QTc Intervals in Drug Poisoning Patients with Tricyclic Antidepressants and Selective Serotonin Reuptake Inhibitors

Açıkalın, Ayça; Satar, Salim; Avc, Akkan; Topal, Metin; Kuvandk, Güven; Sebe, Ahmet

doi:10.1097/mjt.0b013e318197eec6

Cited by 14 publications

(8 citation statements)

References 14 publications

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“…Antidepressants, both selective serotonin reuptake inhibitors and tricyclic (TCA), are known to cause QTc prolongation in overdose [22]. As such, the observed increase in prolonged QTc is interesting as the number of poisonings with antidepressants was unchanged from 2003.…”

Section: Discussionmentioning

confidence: 99%

A one-year observational study of all hospitalized acute poisonings in Oslo: complications, treatment and sequelae

Lund

Drottning

Stiksrud

et al. 2012

Scand J Trauma Resusc Emerg Med

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ObjectivesChanges in poisoning trends may affect both complications and outcomes in patients with acute poisoning. This study reports the treatments given and the frequency of complications, also related to treatment, mortality and sequelae related to various toxic agents.MethodsAll acute poisonings in adults (≥16 years) admitted to the five hospitals in Oslo were included consecutively during one year (2008 to 2009) in an observational cross-sectional multicenter study. A standardized form was completed by the treating physician, which covered the study aims.ResultsThere were 1065 admissions in 912 patients. The median length of hospital stay was one day, and 49% were observed in an intensive care unit (ICU). Active treatment was given to 83%, and consisted of supportive therapy (70%), antidote(s) (38%), activated charcoal (16%) and gastric lavage (9%). The most commonly used antidotes were flumazenil (19%), naloxone (17%) and N-acetylcysteine (11%). The rate of treatment-related complications was 2.4% (21/884). Neither flumazenil, naloxone, nor the combination, was associated with convulsions or other complications. Among those receiving N-acetylcysteine, 5% (6/120) developed allergic reactions, one of which mandated discontinuation of treatment. Nineteen percent presented in a coma. Complications developed in 30%, compared with 18% in a 2003 study, mainly respiratory depression (12%), prolonged QTc interval (6%) and hypotension (5%). Eight patients died (0.8%) and five (0.5%) survived with permanent sequelae, mainly anoxic brain damage.DiscussionFew patients stayed more than two days. The use of the ICU was liberal, considering that only one out of five presented in a coma. Antidotes were frequently given diagnostically. Although N-acetylcysteine induced allergic reactions, most were mild and treatment discontinuation was only necessary once. The frequency of complications had almost doubled in five years, although the poisoning pattern was largely unchanged. However, few patients developed permanent sequelae.

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Section: Discussionmentioning

confidence: 99%

A one-year observational study of all hospitalized acute poisonings in Oslo: complications, treatment and sequelae

Lund

Drottning

Stiksrud

et al. 2012

Scand J Trauma Resusc Emerg Med

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“…Liebelt (2008) pointed to the occurrence of ECG changes both in the setting of therapeutic and toxic doses of Antipsychotics and TCAs. Several studies reported QTC prolongation and wide QRS complex were common findings in patients with TCAs or antipsychotics overdose (Açikalin et al, 2010;Khalaf et al, 2011;Saleh et al,2013 ;Karakiliç et al ,2016;Mishra &Kumar,2018) The potential mechanism underlying QT prolongation by antipsychotic drugs is based on their ability to block the rapidly activating delayed rectifier potassium current (IKr), which leads to lengthening of cardiac repolarization Regarding TCAs, they inhibit sodium channel conductance, so that phase 0 cardiac depolarization is delayed. This may cause slower conduction within the His-Purkinje fibers and ventricular myocardium, causing prolongation of the QRS complex on the ECG (Leung et al, 2012;Waring, 2012).…”

Section: Discussionmentioning

confidence: 99%

B-Type Natriuretic Peptide and Troponin I as Possible Predictive Biomarkers for Cardiotoxicity Induced By Tricyclic Antidepressants and Antipsychotics Overdose

