Tricyclic Antidepressant Cardiotoxicity FREE

Donald S. Robinson, MD; Eileen Barker, MB, ChB, MPH

[+] Author Affiliations

Reprint requests to Clinical Pharmacology Unit, University of Vermont College of Medicine, Burlington, VT 05401 (Dr Robinson).

JAMA. 1976;236(18):2089-2090. doi:10.1001/jama.1976.03270190045029

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ABSTRACT

ABSTRACT | REFERENCES

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/kg^2,3 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,

REFERENCES

ABSTRACT | REFERENCES

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Winsberg BG, Goldstein S, Yepes LE, et al: Imipramine and electrocardiographic abnormalities in hyperactive children . Am J Psychiatry 132:542-545, 1975;.

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Saraf KR, Klein DF, Gittelman-Klein R, et al: Imipramine side effects in children . Psychopharmacologia 37:265-274, 1974;.

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Kantor SJ, Bigger JT, Glassman AH, et al: Imipramine-induced heart block . JAMA 231:1364-1366, 1975;.

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Winsberg BG, Perel JM, Hurwic MJ, et al: Factors in imipramine metabolism in children: protein binding considerations , in Forrest IS, Carr CJ, Usdin E (eds): Phenothiazines and Structurally Related Compounds, Advances in Biochemical Pharmacology , vol 9. New York, Raven Press, 1974;, pp 425-431.

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