Desipramine/imipramine First report of hypersensitivity *00 myocarditis and hepatitis: 2 case reports

Two patients who had been treated with increasing doses of antidepressants for 6 and 3 weeks, died after developing myocarditis.

Case 1: Two days after hospital isation for attempted suicide, a 66-year-old man underwent psychiatric evaluation . Medical history was remarkable for long standing psychiatric illness and adult-onset diabetes mellitus. Shortness of breath and chest pain developed on hospital day 4; acute anterior wall infarct was diagnosed and he was managed conservatively . Oral desipramine 25 mgjday was initiated on day 20 and increased incrementally to 200 mgjday by day 40. The next day, the patient became tachypnoeic , diaphoretic and hypotensive. He experienced bradycardia, shortness of breath and heart arrest , and died on day 42. Autopsy revealed generalised artherosclerosis, aortic sclerosis, and diffuse myocarditis.

Case 2: Oral imipramine 25 then 50 mgjday had been prescribed 21 days before the death of a 54-year-old woman . Medical history was remarkable for alcoholism, depression and severe gastritis. Autopsy revealed gastritis, enteritis , myocarditis and liver cellular infiltrates. Blood imipramine and desipramine levels were 106 and 261 ngjml, respectively.

This report described " , , two cases of hypersensitivity myocarditis and hepatitis In association with Imipramine and desipramine, These cases suggest that hypersensitivity reactions to imipramine may be mediated through Its primary metabolite, desipramine,'

Morrow PL, Hardin NJ, Bonadies J. Hypersensitivity myocarditis and hepatitis associated with imipramine and its metabolite, desipramine. Journal of Forensic Sciences 34: 1016-1020, Jul 1989 ...