Ecg Changes in Pure Imipramine Overdose as Function of Plasma Level<sup>*</sup>

Reed, Kenneth L.; McKim, H.R.

doi:10.1177/070674377802300809

Cited by 4 publications

(1 citation statement)

References 7 publications

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“…35], at risk individ uals with a previous cardiovascular deficit [54,68] and interaction with other treatment regimens [29], Even the healthy are not to tally exempt from untoward effects, as clini cal and research reports have shown changes in cardiovascular status even within thera peutic dose range and plasma concentrations [10,36,56,69], Exercise and stress-related conditions may precipitate unexpected car diac effects [31], These factors illustrate the inherent difficulty for the clinician in the day-to-day use of antidepressant medication, but becomes more pronounced in overdose, accidently or otherwise, when it can lead to death due to cardiac asystole [6,8,23,70], Finally, to complicate matters further, one only has to look at the increased incidence of unexplained sudden death in the antidepres sant-treated group [24,52,72] to realise that we cannot, as yet, predict with any great cer tainty which individual will be prone to un wanted and unexpected cardiotoxic effects.…”

Section: Introductionmentioning

confidence: 99%

A Double-Blind Non-Crossover Placebo-Controlled Study between Group Comparison of Trazodone and Amitriptyline on Cardiovascular Function in Major Depressive Disorder

Silverstone

Si³

et al. 1984

Psychopathology

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The cardiovascular effects of trazodone (TZD), amitriptyline (AMT) and placebo were studied in out-patients with major depression. AMT was shown to have the expected effects on the electrocardiograph and on systolic time intervals consistent with its proven anticholinergic and quinidine-like properties. TZD, in contrast, had no quinidine-like effects and minor effects on systolic time intervals. However, it was not without any cardiovascular effects. Although TZD was shown to be a safer preparation than the reference drug AMT, long-term monitoring is needed to explain the minor effect on heart rate and T wave changes.

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Section: Introductionmentioning

confidence: 99%

A Double-Blind Non-Crossover Placebo-Controlled Study between Group Comparison of Trazodone and Amitriptyline on Cardiovascular Function in Major Depressive Disorder

Silverstone

Si³

et al. 1984

Psychopathology

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Major Adverse Reactions During Desipramine Treatment

Nelson¹

1982

Arch Gen Psychiatry

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Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management

Woolf

Erdman

Nelson

et al. 2007

Clinical Toxicology

130

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American Association of Poison Control Centers, Washington, District of Columbia, USAA review of U.S. poison center data for 2004 showed over 12,000 exposures to tricyclic antidepressants (TCAs). A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce healthcare costs, and reduce life disruption for patients and caregivers. An evidencebased expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate prehospital triage and management of patients with suspected ingestions of TCAs by 1) describing the manner in which an ingestion of a TCA might be managed, 2) identifying the key decision elements in managing cases of TCA ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline applies to ingestion of TCAs alone. Co-ingestion of additional substances could require different referral and management recommendations depending on their combined toxicities. This guideline is based on the assessment of current scientific and clinical information. The panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all the circumstances involved. This guideline does not substitute for clinical judgment. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses. 1) Patients with suspected self-harm or who are the victims of malicious administration of a TCA should be referred to an emergency department immediately (Grade D). 2) Patients with acute TCA ingestions who are less than 6 years of age and other patients without evidence of self-harm should have further evaluation including standard history taking and determination of the presence of co-ingestants (especially other psychopharmaceutical agents) and underlying exacerbating conditions, such as convulsions or cardiac arrhythmias. Ingestion of a TCA in combination with other drugs might warrant referral to an emergency department. The ingestion of a TCA by a patient with significant underlying cardiovascular or neurological disease should cause referral to an emergency department at a lower dose than for other individuals. Because of the potential severity of TCA poisoning, transportation by EMS, with close monitoring of clinical status and vital signs en route, should be considered (Grade D). 3) Patients who are symptomatic (e.g., weak, drowsy, dizzy, tremulous, pal...

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Ecg Changes in Pure Imipramine Overdose as Function of Plasma Level^*

Cited by 4 publications

References 7 publications

A Double-Blind Non-Crossover Placebo-Controlled Study between Group Comparison of Trazodone and Amitriptyline on Cardiovascular Function in Major Depressive Disorder

A Double-Blind Non-Crossover Placebo-Controlled Study between Group Comparison of Trazodone and Amitriptyline on Cardiovascular Function in Major Depressive Disorder

Major Adverse Reactions During Desipramine Treatment

Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management

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Ecg Changes in Pure Imipramine Overdose as Function of Plasma Level*

Cited by 4 publications

References 7 publications

A Double-Blind Non-Crossover Placebo-Controlled Study between Group Comparison of Trazodone and Amitriptyline on Cardiovascular Function in Major Depressive Disorder

A Double-Blind Non-Crossover Placebo-Controlled Study between Group Comparison of Trazodone and Amitriptyline on Cardiovascular Function in Major Depressive Disorder

Major Adverse Reactions During Desipramine Treatment

Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management

Contact Info

Product

Resources

About

Ecg Changes in Pure Imipramine Overdose as Function of Plasma Level^*