Mohamed

Eldin

Salam

2019

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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All rights reserved. AbstractOverdose by tricyclic antidepressants and antipsychotic drugs can lead to potentially lifethreatening cardiotoxicity. In clinical medicine, B-type natriuretic peptide (BNP) and cardiac troponin I (cTnI) are used as serum biomarkers in the diagnosis of cardiac affection. Aim: The study aimed to investigate the utility of BNP and troponin I as early predictors for TCA and antipsychotic drug -induced cardiotoxicity and correlation with severity of poisoning. Method: The study enrolled 45 patients admitted in ICU of Poison Control Center of Ain Shams University Hospitals (PCC-ASUH) with history of tricyclic antidepressants (TCA) and /or antipsychotics overdose. Collected data included sociodemographic data, manner of exposure, clinical variables, ECG changes, Poison Severity Score (PSS), serum levels of BNP and cTnI. Duration of ICU and hospital stay, and outcome were also noted. Results: In contrast to cTnI level, BNP level was significantly higher in cardiotoxicity group. Mean BNP level correlated with ECG and blood pressure changes. Biomarkers levels were nonsignificantly correlated with PSS, total hospital stay &ICU stay. PSS had low sensitivity and accuracy for prediction of cardiotoxicity. Both BNP and cTnI showed at specific cut off point showed 100% specificity with sensitivity of 53.13% & 25.0% respectively Conclusion: Although unsuitable for screening purposes, BNP surpassed cTnI as a useful tool for the diagnosis of cardiotoxicity due to overdose by tricyclic antidepressants and antipsychotic drugs

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“…This finding has also been reported by other studies. These have shown a strong correlation between prescription frequency and rate of antidepressant poisoning which is more pronounced with TCAs (12,(16)(17)(18). The tricyclic antidepressant agents, particularly amitriptyline, are recognized for their potentially lethal cardiovascular and neurological effects in poisoned patients (19).…”

Section: Discussionmentioning

confidence: 99%

Benzodiazepines Co-ingestion in Reducing Tricyclic Antidepressant Toxicity

Eizadi-Mood¹,

Sabzghabaee²,

Saghaei³

et al. 2012

Med Arh

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A im: Tricyclic antidepressant (TCA) overdose is generally associated with central nervous system (CNS) and cardiovascular toxicity manifested by seizure, electrocardiographic (ECG) abnormalities and arrhythmia. The objective of this study was to determine whether TCA toxicity would be reduced in patient where benzodiazepine (BDZ) was co-ingested with TCA. Design: Patients who were diagnosed to be poisoned by ingestion of both a tricyclic antidepressant and benzodiazepine (TCA-BDZ), and patients intoxicated solely by a TCA were assessed, provided that they had one or more clinical signs of toxicity (anticholinergic, cardiovascular or CNS findings) and no underlying cardiac disease. TCA poisoned patients who had ingested any drugs other than benzodiazepines were excluded. Patients transferred from elsewhere and those admitted after the first 24 hours were also excluded. The clinical manifestations of TCA toxicity and outcome of the patients poisoned only with TCA (N=60) were compared with those of the patients who had coingested TCAs and BDZs (N=60). Main Results: The frequency distribution of sinus tachycardia, "QRS more than 100 ms, R/S aVR equal or more than 0.7, R aVR equal or more than 3 mm", arrhythmia, and generalized tonic colonic seizure was less in patients who had co-ingested BDZ with TCA. Evaluating the relationship between ingested TCA dosage and electrocardiographic findings (duration of QRS, QT and PR intervals, the amplitude of R wave in lead aVR and right axis deviation) in both study groups, demonstrated that there was a strong relationship between TCA dosage and QRS duration in the TCA group. This was significantly different from the same correlation in the TCA-BDZ group (r, 0.50 in TCA group versus r, 0.04 in TCA and BDZ group, P < 0.05). No significant differences were found in complications (aspiration pneumonia, non-cardiac pulmonary oedema and death) between the two groups. Conclusions: cardiovascular toxicity and seizure may be less in TCA-BDZ poisoned patients compared with patients intoxicated with TCA-alone.

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QTc Intervals in Drug Poisoning Patients with Tricyclic Antidepressants and Selective Serotonin Reuptake Inhibitors

Cited by 14 publications

References 14 publications

A one-year observational study of all hospitalized acute poisonings in Oslo: complications, treatment and sequelae

A one-year observational study of all hospitalized acute poisonings in Oslo: complications, treatment and sequelae

B-Type Natriuretic Peptide and Troponin I as Possible Predictive Biomarkers for Cardiotoxicity Induced By Tricyclic Antidepressants and Antipsychotics Overdose

Benzodiazepines Co-ingestion in Reducing Tricyclic Antidepressant Toxicity

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