We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Tricyclic Antidepressant Cardiotoxicity

Donald S. Robinson, MD; Eileen Barker, MB, ChB, MPH
JAMA. 1976;236(18):2089-2090. doi:10.1001/jama.1976.03270190045029.
Text Size: A A A
Published online


THE FOOD and Drug Administration (FDA) recently convened a conference of experts to review the question of cardiotoxicity of tricyclic antidepressant (TCA) drugs.1 The main impetus for this meeting was concern over reports of changes detected in the electrocardiograms (ECGs) of children receiving imipramine hydrochloride at a dosage of 5 mg/kg2,3 and of the sudden death of a child receiving a single bedtime dose of imipramine hydrochloride, 14.7 mg/ kg, for school phobia.4 There is also evidence that TCAs given in therapeutic dosages alter myocardial function in adult patients5 and occasionally produce heart block and tachyrhythmias in patients with a normal cardiovascular history.6-11

The present concern stems from an increasing tendency of some physicians to employ higher-than-recommended dosages. Although arrhythmias do occur at standard dosages, the evidence suggests that the likelihood of producing substantial alteration in the ECG and cardiac arrhythmia is dose-related.6,8,10 Thus,


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.