Amitriptyline and Imipramine Poisoning in Children

Goel, K M; Shanks, Robert A.

doi:10.1136/bmj.1.5902.261

Cited by 82 publications

(17 citation statements)

References 8 publications

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“…The lowest amitriptyline ingestion associated with mild toxicity was 50 mg and the lowest dose associated with death was 15 mg/kg (38). The lowest dose of desipramine associated with severe toxicity was 100 mg …”

Section: Minimum Acute Toxic Dose In Children Less Than 6 Years Of Agementioning

confidence: 93%

“…A 1974 level 4 report of 60 children hospitalized for a one-time TCA poisoning estimated the minimum lethal dose of amitriptyline or imipramine to be 30 mg/kg, although the authors included the case of a 2½-year-old child who died within 4 hours of ingesting 15 mg/ kg. While the authors listed 15 mg/kg as the dose associated with severe symptoms in their case series, they stated "…children who ingest tricyclics in whatever dosage should always be admitted…" (38). Additionally, there was a level 2b article (39), a level 3b investigation (40), and a number of level 4 or 6 case series (41)(42)(43)(44)(45)(46)(47)(48) in which the exact TCA ingested was not reported but in which some dose-effect information was available.…”

Section: Minimum Acute Toxic Dose In Children Less Than 6 Years Of Agementioning

confidence: 99%

See 1 more Smart Citation

Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management

Woolf

Erdman

Nelson

et al. 2007

Clinical Toxicology

130

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American Association of Poison Control Centers, Washington, District of Columbia, USAA review of U.S. poison center data for 2004 showed over 12,000 exposures to tricyclic antidepressants (TCAs). A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce healthcare costs, and reduce life disruption for patients and caregivers. An evidencebased expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate prehospital triage and management of patients with suspected ingestions of TCAs by 1) describing the manner in which an ingestion of a TCA might be managed, 2) identifying the key decision elements in managing cases of TCA ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline applies to ingestion of TCAs alone. Co-ingestion of additional substances could require different referral and management recommendations depending on their combined toxicities. This guideline is based on the assessment of current scientific and clinical information. The panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all the circumstances involved. This guideline does not substitute for clinical judgment. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses. 1) Patients with suspected self-harm or who are the victims of malicious administration of a TCA should be referred to an emergency department immediately (Grade D). 2) Patients with acute TCA ingestions who are less than 6 years of age and other patients without evidence of self-harm should have further evaluation including standard history taking and determination of the presence of co-ingestants (especially other psychopharmaceutical agents) and underlying exacerbating conditions, such as convulsions or cardiac arrhythmias. Ingestion of a TCA in combination with other drugs might warrant referral to an emergency department. The ingestion of a TCA by a patient with significant underlying cardiovascular or neurological disease should cause referral to an emergency department at a lower dose than for other individuals. Because of the potential severity of TCA poisoning, transportation by EMS, with close monitoring of clinical status and vital signs en route, should be considered (Grade D). 3) Patients who are symptomatic (e.g., weak, drowsy, dizzy, tremulous, pal...

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Section: Minimum Acute Toxic Dose In Children Less Than 6 Years Of Agementioning

confidence: 93%

Section: Minimum Acute Toxic Dose In Children Less Than 6 Years Of Agementioning

confidence: 99%

Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management

Woolf

Erdman

Nelson

et al. 2007

Clinical Toxicology

130

View full text Add to dashboard Cite

show abstract

“….4~~~~~~~~~~~~~' )74~~. (Goel and Shanks, 1974), although two (Cases 2 and 3) had papilloedema which had not previously been described. Case 2, despite having high plasma drug concentrations, had no abnormal cardiac or anticholinergic signs.…”

Section: Case Historiesmentioning

confidence: 74%

“…While most children ingest small quantities and show only minor symptoms of poisoning, serious manifestations of toxicity-such as coma, convulsions, and cardiac arrhythmias-are seen in a number of cases particularly when the dose ingested is >20 mg/kg (Brown et al, 1971;Goel and Shanks, 1974). Noble and Mathew (1969), in a review of the clinical features of tricyclic antidepressant poisoning in adults, reported that neither active drug nor metabolite was detected in the plasma of any of their patients.…”

mentioning

confidence: 99%

Relationship between clinical features of tricyclic antidepressant poisoning and plasma concentrations in children.

Crome¹,

Braithwaite²

1978

Arch Dis Child

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Clinical features and drug plasma concentrations were studied in 13 children admitted to hospital with tricyclic antidepressant poisoning. Patients with plasma concentrations below 500 microgram/l had anticholinergic signs and increased reflexes but did not have convulsions or cardiac arrhythmias. Four patients with plasma concentrations above 1000 microgram/l suffered convulsions, cardiac arrhythmias, or prolonged coma. The diagnosis of poisoning in 2 of these cases was made only by toxicological analysis. Quantitative estimation of tricyclic antidepressants is useful in atypical or severe poisoning both to reach the diagnosis and to give an idea of the likely duration of symptoms.

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“…Brooke & Weatherly (1959) reported convulsions in three out of 29 patients treated, and suggested that those with preexisting neurological or psychiatric disease were more likely to experience this adverse effect, presumably because they had low convulsive thresholds. Overdosage with either imipramine or amitriptyline was noted to be frequently complicated by seizures, particularly in children (Steele et al, 1967;Goel & Shanks, 1974). Subsequently, convulsions have been reported to occur in patients treated with most of the marketed non-MAOI antidepressant drugs [for review see Trimble (1978Trimble ( , 1980Trimble ( , 1981].…”

Section: Convulsant Effects Of Antidepressant Drugsmentioning

confidence: 99%

Antidepressant drugs, convulsions and epilepsy.

Richens¹,

Nawishy²,

Trimble³

1983

Brit J Clinical Pharma

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1 Evidence concerning the convulsant effects of non-monoamine oxidase inhibitor antidepressant drugs has been reviewed. 2 Mianserin is convulsant in therapeutic doses but seizures have not been reported following overdose. 3 The convulsant effects of mianserin are probably no greater than for other non-monoamine oxidase inhibitor antidepressant drugs. 4 Enzyme-inducing anti-epileptic drugs can reduce the peak plasma concentration of mianserin and shorten its elimination half-life, probably by inducing its metabolism.

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Amitriptyline and Imipramine Poisoning in Children

Cited by 82 publications

References 8 publications

Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management

Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management

Relationship between clinical features of tricyclic antidepressant poisoning and plasma concentrations in children.

Antidepressant drugs, convulsions and epilepsy.

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