The hypotensive effect of imipramine hydrochloride in patients with cardiovascular disease

Müller, Otto; Goodman, Nelson; Bellet, Samuel

doi:10.1002/cpt196123300

Cited by 65 publications

(16 citation statements)

References 4 publications

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“…Orthostatic sequelae include falls, fractures, and lacerations. Myocardial infarctions [10] associated with tricyclic-induced orthostatic hypotension have been reported, but whether tricyclicinduced orthostatic hypotension causes myocardial infarction is unclear. Of the TCA agents, the orthostatic effects of imipramine therapy have been the most thoroughly sub stantiated, although amitriptyline, desipramine and doxepin have also been shown to cause similar orthostatic side effects.…”

Section: Orthostatic Hypotensionmentioning

confidence: 99%

“…For example. Muller et al [10] found that 41% of patients over 60 years of age who had either existing car diac or generalized atherosclerotic disease developed symptomatic orthostatic hypoten sion. In contrast, only 7% of patients less than 60 years of age without symptoms of atherosclerotic cardiovascular disease devel oped symptomatic orthostatic hypotension.…”

Section: Orthostatic Hypotensionmentioning

confidence: 99%

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Cardiovascular Toxicity of Antidepressant Medications

Jackson

Roose²,

Ah³

1987

Psychopathology

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This article reviews the cardiovascular effects of the standard tricyclic antidepressant agents and the cardiovascular effects of the newer antidepressant drugs. The cardiovascular effects of the standard tricyclic agents are orthostatic hypotension, conduction delay, and a potent antiarrhythmic effect. Patients with congestive heart failure receiving cardiac medications are at greatly increased risk for orthostatic hypotension, while patients with preexisting conduction delay are at risk for heart block. Of the newer antidepressant drugs, mianserin, nomifensine, and bupropion initially appeared to be most promising in terms of cardiovascular effects, but subsequently proved to have other serious liabilities; these agents require further testing. Trazodone has emerged as the antidepressant drug with the least risk of death in overdose, and as a useful alternative to the standard tricyclic antidepressant drugs in patients with preexisting conduction disease. However, trazodone therapy has been associated with some adverse effects, and, therefore, from the data presented in this paper, it can be concluded that no drug currently available is without some cardiovascular risk.

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Section: Orthostatic Hypotensionmentioning

confidence: 99%

Section: Orthostatic Hypotensionmentioning

confidence: 99%

Cardiovascular Toxicity of Antidepressant Medications

Jackson

Roose²,

Ah³

1987

Psychopathology

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“…A variety of side effects may occur during treatment with tricyclic antidepressant drugs, the most serious being the cardiac complications (Muller, Goodman & Bellet, 1961;Alexander & Nino, 1969;Coull, Crooks, Dingwall-Fordyce, Scott & Weir, 1970;Editorial 1971;Williams & Sherter, 1971). Electrocardiographic changes include sinus tachycardia, ventricular extrasystoles, prolongation of the PQ and QRS intervals and ST and T wave abnormalities.…”

Section: Introductionmentioning

confidence: 99%

Plasma Concentrations and Cardiotoxic Effects of Desipramine and Protriptyline in the Rat

Bianchetti

Bonaccorsi

Chiodaroli

et al. 1977

British J Pharmacology

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Desipramine and protriptyline were administered to anaesthetized rats by two consecutive intravenous infusions in order to obtain a peak level (first infusion) followed by lower steady state concentrations (second infusion) (Wagner, 1974). Theoretical plasma level time courses were confirmed experimentally. Desipramine and protriptyline were measured in atria and ventricles. Increasing infusion rates led to proportional increases in plasma and atrial concentrations. The tissue/medium ratio ranged from 57 to 21 for desipramine and from 43 to 11 for protriptyline according to the time of determination during infusions. Heart rate changes, deviation of the electrical axis of the heart and prolongation of atrioventricular conduction were recorded at fixed times during infusion. Positive chronotropic effects were noted at plasma concentrations ranging from 0.035 to 0.1 μg/ml for desipramine and from 0.04 to 1.2 μg/ml for protriptyline. At higher plasma concentrations the positive chronotropic effect decreased and bradycardia developed. Both drugs induced right rotation of the electrical axis of the heart. Threshold plasma levels giving 40° rotation were 1.35 μg/ml (desipramine) and 1.75 μg/ml (protriptyline). Atrioventricular conduction was prolonged at threshold plasma concentrations of 2.2 μg/ml for desipramine and 3.6 μg/ml for protriptyline. Desipramine is more cardiotoxic than protriptyline. This difference is discussed in relation to the plasma and heart concentration of the two drugs.

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“…ECG changes include tachycardia, arrhythmias, widening of the PQ and QRS complex, ST and T wave abnormalities. It has also been shown that antidepressant drugs aggravate cardiac disease especially in elderly people suffering from hypertension and atherosclerosis (Muller, Goodman & Bellet, 1961;Kristiansen, 1961;Skou, 1962;Thompson, 1973).…”

Section: Introductionmentioning

confidence: 99%

Plasma Nortriptyline and Cardiac Responses in Young and Old Rats

Bonaccorsi

Franco

Garattini

et al. 1977

British J Pharmacology

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The relationship between plasma concentrations and cardiac effects of nortriptyline was studied in anaesthetized young and old rats. Nortriptyline was administered by two consecutive intravenous infusions which resulted in a peak plasma concentration followed by steady state values. Increasing infusion rates were followed by proportional increases in the drug plasma concentrations ranging from 0.15 to 6.0 μg/ml. In young rats, nortriptyline induced an increase in the heart rate, a right rotation of the electrical axis and a prolongation of the PQ interval. Heart rate changes were not correlated with nortriptyline plasma concentrations, while significant correlations were found for the other two parameters. Plasma concentrations inducing 20% increase of the PQ interval and 40 degrees rotation of the electrical axis were 1.65 and 1.69 μg/ml respectively. Arrhythmias occurred at concentrations higher than 5.2 μg/ml. Nortriptyline caused more severe cardiac effects in old than in young animals. However, plasma concentrations of nortriptyline in old rats were two to five times higher than those found in young rats at similar infusion rates. A higher concentration of the drug at its sites of action seems to be responsible for the more severe cardiac toxicity of nortriptyline observed in old rats.

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The hypotensive effect of imipramine hydrochloride in patients with cardiovascular disease

Cited by 65 publications

References 4 publications

Cardiovascular Toxicity of Antidepressant Medications

Cardiovascular Toxicity of Antidepressant Medications

Plasma Concentrations and Cardiotoxic Effects of Desipramine and Protriptyline in the Rat

Plasma Nortriptyline and Cardiac Responses in Young and Old Rats

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