amitriptyline/imipramine

Reactions 1134 - 13 Jan 2007

SAmitriptyline/imipramine

Cardiomyopathy: case reportA 56-year-old woman developed dilated cardiomyopathy

during treatment with imipramine for bipolar disorder;cardiomyopathy recurred during treatment with amitriptyline.

The woman, who had been receiving imipramine [Tofranil]20 mg/day for about 12 years, was hospitalised for congestiveheart failure. Examination revealed bilateral basilar crackles,hepatojugular reflux and peripheral oedema. On ECG, she hada sinus rhythm of 132 beats/min and T-wave inversion inlateral leads. Chest x-rays revealed bilateral pulmonaryoedema and a cardio-thoracic ratio of 0.54, andechocardiography showed a dilated left ventricle with diffusehypokinesia and a left ventricular ejection fraction (LVEF) of26%.

Imipramine was discontinued and the woman startedreceiving enalapril, furosemide and digoxin. Her conditiongradually improved and, about 3 years after herhospitalisation, she had a LVEF of 71%. Her cardiac status hadnormalised and, about 4 months later, her cardiovasculartreatment was discontinued.

About 7 years later, the woman started receivingamitriptyline [Elavil] 25 mg/day, increased to 50 mg/day8 months later, lithium and paroxetine for bipolar disorderrelapse. She was again hospitalised for congestive heart failurealmost 2 years after starting amitriptyline. On examination, shehad biventricular congestive heart failure with a sinus rhythmof 114 beats/min. Echocardiography showed left ventriculardilation with diffuse hypokinesia and an LVEF of 16%.Amitriptyline and lithium were discontinued and lisinopril,furosemide and digoxin were restarted. Her condition rapidlyresolved and she remained in New York Heart Association(NYHA) class I with normal echocardiogram on follow-upabout 4 years after her second hospitalisation.Briec F, et al. Recurrence of dilated cardiomyopathy after re-introduction of atricyclic antidepressant. Archives des Maladies du Coeur et des Vaisseaux 99:933-935, No. 10, Oct 2006 - France 801059531

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Reactions 13 Jan 2007 No. 11340114-9954/10/1134-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved