Imipramine side effects in children

Saraf, Kishore R.; Klein, Donald F.; Gittelman-Klein, Rachel; Groff, Stephen

doi:10.1007/bf00421540

Cited by 83 publications

(13 citation statements)

References 22 publications

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“…The finding of no significant IMI effect on diastolic or systolic blood pressure is consistent with that of Saraf et al (1974) for hyperactive children. However, others have reported significant elevation of diastolic pressure associated with IMI therapy for enuretic children (Saraf et al, 1974;Werry, Dowrick, Lampen, & Vamos, 1975;Lake, Mikkelsen, Rapoport, Zavadil, & Kopin, 1979) and for hyperactive children (Greenberg & Yellin, 1975;Rapoport et al, 1974). Unfortunately, findings regarding IMl's effect on children's blood pressure are inconsistent since uniform procedures for recording blood pressure have not been used in all studies.…”

Section: Discussionsupporting

confidence: 89%

“…At 5 mg/kg/24 hr, the maximum dose recommended by the Food and Drug Administration (Hayes, Panitch, & Barker, 1975), IMI produces PR interval lengthening in the EKG (Winsberg, Goldstein, Yepes, & Perel, 1975). Doses that exceed the FDA ceiling have caused seizures (Brown, Winsberg, Bialer, & Press, 1973;Petti & Campbell, 1975) and, in one case, death (Saraf, Klein, Gittelman-Klein, & Groff, 1974). Nevertheless, at doses lower than 5 mg/kg/24 hr, imipramine does not appear to be associated with serious side effects.…”

mentioning

confidence: 96%

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Ineffectiveness of imipramine in children who fail to respond to methylphenidate

Winsberg

Kupietz

Yepes

et al. 1980

J Autism Dev Disord

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Ten hyperactive children who had failed to respond to methylphenidate were treated with imipramine in a placebo-controlled, crossover design. No significant drug effects were obtained either on parent and teacher ratings of the child's behavior or on the child's performance in a laboratory measure of sustained attention. Findings suggest that imipramine has limited clinical usefulness in the treatment of hyperactive children who fail to respond to methylphenidate.

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Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 96%

Ineffectiveness of imipramine in children who fail to respond to methylphenidate

Winsberg

Kupietz

Yepes

et al. 1980

J Autism Dev Disord

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“…Three of these were level 1b (120,127,128) and six were level 2b (99,109,112,(129)(130)(131). Among these prospective trials, the lowest dosages of imipramine associated with toxicity were 50-200 mg/day, which were associated with agitation, flushes, and insomnia (129).…”

Section: Imipraminementioning

confidence: 99%

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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“…A review of English language literature over the past 40 years yields several case reports where a mere one to two pills (10 -20 mg/kg) sufficed to kill a toddler (Table 1) (42)(43)(44)46,52,54,(57)(58)(59)(60)(61)(62). With reference to Table 1, the case reports of fatalities involving amitriptyline, desipramine, and imipramine all occurred with doses equal to or greater than 15 mg/kg, most over 30 mg/kg.…”

Section: Tricyclic Antidepressant Toxicity In Childrenmentioning

confidence: 93%

“…With an initial dose in adults of 25-100 mg once a day, a toddler could easily reach the lethal dose in one or two pills. The lowest fatal dose reported was in a 6-year old who ingested 15 mg/kg of imipramine (59). Jue reports an ingestion of desipramine at 6.67 mg/kg in which the child developed bradycardia, premature ventricular contractions, seizures, and cardiac arrest, but eventually recovered (60).…”

Section: Tricyclic Antidepressant Toxicity In Childrenmentioning

confidence: 97%