Abstract
THE FOOD and Drug Administration (FDA) recently convened a conference of experts to review the question of cardiotoxicity of tricyclic antidepressant (TCA) drugs. 1 The main impetus for this meeting was concern over reports of changes detected in the electrocardiograms (ECGs) of children receiving imipramine hydrochloride at a dosage of 5 mg/kg 2,3 and of the sudden death of a child receiving a single bedtime dose of imipramine hydrochloride, 14.7 mg/ kg, for school phobia. 4 There is also evidence that TCAs given in therapeutic dosages alter myocardial function in adult patients 5 and occasionally produce heart block and tachyrhythmias in patients with a normal cardiovascular history. 6-11 The present concern stems from an increasing tendency of some physicians to employ higher-than-recommended dosages. Although arrhythmias do occur at standard dosages, the evidence suggests that the likelihood of producing substantial alteration in the ECG and cardiac arrhythmia is dose-related. 6,8,10 Thus,
Published Version
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