Desipramine overdose GeneraH.ed seizure. and bradycardia

A 26-year-old man with a 7-year history of depression was hospitalised after attempting sUicide with an overdose at deSipramine.

During transportation to hospital he suffered a grand mal seizure. Seizures continued In the hospital emergency room, and were treated with HXlOmg of IV phenytoin administered in 2 doses 30 min apart. About 20 hOurs atter admission the pat'ent experienced 5 successive tonic-clonic generalised seizures toUowed by a dTOp in heaTt rate to 30 beats/min and respiratory arrest successfully trealed by cardiopulmonary resuscitation. An ECG at the time showed a widened QRS complex. Normal sinus rhythm and spontaneous respirations were achieved with sodium bicarbonate 133.8 mEq and physostigmine 1 mg IV. Plasma desipramine concentration at the time was 1627 ng/ml. A 3-hour charcoal haemoperfusion was performed 22 hours after admission in an attempt to reduce the tricyclic plasma concentrations However, on day 4 after charcoal haemoperfuSlon plasma deSipramine had increased from 1627 to 1729 ng/ml. 12 days after admlssJon the patient was discharged completely recovered. The plasma desipramine concentration had fallen to 174 ng/ml

As nas been previously reported charcoal haemoperfUSlon performed tor a limited period of time may Significantly Increase the rate of plasma drug clearance but account for the actual remol/al of only minimal quantities of drug. The paradoxical Increase in plasma desipramine after haemoperfusion indicates redistrtbution of the drug from peripheral (tissue) sites. Sawyer W T el 31 Ame"can Journal 01 Psychrarry 141 122 (Jan 1984)

0157-7271/84/0225-0007/0$01.00/0 cADIS Press Reactions 25 Feb 1984 7