data , reference to the data , and factors affectingblood-level values. For additional pharmacokinetic infor-mation and other tissue levels, users are referred toBaselt s reference, Disposition of Toxic Drugs and Chemi-cals in are cautioned against pharmacists usingpharmacokinetics for interpretation of Blood-Level datawhen death is involved.

2 It should be obvious that kinet-ics, even pharmacokinetics, are not applicable to themoribund of Blood LevelsTherapeutic Blood LevelWinek defines a therapeutic blood level as that concen-tration of drug and/or its active metabolite(s) present inthe blood (serum or plasma) following therapeutically ef-fective dosage in Blood LevelThe concentration of drug and/or its active metabolite(s)or Chemical present in the blood (serum or plasma) thatis associated with serious toxic symptoms in Blood LevelThe concentration of drug and/or its active metabolite(s)or Chemical present in the blood (serum or plasma) thathas been reported to cause death, or is so far abovereported therapeutic or toxic concentrations, that one canjudge that it might cause death in Blood LevelSome of the values under normal represent normal bodyconstituents and others represent values related tonormal environmental exposure. Values can, and do, varywith geographical and chemicals in the table are reported in bothmg% and g/mL.

3 Drugs are listed by both their trade andgeneric names. Mg% (milligram percent) is equal tomg/dL (milligram/deciliter); g/mL (microgram/milliliter) isequal to mg/L (milligram/liter).NOTE:Divide the mg% level by 100 to obtain mg/mL Dividethe g% level by 100 to obtain g/mL. To convertmg/L or g/L to mg% or g%, divide level by :1mg/L = g/L = g% g is the representation for microgram (mcg).Many therapeutic drugs are reported in nanograms/milliliter (ng/mL). To convert the listed mcg/mL in thistable to ng/mL, multiply the listed value by 1000. Forexample, digoxin concentration of mcg/mLwould be x 1000 = ng/mL. Put simply, youmove the decimal point three places to the Charles L. WinekDr. winek is a professor of toxicol-ogy at Duquesne University Schoolof Pharmacy and also teaches forthe University's School of Educa-tion, Graduate School of Arts andSciences, and the Law School. Heis a diplomate of both AmericanBoard of Forensic Toxicology andthe Academy of ToxicologicalSciences.

4 Dr. winek is currently the director of Pittsburgh CriminalisticsLaboratory and is the former chief toxicologist for the AlleghenyCounty Coroner's Office, positions he held for 32 years. He con-tinues to testify frequently as an expert witness in both criminaland civil cases in Allegheny County and throughout the winek has published 119 articles in scientific journals andauthored, co-authored or contributed to 29 , Dr. winek is toxicology editor for the scientificjournal Forensic Science International and a member of theeditorial boards of The Journal of Applied Toxicology and thejournal Analytical Toxicology.(NOTE: Winek's Drug & Chemical Blood-Level data 2000 isreprinted with written permission as a courtesy to our HealthCare accepts no responsibility for the accuracy of itscontents.)Suggested additions or corrections can be made by contacting theauthor at Recommendations are always and Chemical Blood Level data - 2001 Therapeutic or NormalToxicLethalDRUGmg%ug/mlmg%ug/mlmg% ug/mlAcebutolol (Spectral) - - **Acetaminophen (Tylenol)1 - 210 - 2015150>16>160 Acetazolamide (Diamox) - - 15**Acetohexamide ( Dymelor) - - 56**Acetone**20 - 30200 - 30055550 Acetonitrile [met: to Cyanide]** Acid [as met:2 - 1020 - 10015 - 30150 - 30050500 Salicylate-for analgesic use]Acetylsalicylic Acid [as met.]

5 2 - 2520 - 250** Salicylate-for rheumatoid arthritis]Actidil (Triprolidine) - - **Actifed (Pseudoephedrine) - - ** (Triprolidine) - - **Actron (Ketoprofen) - - **Adalat (Nifedipine, Procardia) - - **Alcaine (Proparacaine)** **Alfenta (Alfentanil) - - **Alfentanil (Alfenta) - - **Allegra (Fexofenadine) - - **Alphaprodine (Nisentil) - - ** (Xanax) - - ** - - **Amantadine (Symmetrel) - - - - - - (Zolpidem) - - ** - - (Theophylline)1 - 210 - 203 - 430 - 405 - 2550 - 250 Amitriptyline (Elavil) - - > > - - 20 Amitriptyline (Elavil) - - > > ** [+met: Nortriptyline] - - **Amobarbital (Amytal) - - 51 - 310 - - - 96 Amoxapine (Asendin) - - ** - - 20 Amoxapine (Asendin) - - ** [+met: 8-OH-amoxapine] - - > > > >1 Amytal (Amobarbital) - - 51 - 310 - - - 96 Anafranil (Clomipramine) - - **Anaprox (Naproxen) - 1231 - 12040400**Analeridine (Leritine)< < ** - - ** (Flubiprofen)1 - - 22**Antabuse (Disulfiram) - - **37 - 58370 - - **11110 Aralen (Chloroquine) - - ** - - - - - - 15 Asendin (Amoxapine) - - ** - - 20 APage 1 Drug and Chemical Blood Level data - 2001 Therapeutic or NormalToxicLethalDRUGmg%ug/mlmg%ug/mlmg% ug/mlAsendin (Amoxapine) - - ** [+met: 8-OH-amoxapine]Astemizole (Hismanal) (Hydroxyzine, Vistaril) - - ** - 39 Atenolol (Tenorim) - - **Ativan (Lorazepam) - - - - **Atromid (Clofibrate) ** - - ** (Moxifluxacin) - - **Aventyl (Nortriptyline) - - [met.

6 Amitriptyline (Elavil)]AZT (Retrovir, Zidovadine) - - **Baclofen (Lioresal) - - - **Barbital1 - - 266 - 860 - 80>10>100 Barbiturates (intermediate acting) - - 51 - 310 - 30>3>30 Barbiturates (long acting)1 - 410 - 404 - 640 - 60>8>80 Barbiturates (short acting) (Diphenhydramine) - - > >8 Benemid (Probenecid)10 - 20100 - 200**Bentyl (Dicyclomine) - - **Benzedrex (Propylhexedrine) ** - - 3 Benzene**>0> - - (Didrex) - - > > (Cogentin) - - - - (Bethanidine) - - **Bethanidine (Bethanid) - - ** - - (Timolol) - - ** (Terbutaline) - - ** (Esmolol) - - ** - 233 - 23050-150500-15002002000 Bromide [met: Carbromal (Carbital)] - 125400 - - - 2450 Bropheniramine (Dimetane) - - **Bupivacaine (Marcaine) - - 10**Buprenex (Buprenorphine) - - **Buprenorphine (Buprenex) - - **Bupropion (Wellbutrin) - - ** (Buspirone) - - **Buspirone (Buspar) - - ** (Butisol) - - **>3>30 Butalbital (Sandoptal, Fioricet, Fiorinal) - - - 47 - - - 26 Butanediol**28280 Butaperazine (Repoise) - - **Butazolidin (Phenylbutazone) - - 1502020040400 Butisol (Butabarbital) - - **>3>30 BPage 2 Drug and Chemical Blood Level data - 2001 Therapeutic or NormalToxicLethalDRUGmg%ug/mlmg%ug/mlmg% ug/mlButorphanol (Stadol) - **Butyl Nitrite (Nitrite) - - 4** - - **>10>100 Calan (Isoptin, Verapamil) - - - - 85 Captopril (Capoten) - - **2 - 620 - 60 Capoten (Captopril) - - **2 - 620 - 60 Carbamazepine (Tegretol) - - 12> >15>5>50 Carbital (Carbromal) [as met.

