Brugada phenocopy induced by tricyclic antidepressant poisoning

The concept of preemptive analgesia, albeit long-standing, has reemerged. Consequently, recent research has focused on testing a variety of drugs preoperatively to prevent the occurrence of postoperative pain, a major factor of morbidity. Amitriptyline is a tricyclic antidepressant used to treat chronic pain. Because amitriptyline acts on pain transmission pathways, it could theoretically be used as an agent for the prevention of postoperative pain. This study evaluated the effectiveness of amitriptyline in preventing pain in patients submitted to hysterectomy, the most commonly performed gynecological surgery. A randomized, double-blind clinical trial was conducted with 145 patients, 72 of these receiving amitriptyline and 73 placebo. All patients were evaluated at 6, 12, 24 and 48 hours after surgery using a visual analog scale (VAS) for pain and algometry to determine the pressure-pain threshold. Statistical analysis was conducted using the chi-square test of association, Student's t-test, and the Mann-Whitney test, with Fisher's exact test being used whenever appropriate. No statistically signicant difference was found between the two groups with respect to pain at any of the time points evaluated, leading to the conclusion that at a dose of 25 mg, amitriptyline is ineffective in preventing postoperative pain in patients submitted to abdominal hysterectomy

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Evaluation of Myocardial Cell Damage by In-111-Monoclonal Antimyosin Antibodies in Patients Under Chronic Tricyclic Antidepressant Drug Treatment

Circulation ◽

10.1161/01.cir.91.6.1619 ◽

1995 ◽

Vol 91 (6) ◽

pp. 1619-1623 ◽

Cited By ~ 15

Author(s):

Vicens Martí ◽

Manel Ballester ◽

Claudi Udina ◽

Ignasi Carrió ◽

Enric Alvarez ◽

...

Keyword(s):

Drug Treatment ◽

Cell Damage ◽

Antidepressant Drug ◽

Myocardial Cell ◽

Tricyclic Antidepressant ◽

Antidepressant Drug Treatment ◽

Myocardial Cell Damage

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Monitoring of tricyclic antidepressant plasma levels and clinical response: a review of the literature. Part II

Psychiatry and Psychobiology ◽

10.1017/s0767399x00002911 ◽

1989 ◽

Vol 4 (2) ◽

pp. 81-90 ◽

Cited By ~ 2

Author(s):

I.R. De Oliveira ◽

P.A.S. Do Prado-Lima ◽

B. Samuel-Lajeunesse

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Elderly Patients ◽

Plasma Levels ◽

Tricyclic Antidepressant ◽

Review Of The Literature ◽

Central Nervous System Toxicity ◽

Routine Measurement ◽

System Toxicity

SummaryPart II of this paper contains some general considerations on tricyclic antidepressant (TCA) monitoring. Long-term assessment of TCA plasma levels is advised by the few existent studies, although each of these focusses on different aspects. Cardiovascular and central nervous system toxicity is reviewed as well as pharmacokinetics and the importance of protein binding. Some consideration is also given to their use in elderly patients. The authors conclude that although available data support its usefulness in many situations, routine measurement of TCA levels is not warranted.

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Antidepressants and Risk of Sudden Cardiac Death: A Network Meta-Analysis and Systematic Review

Medical Sciences ◽

10.3390/medsci9020026 ◽

2021 ◽

Vol 9 (2) ◽

pp. 26

Author(s):

Narut Prasitlumkum ◽

Wisit Cheungpasitporn ◽

Nithi Tokavanich ◽

Kimberly R. Ding ◽

Jakrin Kewcharoen ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Mental Disorders ◽

Ventricular Arrhythmia ◽

Cardiac Death ◽

Selective Serotonin Reuptake Inhibitors ◽

Meta Analysis ◽

Tricyclic Antidepressant ◽

Systemic Review ◽

Analysis Model ◽

Antidepressant Use

Background: Antidepressants are one of the most prescribed medications, particularly for patients with mental disorders. Nevertheless, there are still limited data regarding the risk of ventricular arrhythmia (VA) and sudden cardiac death (SCD) associated with these medications. Thus, we performed systemic review and meta-analysis to characterize the risks of VA and SCD among patients who used common antidepressants. Methods: A literature search for studies that reported risk of ventricular arrhythmias and sudden cardiac death in antidepressant use from MEDLINE, EMBASE, and Cochrane Database from inception through September 2020. A random-effects model network meta-analysis model was used to analyze the relation between antidepressants and VA/SCD. Surface Under Cumulative Ranking Curve (SUCRA) was used to rank the treatment for each outcome. Results: The mean study sample size was 355,158 subjects. Tricyclic antidepressant (TCA) patients were the least likely to develop ventricular arrhythmia events/sudden cardiac deaths at OR 0.24, 0.028–1.2, OR 0.32 (95% CI 0.038–1.6) for serotonin and norepinephrine reuptake inhibitors (SNRI), and OR 0.36 (95% CI 0.043, 1.8) for selective serotonin reuptake inhibitors (SSRI), respectively. According to SUCRA analysis, TCA was on a higher rank compared to SNRI and SSRI considering the risk of VA/SCD. Conclusion: Our network meta-analysis demonstrated the low risk of VA/SCD among patients using antidepressants for SNRI, SSRI and especially, TCA. Despite the relatively lowest VA/SCD in TCA, drug efficacy and other adverse effects should be taken into account in patients with mental disorders.

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