• Dori M Franco, Zabiullah Ali, Barry Levine, Robert A Middleberg, and David R Fowler.
• From the *Office of the Armed Forces Medical Examiner, Rockville; †Office of the Chief Medical Examiner, State of Maryland, Baltimore, MD; and ‡NMS Labs, Willow Grove, PA.
• Am J Forensic Med Pathol. 2014 Dec 1; 35 (4): 234-6.

AbstractTapentadol (Nucynta) is a centrally acting opioid analgesic prescribed for the treatment of moderate to severe acute pain. Its efficacy is believed to be due to μ-opioid receptor agonist activity and inhibition of norepinephrine reuptake resulting in increased norepinephrine concentrations. There is only one other case in the literature relating to the toxicity of this agent or report of a fatality. This case report documents a case in which tapentadol was identified as the cause of death. The tapentadol concentration found in the heart blood submitted in this case was more than 20 times the upper limit of the therapeutic range. Possible mechanisms of death include respiratory depression, central nervous system depression, and serotonin syndrome. Based on the scene investigation and autopsy findings in this case, the medical examiner determined that the cause of death was narcotic (Nucynta) intoxication and the manner of death was undetermined.

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