7 Bromide] - 125400 - - - 2450 Carbocaine (Mepivacaine) - - Monoxide1 - 2%**15 - 35%**48-95%** [% Hemoglobin as Carboxyhemoglobin]Carbon Tetrachloride**2 - 520 - 5010 - 20100 - 200 Carbromal (Carbital) [as met: Bromide] - 125400 - - - 2450 Cardene (Nicardipine) - - **Cardizem (Diltiazem) - - - - (Soma)1 - 4 10 - 403 - 530 - 5011110 Cataflam (Voltaren, Diclofenac) - - **Catapres (Clonidine) (Citalopram) - - ** - - (Methsuximide) - 410 - >44** [as met: Desmethylmethsuximide]Centrax (Prazepam) - - **China White (Methylfentanyl)** - - (Chlorpheniramine) - 320 - 30**Chloral Hydrate (Noctec) - - 121010025250 [as met: Trichloroethanol]Chloramphenicol (Chloromycetin)1 - 210 - 20**20200 Chlorcyclizine - - ** - - (plus metabolite - Norchlormepramine) - - (Librium) - - (Trancopal) - - **Chloromycetin (Chloramphenicol)1 - 210 - 20**20200 Chloroform2 - 5020 - 5007 - 2570 - 25039390 Chlorophen (Chlorphentermine) **Chloroprocaine (Nesacaine) - - 4**Chloroquine (Aralen) - - ** - - **Chlorpheniramine (Chlor-Trimeton) - - ** - - (Chlorophen) **Chlorpromazine (Thorazine) - - - - - - 12 Chlorpropamide (Diabenese) - - 36320 - 75200 - 750**Chlorprothixene (Taractan) - - - - **Chlor-Trimeton (Chlorpheniramine) - - ** - - 3 Drug and Chemical Blood Level data - 2001 Therapeutic or NormalToxicLethalDRUGmg%ug/mlmg%ug/mlmg% ug/mlChlorthalidone (Combipress) - - **Cimetidine (Tagamet) - - **Citalopram (Celexa) - - ** - - (Prilocaine) - - 5**Claritin (Loratidine) - - ** [metabolite.

8 Descarboethoxyloratadine] - - **Clinoril (Sulindac) - - 5**Clofibrate (Atromid) **Clomipramine (Anafranil) - - **Clonazepam (Klonopin) - - **Clonidine (Catepres) (Tranxene) - - > > ** [as met: N-DesmethyldiazepamClozapine (Clozaril) - - **Clozaril (Clozapine) - - ** - - - - - - **> > (Benztropine) - - - - (Colchicine) ** - - (Colbenemid) ** - - (Chlorthalidone) - - **Compazine (Prochlorperazine)**> > - - - - (Warfarin) - 0 - **Cresol** - - - ** - - 53 Cylert (Pemoline) - - ** - - (Flexeril) - - **> > - 1880 - 180**Cyclosporine (Sandimmune) - - **Dalmane (Flurazepam) - - - (Flurazepam) - - ** [+met: N-Desalkylflurazepam]Dantrium (Dantrolene) - - 3**Dantrolene (Dantrium) - - 3**Darvon (Propoxyphene) - - - - - (Propoxyphene) - - - - - - 47 [+ met: Norpropoxyphene] **Demerol (Meperidine) - - - - 20 Depakene (Valproic Acid)5 - 1050 - - - 200**Desipramine (Norpramin) - - > > - 210 - 20 [met: Imipramine (Tofranil)] - 416 - >44** [met: Celontin (Methsuximide)]DPage 4 Drug and Chemical Blood Level data - 2001 Therapeutic or NormalToxicLethalDRUGmg%ug/mlmg%ug/mlmg% ug/mlDesyrel (Trazodone) - - ** **> >3 Diabenese (Chlorpropamide) - - 36320 - 75200 - 750** - - **Diamox (Acetazolamide) - - 15**Diazepam (Valium) - - - - 20>3>30 Diazepam (Valium) - - **> >34 [+ met.]

