Comedian Bob Saget Had Clonazepam and Trazadone in His System.

The autopsy was released, and the results of the tox screen are at the end. https://www.scribd.com/document/558121648/Bob-Saget-autopsy Scroll down a little more than a third down the page. It states that plasma concentrations are consistent with 6 mg a day of Clonazepam (Klonopin). The following article,  https://greeleytribune.net/bob-sagets-autopsy-report-describes-severe-skull-fracture/#:~:text=Bob%20Saget%E2%80%99s%20autopsy%20report%20describes%20severe%20skull%20fracture,brain%2C%20according%20to%20an%20autopsy%20report%20released%20Friday., mentions the following:

There was no indication in the autopsy findings that any of those drugs may have contributed to Saget’s injuries. But doctors said they can make people sleepy and contribute to falls.

 

Despite warnings about side effects, benzodiazepines are widely prescribed to older people. People who take them face an increased risk of falls and fractures, auto accidents and reduced cognition.

 

The use of multiple drugs “is a very dangerous cause of falls in the elderly,” Dr. Neha Dangyach, Neuro-Emergency Management and Transfer to Mount Sinai Health System. She said some combinations can cause a drop in blood pressure or confusion.

Trazadone can cause drowsiness and sleepiness. One doctor stated on Twitter that if Saget fell hard and struck his head on a coffee table, it could cause the kind of head trauma he suffered. Could the prescription benzo and tricyclic antidepressant combination have played a role in his death? We will likely never know. Can't imagine taking 6 mg Klonopin, I couldn't function on 1 mg. And I was on trazadone 100 mg at one point, didn't stay on it, made me super drowsy. Saget was on 300 mg.

Also found was caffeine, so he had been ingesting some form of caffeine, such as a beverage, perhaps to counteract the effects of his medications?

it sounds like he was in very heavy tolerance.

That is so sad. I remember America's Funniest Home Videos like it was yesterday. Makes you wonder how many people are actually in tolerance of these meds and die of "some other reason"

"“It is in my opinion that the death of Robert Saget, a 65-year-old white male found unresponsive in a hotel room, is the result of blunt head trauma. It is the most probable that the decedent suffered an unwitnessed fall backwards and struck the posterior aspect of his head. The manner of death is accident,” the statement from Chief Medical Examiner Dr. Joshua D. Stephany said in his report."

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"The (autopsy) report noted that a PCR test showed that Saget, 65, was also positive for Covid-19."

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"The autopsy also noted he had an enlarged heart; 95% blocked on one side."

https://kesq.com/news/2022/02/10/autopsy-report-says-bob-saget-had-covid-19-and-died-as-a-result-of-blunt-head-trauma/

In a statement released Wednesday, Saget’s family said they have been “overwhelmed with the incredible outpouring of love from Bob’s fans, which has been a great comfort to us and for which we are eternally grateful.”

“As we continue to mourn together, we ask everyone to remember the love and laughter that Bob brought to this world, and the lessons he taught us all: to be kind to everyone, to let the people you love know you love them, and to face difficult times with hugs and laughter,” the statement added.

I have some experience with the combination of clonazepam and trazodone, and I can say that it was completely horrible -- very dangerous. I only lasted a few days before I asked the doctor if it was okay to stop the trazodone. I was fainting every day.

The doctor who prescribed it wanted me to cut down my use of clonazepam, which was .5 mg two times per day at that point. So, she made a plan to get me off it in four weeks by cutting my total dose by a half-tablet, or .25 mg, each week -- clearly, waaaaaay faster than what is considered appropriate in the Ashton Manual (which I had not seen at that point in time). She prescribed trazodone to counteract the effects of cutting down the clonazepam. Well, I was fainting every morning for the few mornings that I did that. A total disaster.

