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Use of Iatrogenic Lipid Emulsion and Subsequent Plasmapheresis for the Treatment of Amitriptyline Overdose. Case Rep Crit Care 2022; 2022:1090795. [PMID: 36247415 PMCID: PMC9556258 DOI: 10.1155/2022/1090795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 09/27/2022] [Indexed: 11/29/2022] Open
Abstract
Plasmapheresis for the treatment of hypertriglyceridemia is relatively uncommon and mostly reported either in patients experiencing hypertriglyceridemia-induced acute pancreatitis or patients with therapy-resistant familial hypercholesterolemia. Standard therapies for hypertriglyceridemia include dietary modification and lipid-lowering medication. For severe hypertriglyceridemia, the risk of pancreatitis increases significantly as triglyceride levels increase above 1000 mg/dL, and current therapies are unable to reduce triglyceride levels rapidly enough. Here, we report a case of a 48-year-old male patient who presented to the emergency department due to an amitriptyline overdose. In addition to being started on IV sodium bicarbonate therapy, an intravenous 20% fat emulsion bolus at 1.5 mL/kg was administered followed by 0.25 mL/kg/min infusion for 4 hours as a strategy to absorb lipophilic amitriptyline. Two days posttreatment, he was noted to have substantial hypertriglyceridemia (serum triglycerides: 6,475 mg/dL). His amylase was within the normal range at 37 U/L (reference range: 20-100 U/L), his lipase was low at 40 U/L (reference range: 75-390 U/L), and he was without evidence of any clinical sequelae secondary to hypertriglyceridemia (e.g., pancreatitis). Due to the severity of his hypertriglyceridemia, plasmapheresis was initiated urgently for rapid reduction in serum triglyceride levels to prevent pancreatitis and end-organ damage. He underwent a 1-plasma volume exchange with 5% albumin as the replacement fluid. This reduced his triglyceride levels to 185 mg/dL (reference range: 3-149 mg/dL). His symptoms secondary to his amitriptyline overdose were also resolved. Here, we report a 2-step process of intravenous lipid emulsion followed by plasmapheresis for amitriptyline overdose.
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Kamasak T, Kader Ş, Mutlu M, Özkaya K, Erduran E, Orhan F, Dilber E, Kalyoncu M, Karagüzel G, Cakır M, Bahat E, Cansu A. Amitriptyline Intoxication in Children: Twenty Years' Experience in a Tertiary Care Center in Turkey. Pediatr Emerg Care 2021; 37:e1377-e1381. [PMID: 32150000 DOI: 10.1097/pec.0000000000002055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Amitriptyline ingestion is an important cause of poisoning morbidity and mortality in Turkey and other countries. In contrast to adults, data concerning amitriptyline intoxication in children are limited. The purpose of this study was to investigate amitriptyline intoxication findings in the pediatric population, based on age groups and reported dosages. METHODS The medical records of 192 patients admitted to the Karadeniz Technical University Medical Faculty Farabi Hospital Pediatric Emergency Department, Turkey, due to amitriptyline intoxication in 1997-2017 were examined retrospectively. Patients were divided into 6 groups based on amitriptyline doses and 4 groups based on age. Complete blood count, blood glucose, serum electrolytes, renal and liver function tests, coagulation tests (prothrombin time and partial thromboplastin time), and blood gas analysis were studied in all patients. Electrocardiography was performed on all children, and chest radiography and electroencephalography on those with respiratory or central nervous system symptoms. RESULTS Amitriptyline intoxication was most frequently observed between the ages of 1 and 4 years. The most common signs and symptoms observed at time of hospital admission were lethargy and drowsiness (45.3%), sinus tachycardia (19.2%), and nausea and vomiting (13%). The most common laboratory finding was hyperglycemia (17.7). Six patients were intubated because of respiratory failure, and mechanical ventilation was initiated in these cases. One patient with amitriptyline overdose had persistent supraventricular tachycardia. Four children died due to amitriptyline intoxication. CONCLUSIONS Tricyclic antidepressant intoxication is a leading cause of mortality and morbidity in children. It is therefore particularly important to identify the clinical and laboratory findings that develop with high-dose consumption.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Elif Bahat
- Pediatric Nephrology, Karadeniz Technical University, Trabzon, Turkey
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3
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Nguyen H, Kidron A, Ghildyal C, Veluri S, Nguyen N, Nguyen Q, Nguyen H. Novel Presentation of Cardiotoxicity and Other Complications in Tricyclic Antidepressant Poisoning. Cureus 2021; 13:e17181. [PMID: 34540415 PMCID: PMC8439401 DOI: 10.7759/cureus.17181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/14/2021] [Indexed: 11/05/2022] Open
Abstract
Tricyclic antidepressant (TCA) is a known frequently used and highly potent antidepressant that serves as an unsuspecting source of acute human poisoning. We present a case of an Asian female in her mid-30s who suffered TCA toxidrome that manifested as severe cardiovascular toxicities including arrhythmia characterized by QT elongation that was managed emergently. Hemodynamics and ECG findings improved gradually following appropriate therapy in the intensive care unit. Following two days of treatment, the patient regained consciousness and after seven days the patient made a full clinical recovery and was discharged with no residual neurological effects. The relevant medical literature on TCA poisoning is reviewed.
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Affiliation(s)
- Hiep Nguyen
- Osteopathic Medicine, Nova Southeastern University Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Ariel Kidron
- Emergency Medicine, Nova Southeastern University Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Christopher Ghildyal
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Shriya Veluri
- School of Interdisciplinary Studies, University of Texas at Dallas, Richardson, USA
| | - Nghi Nguyen
- Medicine, University of Saint Thomas, Houston, USA
| | - Quan Nguyen
- Clinical Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Hoang Nguyen
- Basic Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
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Neumann J, Binter MB, Fehse C, Marušáková M, Büxel ML, Kirchhefer U, Hofmann B, Gergs U. Amitriptyline functionally antagonizes cardiac H 2 histamine receptors in transgenic mice and human atria. Naunyn Schmiedebergs Arch Pharmacol 2021; 394:1251-1262. [PMID: 33625558 PMCID: PMC8208937 DOI: 10.1007/s00210-021-02065-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
We have previously shown that histamine (2-(1H-imidazol-4-yl)ethanamine) exerted concentration-dependent positive inotropic effects (PIE) or positive chronotropic effects (PCE) on isolated left and right atria, respectively, of transgenic (H2R-TG) mice that overexpress the human H2 histamine receptor (H2R) in the heart; however, the effects were not seen in their wild-type (WT) littermates. Amitriptyline, which is still a highly prescribed antidepressant drug, was reported to act as antagonist on H2Rs. Here, we wanted to determine whether the histamine effects in H2R-TG were antagonized by amitriptyline. Contractile studies were performed on isolated left and right atrial preparations, isolated perfused hearts from H2R-TG and WT mice and human atrial preparations. Amitriptyline shifted the concentration-dependent PIE of histamine (1 nM-10 μM) to higher concentrations (rightward shift) in left atrial preparations from H2R-TG. Similarly, in isolated perfused hearts from H2R-TG and WT mice, histamine increased the contractile parameters and the phosphorylation state of phospholamban (PLB) at serine 16 in the H2R-TG mice, but not in the WT mice. However, the increases in contractility and PLB phosphorylation were attenuated by the addition of amitriptyline in perfused hearts from H2R-TG. In isolated electrically stimulated human atria, the PIE of histamine that was applied in increasing concentrations from 1 nM to 10 μM was reduced by 10-μM amitriptyline. In summary, we present functional evidence that amitriptyline also acts as an antagonist of contractility at H2Rs in H2R-TG mouse hearts and in the human heart which might in part explain the side effects of amitriptyline.