9 N-Desmethyldiazepam]Diazoxide (Hyperstat) - - 20>10>100**Diazinon** - - 277 Dichloromethane (Methylene Chloride)** - 6095 - 600 Diclofenac (Voltaren, Cataflam) - - ** - - 59770**Dicyclomine (Bentyl) - - **Didrex (Benzphetamine) - - > > - - - - - - (Tenuate) - - ** (Motofen) **Diflucan (Fluconazol) - - 15**Diflunisal (Dolobid) - 139 - 130**37 - 58370 - - - - - (Hydrocodone) - - - - - - 12 Dilantin (Phenytoin, Diphenylhydantoin)1 - 210 - 202 - 520 - 50>10>100 Dilaudid (Hydromorphone) - - ** (Cardizem) - - - - (Brompheniramine) - - **Dimethylsulfoxide (DMSO) - - 3380**160 - 3001600 - - - **Dinitro-O-Cresol**3 - 630 - (Benadryl) - - > >8 Diphenoxylate (Lomotil) - - **Diphenylhydantoin (Phenytoin, Dilantin)1 - 210 - 202 - 520 - 50>10>100 Diprivan (Propofol) - - 16**Disopyramide (Norpace) - - (Antabuse) - - **37 - 58370 - 580 Divinyl Oxide**70700 DMSO (Dimethylsulfoxide) - - 3380**160 - 3001600 - 3000 Dolobid (Diflunisal) - 139 - 130**37 - 58370 - 580 Dolophine (Methadone) - - - - - - (Doxapram) - - ** - **Doral (Quazepam) - - 148**Doriden (Glutethimide) - - 121 - 810 - 803 - 1030 - 100 Dothiepin (Prothiaden) - - ** - - (Dopram) - - **Doxepin (Sinequan) - - - - - -26 Doxepin (Sinequan) - - > > - - 35 [+met: N-DesmethyldoxepinPage 5 Drug and Chemical Blood Level data - 2001 Therapeutic or NormalToxicLethalDRUGmg%ug/mlmg%ug/mlmg% ug/mlDoxylamine (Unisom) - - ** - - 12 Duranest (Etidocaine) - - **Dymelor (Acetohexamide) - - 56** - - **Effexor (Venlafaxine) - - ** [met: O-Desmethylvenlafaxine] - - - - **Elavil (Amitriptyline) - - > > - - 20 Elavil (Amitriptyline) - - > > - - 20 [+met.]

10 Nortriptyline]Eldepryl (Selegiline) - - ** - - ** (Vasotec) - - **Encainide (Enkaid) - - ** {as met: O-Demethylencainide]Encainide (Enkaid) - - ** [as met: - - - - ** - - 21 Estazolam (Prosom) - - **Ethanol (listed toxic concentration is legal**80 - 100800 - 1000>350>3500 intoxication for driving in most states)Ethchlorvynol (Placidyl) - - ** - - 213 Ethinamate (Valmid) - - 11**10 - 20100 - 200 Ethosuximide (Zarontin)4 - 1040 - 100**25250 Ethyl Chloride20 - 30200 - 300**40 400 Ethyl Ether90 - 100900 - 1000**140 - 1891400 - 1890 Ethylene Glycol** - 4002000 - 4000 Etidocaine (Duranest) - - **Etodolac (Lodine) - - 47**Famotidine (Pepcid) - - **Felbamate (Felbatol) - - 3314 - 20140 - 200**Felbatol (Felbamate) - - 3314 - 20140 - 200**Feldene (Piroxicam) - - **Felodipine (Plendil) - - - **Fenfluramine (Pondimin) - - - - - - 15 Fenoprofen (Nalfon) - - **71710 Fentanyl (Sublimaze) - - **Fexofenadine (Allegra) - - **Fioricet (Butalbital) - - - 47 - - - 26 Fiorinal (Butalbital) - - - 47 - - - 26 Flecainide (Tambocar)}