Abstract
A hospital based drug information system has been used to investigate a suspected association between unexpected death and the administration of the tricyclic antidepressant, amitriptyline in patients with a diagnosis of cardiac disease. The hospital information system made it possible to establish that 6 out of 53 such patients died suddenly and unexpectedly following the administration of the drug compared with no deaths in 53 control patients matched for age, sex, diagnosis and duration of stay. This high frequency of unexpected death was not found in patients without cardiac disease receiving amitriptyline nor in patients with cardiac disease receiving imipramine. It was observed that the cardiac patients receiving imipramine comprised a geriatric population occupying long stay beds whereas the amitriptyline patients occupied acute medical beds. It is concluded that amitriptyline should be used with caution in patients with cardiac disease. The importance of the accurate recording of medical information is stressed and the potentialities of hospital information systems are discussed.
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