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Affiliation(s)
- Joachim Neumann
- Institut für Pharmakologie und Toxikologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, D-06097, Halle, Germany
| | - Maximilian Benedikt Binter
- Institut für Pharmakologie und Toxikologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, D-06097, Halle, Germany
| | - Charlotte Fehse
- Institut für Pharmakologie und Toxikologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, D-06097, Halle, Germany
| | - Margaréta Marušáková
- Institut für Pharmakologie und Toxikologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, D-06097, Halle, Germany.,Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | - Maren Luise Büxel
- Institut für Pharmakologie und Toxikologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, D-06097, Halle, Germany
| | - Uwe Kirchhefer
- Institut für Pharmakologie und Toxikologie, Medizinische Fakultät, Westfälische Wilhelms-Universität, Domagkstr. 12, D-48149, Münster, Germany
| | - Britt Hofmann
- Cardiac Surgery, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, D-06120, Halle, Germany
| | - Ulrich Gergs
- Institut für Pharmakologie und Toxikologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, D-06097, Halle, Germany.
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Ando M, Tamura R, Nakasako S, Takimoto S, Ariyoshi K, Yamaguchi M, Sakizono K, Eto M, Fukushima S, Sugioka N, Hashida T. Plasma concentration of amitriptyline and metabolites after resuscitation from cardiopulmonary arrest following an overdose: A case report. Clin Case Rep 2021; 9:805-811. [PMID: 33598249 PMCID: PMC7869369 DOI: 10.1002/ccr3.3656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 11/05/2020] [Accepted: 11/24/2020] [Indexed: 11/26/2022] Open
Abstract
It may need to pay attention to the sustention of moderate cardiotoxicity and delayed elevation of plasma 10-hydroxynortriptyline level in severe amitriptyline overdose case.
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Affiliation(s)
- Motozumi Ando
- Faculty of Pharmaceutical SciencesKobe Gakuin UniversityKobeJapan
- Present address:
Department of Clinical Pharmacy and Sciences, School of PharmacyAichi Gakuin UniversityNagoyaJapan
| | - Ryo Tamura
- Department of PharmacyKobe City Medical Center General HospitalKobeJapan
| | | | - Satsuki Takimoto
- Faculty of Pharmaceutical SciencesKobe Gakuin UniversityKobeJapan
| | - Koichi Ariyoshi
- Department of Emergency MedicineKobe City Medical Center General HospitalKobeJapan
| | - Marie Yamaguchi
- Department of Clinical Laboratory MedicineKobe City Medical Center General HospitalKobeJapan
| | - Kenji Sakizono
- Department of Clinical Laboratory MedicineKobe City Medical Center General HospitalKobeJapan
| | - Masaaki Eto
- Department of Clinical Laboratory MedicineKobe City Medical Center General HospitalKobeJapan
| | - Shoji Fukushima
- Faculty of Pharmaceutical SciencesKobe Gakuin UniversityKobeJapan
| | - Nobuyuki Sugioka
- Faculty of Pharmaceutical SciencesKobe Gakuin UniversityKobeJapan
| | - Tohru Hashida
- Department of PharmacyKobe City Medical Center General HospitalKobeJapan
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Tylutki Z, Mendyk A, Polak S. Physiologically based pharmacokinetic-quantitative systems toxicology and safety (PBPK-QSTS) modeling approach applied to predict the variability of amitriptyline pharmacokinetics and cardiac safety in populations and in individuals. J Pharmacokinet Pharmacodyn 2018; 45:663-677. [PMID: 29943290 PMCID: PMC6182726 DOI: 10.1007/s10928-018-9597-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/22/2018] [Indexed: 12/17/2022]
Abstract
The physiologically based pharmacokinetic (PBPK) models allow for predictive assessment of variability in population of interest. One of the future application of PBPK modeling is in the field of precision dosing and personalized medicine. The aim of the study was to develop PBPK model for amitriptyline given orally, predict the variability of cardiac concentrations of amitriptyline and its main metabolite-nortriptyline in populations as well as individuals, and simulate the influence of those xenobiotics in therapeutic and supratherapeutic concentrations on human electrophysiology. The cardiac effect with regard to QT and RR interval lengths was assessed. The Emax model to describe the relationship between amitriptyline concentration and heart rate (RR) length was proposed. The developed PBPK model was used to mimic 29 clinical trials and 19 cases of amitriptyline intoxication. Three clinical trials and 18 cases were simulated with the use of PBPK-QSTS approach, confirming lack of cardiotoxic effect of amitriptyline in therapeutic doses and the increase in heart rate along with potential for arrhythmia development in case of amitriptyline overdose. The results of our study support the validity and feasibility of the PBPK-QSTS modeling development for personalized medicine.
