Reactions 1352 - 21 May 2011

SImipramine

Heart disorders leading to death in a child: casereport

A 6-year-old boy with attention-deficit hyperactivitydisorder developed heart disorders following treatmentwith imipramine; he subsequently died.

The boy started receiving imipramine 50 mg/day [routenot stated]. This dosage was gradually increased to200 mg/day over the following 3 months, based on clinicalresponse. One day, he collapsed at school. Although hisheartbeat was re-established with CPR, his pupils werefixed and dilated and he had no spontaneous respiration.

The boy was taken to the emergency department wherehe was intubated. An ECG revealed ventricular fibrillationand tachycardia, with a QT interval of 580 msec. Tricyclicantidepressant (TCA)-induced cardiotoxicity wassuspected. Therapeutic drug monitoring revealed a totalplasma concentration of TCA (imipramine plusdesipramine) of 1000 ng/mL. He experienced recurrentventricular fibrillation and cardiac arrest, and subsequentlydied. A postmortem examination conducted 20 hours laterrevealed no anatomical cause of death. His postmortemtotal plasma concentration of TCA was 6500 ng/mL.

Author comment: "[T]he failure to consider age and bodyweight when prescribing a drug, imipramine, with a narrowtherapeutic index caused the death of an otherwise physicallyhealthy 6-year-old child. This death could also have beenavoided by using therapeutic drug monitoring to properlyadjust the dose."Preskorn SH. Inadvertent fatal imipramine poisoning of a child: What happened toTommy?. Journal of Psychiatric Practice 17: 118-123, No. 2, Mar 2011. Availablefrom: URL: http://dx.doi.org/10.1097/01.pra.0000396063.90021.02 -USA 803054553

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Reactions 21 May 2011 No. 13520114-9954/10/1352-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved