Forty patients ingesting tricyclic antidepressant (TAD) overdoses were studied as a pharmacologic model to determine whether total tricyclic antidepressant plasma levels correlated with major adverse effects and electrocardiographic findings. Maximum TAD plasma levels were higher in patients who died (p less than 0.025) or had cardiac arrest (p less than 0.02), needed respiratory support (p less than 0.005), were unconscious (p less than 0.02), had grand mal seizures (p less than 0.001), ventricular rate larger than or equal to 120/min (p less than 0.01), cardiac arrhythmia (p less than 0.05), QRS duration larger than or equal to 100 msec (p less than 0.001), or bundle branch block (p less than 0.05). TAD plasma levels correlated with the dose ingested by history (N = 29, r = 0.58, p less than 0.001). Measurement of total TAD (free and protein-bound) appears to correlate well with biologic response.

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Tricyclic antidepressant plasma levels were measured in nine hospitalized adolescent overdose patients to define the medical seriousness of the drug ingestion. Seven out of nine of these patients ingested medication prescribed for treatment of their psychiatric symptoms. Indications for tricyclic therapy in adolescents are vague. The more frequent use of these drugs makes the potential for life-threatening ingestions relatively common. The amount of drug ngested is usually poorly documented. Plasma measurements are of value in assessing the efficacy of the various medical treatments of overdose patients. Two of these nine overdoses were medically serious as defined by plasma measurements. Supportive care with cardiac monitoring was adequate in one case; however, a fatality occurred in the other under what could be described as optimal patient management conditions.