Reactions 648 - 26 Apr 1997

SDesipramine/imipramine

Sudden death in children: 2 case reportsSudden death occurred in 2 boys after they were treated

with tricyclic antidepressants.The first boy, aged 9 years, was hospitalised with increasing

aggressive behaviour; he had a history of multiple psychiatricdisorders. He was prescribed desipramine 25mg twice daily,increased to 50mg twice daily after 3 days, for depression. Hewas discharged with a prescription for desipramine 50mgtwice daily.

Five weeks after the start of desipramine therapy, the boyfell down some stairs and then experienced an episode ofstomach pains and dizziness. He then experienced jerkingmovements, followed by cardiac arrest. His parents performedcardiopulmonary resuscitation and he began breathing again.He then vomited and experienced a series of cardiac arrests.He was taken to hospital, but could not be resuscitated.

The boy occasionally took desipramine 100mg as a singledose if he had missed a dose, and had done so the night hedied.

The second boy, aged 7 years, had been diagnosed withadjustment disorder with mixed disturbance of emotion andconduct, oppositional defiant disorders and possible majordepression. He was treated with imipramine 25mg at bedtime,increased over 6 months to 150 mg at bedtime. Six monthsafter the start of imipramine, thioridazine 25mg every 2 hoursas needed for extreme agitation was added to his regimen.One month before his death, he was taking thioridazine25–75mg at night when required, but it is not known whetherhe took the agent prior to his death.

Eight months after the start of imipramine, the boy collapsedafter running home from school. He was taken to hospital, butresuscitation efforts were unsuccessful.

There was no evidence to suggest that either boy had takentheir medication other than as prescribed. Both boys had hightricyclic antidepressant blood concentrations at postmortem;approximately 10 000 ng/ml in the first boy and 2 000 ng/ml inthe second, which raises the possibility that they had toxicconcentrations prior to death.

Author comment: Thioridazine may have led to addedtoxicity either directly or by its effects on tricyclic antidepressantmetabolism. ‘That there are now two more sudden deathsassociated with the use of tricyclics in children increasesconcern that they play some role in this rare outcome.’Varley CK, et al. Case study: two additional sudden deaths with tricyclicantidepressants. Journal of the American Academy of Child and AdolescentPsychiatry 36: 390-394, Mar 1997 - USA 800523401

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Reactions 26 Apr 1997 No. 6480114-9954/10/0648-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved