Doxepin Induced Torsade De Pointes

Strasbero, Boris; Coelho, Aldo; Welch, William J.; Swiryn, Steven; Bauernfeind, Robert A.; Rosen, Kenneth M.

doi:10.1111/j.1540-8159.1982.tb06570.x

Cited by 30 publications

(12 citation statements)

References 13 publications

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“…Anectodal case reports are available describing all forms of arrhythmias, including both supraventricular and ventricular arrhythmias, atrioventricular blocks, torsade de pointes ventricular tachycardia, and rarely, sudden death . [3][4][5][6][7][9][10][11][12][13]16,17 Our data failed to reveal any significant arrhythmogenic effect of PCAs. Similar results are available from data in the literature .…”

Section: Discussioncontrasting

confidence: 71%

Cardiovascular Effects of Polycyclic Antidepressants

et al. 1986

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Every day, thousands of people in the United States receive polycyclic antidepressants (PCAs) prescribed by their primary care physicians. We have examined the cardiovascular manifestations of polycyclic antidepressants in 14 patients with primary depression receiving various antidepressant drugs for a period of six months or more. None had suffered from any systemic illness. All 14 received a commonly prescribed PCA, such as doxepin, amitriptyline, imipramine, desipramine or amoxapine, in therapeutic doses. None developed any significant adverse reaction. Left ventricular function, as determined by M-mode echocardiogram, was within normal limit in all patients. A twenty-four-hour ambulatory electrocardiogram revealed rare supraventricular ectopic beats in 8 patients and ventricular ectopic activity (Lown grade 1) in 4 patients. In 1 patient, who received additional lithium carbonate for treatment of depression, both supraventricular and ventricular ectopic activity developed on rare occasions. In 4 of the 8 patients the plasma concentration of PCA was optimal or near optimal, and in 4 of the 8 patients it was subtherapeutic (even though these 4 patients had shown clinical improvement with continued polycyclic therapy). It appears from the present data that antidepressant therapy with PCAs prescribed in therapeutic doses was well tolerated, without any significant adverse cardiovascular reaction, in otherwise healthy young patients with primary depression.

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Section: Discussioncontrasting

confidence: 71%

Cardiovascular Effects of Polycyclic Antidepressants

et al. 1986

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“…Single reports of proarrhythmic QT prolongation exists with chlorpromazine [197], amitriptiline [48], doxepine [221], and maprotiline [83].…”

Section: Characteristics Of Proarrhythmia After Drug-lnduced Qt Prolomentioning

confidence: 96%

QT-Interval prolonging drugs: Mechanisms and clinical relevance of their arrhythmogenic hazards

Zehender

Hohnloser

Just

1991

Cardiovasc Drug Ther

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The antiarrhythmic principle of drug-induced QT-interval prolongation is well known. However, with the widespread use of the presently known and new Class III antiarrhythmic agents under investigation, and the growing number of agents not primarily designed as antiarrhythmic drugs that potentially cause QT prolongation, we have also become aware of the proarrhythmic hazards associated with many of these agents. The proarrhythmic risk differs markedly from one agent to another and interferes with many individual clinical variables (e.g., hypokalemia, sinus bradycardia). This paper summarizes the present data on the proarrhythmic risk of drug-induced QT prolongation, including the value and problems of the rate-corrected QT interval, the mechanisms involved in the genesis of proarrhythmia, and the clinical cofactors that facilitate the occurrence of proarrhythmic events. In addition, an extensive database provides information on the known proarrhythmic risk of all currently used QT-prolonging agents.

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“…Torsade de pointes and VF were documented in these patients only shortly after their admission in the hospital, with a mean of 6.5 (Fig 4) the mean 24-hour heart rate did not statistically differ (using ANOVA) between the 2 groups, although it was slower in patients than in normal subjects (72.7+10.3 versus 79±7 beats * min1, respectively). The day-to-night ratio of the heart rate, a particularly stable characteristic of the autonomic ner-QRS/mi 12) who are asymptomatic at a mean 7-year follow-up (range, 1 to 16). However, 3 of them have persistant short-coupled VPBs (isolated, couplets, and triplets) documented by 24-hour ECG recordings.…”

Section: Clinical and Laboratory Featuresmentioning

confidence: 99%

“…All patients had a physical examination, chest radiography, 12-lead ECG, and M-mode or two-dimensional echocardiography, but only 9 …”

Section: Study Patientsmentioning

confidence: 99%

Short-coupled variant of torsade de pointes. A new electrocardiographic entity in the spectrum of idiopathic ventricular tachyarrhythmias.

et al. 1994

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BACKGROUND Torsade de pointes is characterized not only by its particular ECG pattern but by its context of congenital or acquired long QT syndrome and the long coupling interval of the initial premature beat. METHODS AND RESULTS We observed 14 patients aged 34.6 +/- 10 years (mean +/- SD) with no structural heart disease who presented with syncope related to a typical ECG aspect of torsade de pointes. However, there was no evidence of long QT syndrome, and the torsade had the unusual particularity of an extremely short coupling interval of the first beat or of the isolated premature beats (245 +/- 28 milliseconds). In 10 cases they deteriorated into ventricular fibrillation. Four patients had a familial history of sudden death. Only 2 patients had a tachyarrhythmia inducible by programmed stimulation. At Holter recordings the heart rate variability was globally and significantly depressed, the vagal limb of the autonomic nervous system being predominantly affected. During a mean follow-up of 7 years there were 5 deaths (4 sudden). Nine patients are alive, 3 with implanted defibrillators and 6 treated with verapamil alone. Unlike the other types of antiarrhythmic agents including beta-blockers and amiodarone, verapamil is in our experience the only drug apparently active on the arrhythmias; however, it does not prevent sudden death. CONCLUSIONS The short-coupled variant of torsade de pointes should be identified because of their ECG pattern and the risk of sudden death in young adults with no structural heart disease.

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Doxepin Induced Torsade De Pointes

Cited by 30 publications

References 13 publications

Cardiovascular Effects of Polycyclic Antidepressants

Cardiovascular Effects of Polycyclic Antidepressants

QT-Interval prolonging drugs: Mechanisms and clinical relevance of their arrhythmogenic hazards

Short-coupled variant of torsade de pointes. A new electrocardiographic entity in the spectrum of idiopathic ventricular tachyarrhythmias.

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