Liver and peripheral blood concentration ratio (L/P) as a marker of postmortem drug redistribution: a literature review

The liver to peripheral blood (L/P) ratio, based upon review of previously published works, was evaluated as a marker of postmortem redistribution (PMR). Literature supported the proposed model that drugs exhibiting an L/P ratio of less than 5 are prone to little or no PMR, while those with an L/P ratio greater than 20-30 have propensity for significant redistribution. Many antidepressants, including both tricyclic antidepressants and selective serotonin re-uptake inhibitors, were markedly differentiated from drugs previously verified to be free from, or exhibit little, PMR. The magnitude of the liver to blood concentrations also appeared to provide an advantage over the conventional central to peripheral blood ratio model of PMR by demonstrating a wide range of values (1.6-97) for interpretation of drugs' potential for, and variations in, redistribution.