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Doctors' Answers to "Frequently Asked Questions" - Flunitrazepam

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Question: What is the lethal dose of flunitrazepam for an adult? The specific scenario involves suspected oral administration of 2 mg to 100 mg of rohypnol plus a small amount of champagne.

I am researching a case involving a near-fatal dose of flunitrazepam. The patient consumed flunitrazepam (rohypnol) and alcohol (champagne) and went into a comatose state for approximately 20 minutes. The patient was, at the time, a suspected heroin addict, and his spouse was present during the incident.

My questions regard the discrepancies in the spouse's description of events. Specifically, the spouse reported that she found her husband passed out on the floor, after having taken 50 pills at 2 mg each. It appears that this is an exaggeration, because 50 pills would seem to be a lethal dose, even for a flunitrazepam addict taking 6 mg daily.

Does anyone know of specific cases involving lethal doses of flunitrazepam? What was the dose, route of administration, and surrounding circumstances? I am aware of lethal doses in children, lethal doses administered by Vienna nurses in a serial homicide, and some other lethal dose cases, but I cannot find the details pertaining to the actual doses.

Basically, is it correct to say that 100 mg of rohypnol is definitely fatal? If it is, it conflicts with the spouse's description, because the husband should have died. Thus an event which has been seen by some as an attempted suicide may be in fact an attempted murder. Rohypnol is a well known "date rape" drug of course, and it's presence in this case is thus suspicious, although it was reportedly prescribed to the husband for purposes of mediating opiate withdrawal (a respected indication).

If the husband had indeed taken a large dose, what kind of medical report might be expected? Would blood be tested or urine or both? Would the necessity for emergency treatment be a factor in delaying and negatively affecting potential test results? A toxic child level starts at .27 mg/kg...what is the toxic adult range?

Answer: About the only data that I could find was an article by Boxenbaum, H.G. in Journal of Biopharmakinet Biopharm 1978,6:283-293. Hope this helps.
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