Tissue Distribution of Molidone in a Multidrug Overdose

Molindone hydrochloride (Moban | is a dihydroindolone compound dissimilar in structure to other antipsychotic drugs (i.e., phenothiazines, butyrophenones, dibenzepines, and thioxanthenes). The antipsychotic (or neuroleptic) activity of molindone makes it particularly useful in the treatment of schizophrenia. There are a few published cases which report the tissue distribution of molindone in the human body. We report the analysis of molindone in postmortem samples using a solvent mixture (toluene/hexane/isoamyl alcohol) base extract followed by an acid (0.5M H2SO 4) wash. Molindone was identified by gas chromatography-mass spectrometry (m/z 100, 176, 276) and quantitated using a gas chromatograph and nitrogen-phosphorus detector. The range of linearity was 0.1 mg/L to 5.0 mg/L. We report our findings of molindone concentrations in blood, liver, bile, gastric, and urine as follows: 6 mg/I in blood; 26 mg/kg in liver; 23.1 mg/L in bile; 1200 mg/L in gastric; and 37.3 rag//in urine. Vitreous lithium (5.9 retool/L) was determined by flame atomic absorption spectrometry. The medical examiner listed the cause of death as a combined drug overdose of molindone and lithium. The tissue results are compared with another case and the pharmacology of molindone is presented.