Death related to consumption of Rauvolfia sp. powder mislabeled as Tabernanthe iboga

Thomas Gicquel; Chloé Hugbart; Françoise Le Devehat; Sylvie Lepage; Alain Baert; Renaud Bouvet; Isabelle Morel

doi:10.1016/j.forsciint.2016.06.014

Death related to consumption of Rauvolfia sp. powder mislabeled as Tabernanthe iboga

Forensic Sci Int. 2016 Sep:266:e38-e42. doi: 10.1016/j.forsciint.2016.06.014. Epub 2016 Jun 17.

Authors

Thomas Gicquel¹, Chloé Hugbart², Françoise Le Devehat³, Sylvie Lepage⁴, Alain Baert², Renaud Bouvet⁵, Isabelle Morel⁶

Affiliations

¹ Rennes University Hospital, Forensic and Toxicology Laboratory, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France; INSERM, UMR 991, University of Rennes 1, 2, avenue du Professeur Léon Bernard, 35043 Rennes Cedex, France. Electronic address: [email protected].
² Rennes University Hospital, Department of Forensic Medicine, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France.
³ PNSCM, CNRS, UMR 6226, Rennes Institute of Chemical Sciences (ISCR), University of Rennes 1, 35043 Rennes, France.
⁴ Rennes University Hospital, Forensic and Toxicology Laboratory, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France.
⁵ Rennes University Hospital, Department of Forensic Medicine, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France; University of Rennes 1, Faculty of Medicine, 2, avenue du Professeur Léon Bernard, 35043 Rennes Cedex, France.
⁶ Rennes University Hospital, Forensic and Toxicology Laboratory, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France; INSERM, UMR 991, University of Rennes 1, 2, avenue du Professeur Léon Bernard, 35043 Rennes Cedex, France.

PMID: 27342343
DOI: 10.1016/j.forsciint.2016.06.014

Abstract

Powdered roots of iboga (Tabernanthe iboga) contain ibogaine, an alkaloid that has been used to treat addictions. We report the case of a 30-year-old woman who died after ingesting a powder labeled as Tabernanthe iboga she had bought online. Analysis of the powder revealed the absence of ibogaine but the presence of toxic alkaloids (ajmaline, yohimbine and reserpine) found in Rauvolfia sp. plant species. An original and specific LC-MS/MS method developed to quantify ajmaline, yohimbine and reserpine showed respective concentrations of 109.1ng/mL, 98.2ng/mL and 30.8ng/mL in blood, and 1528.2ng/mL, 914.2ng/mL and 561.2ng/mL in bile. Moreover, systematic toxicological analyses of biological samples showed the presence of oxazepam at therapeutic concentration and cannabinoids. Death could be attributed to ingestion of a substantial quantity of crushed roots of Rauvolfia in association with concomitant drug withdrawal.

Keywords: Ajmaline; Poisoning; Rauvolfia; Reserpine; Yohimbine; iboga.

Publication types

Case Reports

MeSH terms

Adult
Chromatography, Liquid
Female
Forensic Toxicology
Humans
Powders
Product Labeling*
Rauwolfia / poisoning*
Secologanin Tryptamine Alkaloids / isolation & purification
Secologanin Tryptamine Alkaloids / poisoning*
Tandem Mass Spectrometry

Substances

Powders
Secologanin Tryptamine Alkaloids