I have low blood pressure to begin with, so I may be more sensitive to the effects of trazodone than others, but according to this webpage at Drugs.com, it's a potentially problematic combination of medications:

"Drug Interactions between Klonopin and trazodone"

https://www.drugs.com/drug-interactions/klonopin-with-trazodone-703-357-2228-0.html

Interactions between your drugs

Moderate

clonazePAM

traZODone

Applies to: Klonopin (clonazepam) and trazodone

Using clonazePAM together with traZODone may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

There's also this excellent article in Forbes magazine:

https://www.forbes.com/sites/lipiroy/2022/02/12/what-you-should-know-about-traumatic-brain-injury/?sh=41f8d1482a35

Actor and comedian, Bob Saget, died on January 9th, 2022 at age 65. He was found unresponsive in his Ritz-Carlton Hotel room in Orlando, Florida. At the time, the cause of death was unknown; a January 10th autopsy report ruled out drugs or foul play. Now we know what took the life of this beloved entertainer, husband and father.

The report from the Orange County Medical Examiner, released February 10th, revealed multiple signs of head trauma, including posterior scalp abrasions, skull fracture-induced eyelid discoloration, a subdural hematoma as well as a subarachnoid hemorrhage (more details later).

The autopsy report, obtained by People, also revealed that Saget was positive for Covid-19. In December 2021, The Full House star had revealed that he had Covid-19. A PCR test can remain positive for several weeks. The toxicology report did not reveal illicit substances but was notable for clonazepam (a.k.a. Klonopin), a benzodiazepine used to treat conditions such as panic disorder, seizures and anxiety. He also tested positive for trazodone, a medication for treating insomnia. Chronic heart disease (atherosclerosis of the aorta and coronary arteries), not an uncommon finding in Saget’s age group, was another autopsy finding.

As an addiction medicine doctor, I treat many patients who take sedating substances: opioids, antidepressants, sleeping meds and many others (alcohol worsens sedation). I always provide the standard warning about drowsiness, not driving or operating heavy machinery. So, I couldn’t help but wonder: did Saget trip and fall backwards after taking clonazepam and trazodone – two medications known to cause drowsiness? Or was he feeling lightheaded from his meds? It’s a moot point now for Mr. Saget’s family. But it’s an important reminder for the millions of people who take sedating medications and other substances including alcohol which can impair both our balance and judgement. 

After the tragic discovery of head trauma as the cause of Saget’s death and as an injury sustained by so many of my patients and family members, I decided to write about the key features about brain and skull trauma.

Traumatic Brain Injury

According to the CDC, traumatic brain injury (TBI) is a leading cause of death and disability in the United States, killing approximately 166 people each day. Males represent nearly 80% of all reported TBI cases. The two main causes of TBIs include a bump, blow or jolt to the head; or a penetrating injury to the head such as a gunshot or knife wound.

“Falls remain the leading cause of TBI, followed by motor vehicle accidents,” explains Isaac Karikari, MD, associate professor of neurosurgery at Duke University Hospital. “Patients who are 65 years and older suffer the highest mortality when they develop TBI.”

The CDC lists 3 main types of TBI. Mild TBI or concussions are typically not life-threatening but can still be serious. Moderate and severe TBI can lead to life-long health problems (for those who survive) and result in a substantial societal and economic toll. The lifetime economic cost of TBI (including medical costs) was about $76.5 billion in 2010.

Symptoms vary widely and depend on the severity of the head injury, ranging from headache, confusion, vomiting and mood changes to slurred speech, paralysis, coma and loss of bowel or bladder control.

TBI-Related Injuries

The American Association of Neurological Surgeons (AANS) describes multiple injuries caused by TBIs including “mass lesions” which can increase pressure within the brain. A hematoma is a blood clot anywhere within the brain; an epidural hematoma (which claimed the life of actress Natasha Richardson) develops between the dura mater and the inside of the skull versus a subdural hematoma (experienced by Saget) which collects between the dura mater and the arachnoid layer.

A contusion is bruising of brain tissue consisting of injured or swollen brain mixed with blood leaked from arteries, veins or capillaries. A subarachnoid hemorrhage (SAH), also found on Saget’s autopsy, occurs when blood enters the subarachnoid space and is mostly mild; severe SAH can lead to hydrocephalus, a buildup of fluid in the ventricles or cavities deep within the brain.

“Epidural hematomas are notorious for causing a lucid interval,” describes Christa Swisher, MD, a neurocritical care physician at Atrium Health. “You may seemingly feel fine but then later as the hemorrhage outside the brain gradually worsens and increases pressure on the brain, it causes more and more symptoms and could eventually lead to death if not recognized and treated in time.”

When to Call 911 – Especially Among Elderly Adults

As a reassuring reminder, most falls and head injuries are benign and do NOT result in serious or long-term consequences. But if the impact was significant (i.e. not just a light tap) or if concerning symptoms develop (dizziness, blurry vision, behavior changes, etc.), then 911 should be called.

“Patients should be monitored at home for new or worsening symptoms such as a severe headache, confusion or vomiting,” states Dr. Swisher. “In a scenario like this, 911 should be called immediately.”

Dr. Karikari concurs: “Any elderly person who falls and strikes his or her head should be monitored closely by family members or caretakers. Any change in their mental status, headache complaints and excessive sleepiness should prompt immediate medical evaluation.”

TBIs may also be missed or misdiagnosed in older adults who are more likely to be hospitalized and die from head trauma. Symptoms of TBI often overlap with other medical conditions commonly experienced by older adults such as dementia. Take special note of older individuals who take anticoagulants such as warfarin (Coumadin), apixaban (Eliquis) or rivaroxaban (Xarelto); or antiplatelet medications like Aspirin or clopidogrel (Plavix). These meds can increase the risk of a brain bleed following a TBI. Have a low threshold for calling 911.

Prevention

Many head injuries are preventable, according to the Cleveland Clinic. Review your medicines with your doctor or pharmacist – find out which ones cause dizziness and increase your risk of falls. Fall-proof your home by clearing away toys, removing loose rugs and installing bathtub grab bars and staircase handrails. Wear a helmet when biking, skating, riding a motorcycle or playing sports like hockey or football. Buckle up when behind the wheel using seat belts, or use car seats or booster seats for kids; avoid driving when under the influence or feeling drowsy. Optimize your vision by getting regular eye exams and setting up good lighting in stairwells and hallways. Build muscle and improve balance through activities such as yoga, tai chi and strength training. Use walking assistive devices, if needed, such as canes and walkers to be steadier on your feet.

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On a personal note, I wanted to share my story with the legend himself. I had the opportunity to see Mr. Saget perform live last June at a comedy club, Levity Live, in West Nyack, NY. The cherished comic could not contain his jubilation at the sight of a live audience…and applied his unique brand of sarcasm: “I mean, who goes out on a Wednesday night to see comedy in an abandoned mall?” We all laughed because we all indeed drove out to the Palisades Center in the middle of the week because we loved Bob! And he reciprocated: “YOU do. And I love you.” I got it. The outpouring of love from his fellow comedians and closest friends – Jeff Ross, Steve Martin, Mindy Kaling, George Wallace and countless others – echoed loud and clear in my broken heart. I send my deepest condolences to Mr. Saget’s family and loved ones...and hope Bob’s having a hearty laugh in heaven.

I wonder if he was on heart meds too for his enlarged heart?

The tox screen showed no traces for any other meds. He should have been on something, he had atherosclerosis as well, and the blockage in his aorta was significant enough his heart may have been working harder to compensate, leading to the cardiomyopathy. I recall a news article mentioning that he said there was a family history of heart problems, and premature deaths of several relatives, yet he was on no heart meds. Strange.

I guess that's the end of this story:

"Bob Saget's family sues to stop the release of records from death investigation"

https://www.npr.org/2022/02/15/1081018419/bob-saget-family-lawsuit-records

"Judge blocks release of further records in Bob Saget death"

https://www.wesh.com/article/bob-saget-judge-blocks-release-records/39109933#

I guess that's the end of this story:

 

"Bob Saget's family sues to stop the release of records from death investigation"

 

"Judge blocks release of further records in Bob Saget death"

I can't blame them considering all the speculation on social media. They want to stop it from getting into the hands of the likes of TMZ and The Daily Mail, and other tabloids who would use FOIA to get their hands on it and add more fodder to the theory mill.