Heath Ledger died of an accidental overdose of painkillers, sleeping pills, anti-anxiety medication and other prescription drugs, the New York City medical examiner said Wednesday.
The cause of death was "acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam and doxylamine," spokeswoman Ellen Borakove said in a statement.
The medical examiner's office only provided generic names, so it is unknown whether he took generic or brand-name drugs. Police had said they found six types of prescription drugs, including sleeping pills and anti-anxiety medication, in Ledger's apartment.
Oxycodone is a painkiller marketed as OxyContin and used in other painkillers such as Percodan and Percocet; hydrocodone is used in a number of painkillers, including Vicodin.
Diazepam and alprazolam are the generic names for the anti-anxiety drugs Valium and Xanax, and the other two drugs are sleep aids commonly sold under the brands Restoril and Unisom.
Borakove wouldn't say what concentrations of each drug were found in Ledger's blood, or whether one drug played a greater part than another in causing his death.
"What you're looking at here is the cumulative effects of these medications together," she said.
The ruling comes two weeks after the 28-year-old Australian-born actor was found dead in the bed of his rented SoHo apartment.
Ledger's family returned to the actor's hometown of Perth, Australia, on Tuesday to prepare for his funeral. Arrangements were private.
In a statement released through Ledger's publicist, the actor's father, Kim, said Wednesday: "While no medications were taken in excess, we learned today the combination of doctor-prescribed drugs proved lethal for our boy. Heath's accidental death serves as a caution to the hidden dangers of combining prescription medication, even at low dosage."
Heath Ledger was discovered by his masseuse Jan. 22 after she arrived for an appointment that afternoon. She entered his bedroom to set up for the massage and found him unresponsive, and proceeded to call Mary-Kate Olsen three times over the next 9 minutes before dialing 911. Ledger had been dead for some time, and police say no foul play occurred. Police said they found a rolled-up $20 bill near the bed.
Ledger, nominated for an Oscar for his role in "Brokeback Mountain," had returned to New York from London, where he had been filming a $30 million Terry Gilliam film, "The Imaginarium of Doctor Parnassus," days before his death. He said in a November interview that his roles in the Batman movie "The Dark Knight" and the Bob Dylan biopic "I'm Not There" had taken a toll.
"Last week I probably slept an average of two hours a night," Ledger told The New York Times. "I couldn't stop thinking. My body was exhausted, and my mind was still going." He said he had taken two Ambien pills, which only gave him an hour of sleep.