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Affiliation(s)
- Zofia Tylutki
- Unit of Pharmacoepidemiology and Pharmacoeconomics, Department of Social Pharmacy, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9 Str., 30-688, Krakow, Poland.
| | - Aleksander Mendyk
- Department of Pharmaceutical Technology and Biopharmaceutics, Jagiellonian University Medical College, Medyczna 9 St, 30-688, Krakow, Poland
| | - Sebastian Polak
- Unit of Pharmacoepidemiology and Pharmacoeconomics, Department of Social Pharmacy, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9 Str., 30-688, Krakow, Poland
- Certara-Simcyp, Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK
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Aydın M, Yardan T, Baydın A, Genç S. ADORA RISK IDENTIFICATION OF TRICYCLIC ANTIDEPRESANT. KONURALP TIP DERGISI 2018. [DOI: 10.18521/ktd.445529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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8
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Mitchell NC, Bowman MA, Gould GG, Koek W, Daws LC. Ontogeny of Norepinephrine Transporter Expression and Antidepressant-Like Response to Desipramine in Wild-Type and Serotonin Transporter Mutant Mice. J Pharmacol Exp Ther 2016; 360:84-94. [PMID: 27831486 DOI: 10.1124/jpet.116.237305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/08/2016] [Indexed: 12/30/2022] Open
Abstract
Depression is a major public health concern with symptoms that are often poorly controlled by treatment with common antidepressants. This problem is compounded in juveniles and adolescents, because therapeutic options are limited to selective serotonin reuptake inhibitors (SSRIs). Moreover, therapeutic benefits of SSRIs are often especially limited in certain subpopulations of depressed patients, including children and carriers of low-expressing serotonin transporter (SERT) gene variants. Tricyclic antidepressants (TCAs) offer an alternative to SSRIs; however, how age and SERT expression influence antidepressant response to TCAs is not understood. We investigated the relation between antidepressant-like response to the TCA desipramine using the tail suspension test and saturation binding of [3H]nisoxetine to the norepinephrine transporter (NET), the primary target of desipramine, in juvenile (21 days postnatal [P21]), adolescent (P28), and adult (P90) wild-type (SERT+/+) mice. To model carriers of low-expressing SERT gene variants, we used mice with reduced SERT expression (SERT+/-) or lacking SERT (SERT-/-). The potency and maximal antidepressant-like effect of desipramine was greater in P21 mice than in P90 mice and was SERT genotype independent. NET expression decreased with age in the locus coeruleus and increased with age in several terminal regions (e.g., the cornu ammonis CA1 and CA3 regions of the hippocampus). Binding affinity of [3H]nisoxetine did not vary as a function of age or SERT genotype. These data show age-dependent shifts for desipramine to produce antidepressant-like effects that correlate with NET expression in the locus coeruleus and suggest that drugs with NET-blocking activity may be an effective alternative to SSRIs in juveniles.
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Affiliation(s)
- Nathan C Mitchell
- Departments of Cellular and Integrative Physiology (N.C.M., M.A.B., G.G.G., L.C.D.), Psychiatry (W.K.), and Pharmacology (W.K., L.C.D.), University of Texas Health Science Center, San Antonio, Texas
| | - Melodi A Bowman
- Departments of Cellular and Integrative Physiology (N.C.M., M.A.B., G.G.G., L.C.D.), Psychiatry (W.K.), and Pharmacology (W.K., L.C.D.), University of Texas Health Science Center, San Antonio, Texas
| | - Georgianna G Gould
- Departments of Cellular and Integrative Physiology (N.C.M., M.A.B., G.G.G., L.C.D.), Psychiatry (W.K.), and Pharmacology (W.K., L.C.D.), University of Texas Health Science Center, San Antonio, Texas
| | - Wouter Koek
- Departments of Cellular and Integrative Physiology (N.C.M., M.A.B., G.G.G., L.C.D.), Psychiatry (W.K.), and Pharmacology (W.K., L.C.D.), University of Texas Health Science Center, San Antonio, Texas
| | - Lynette C Daws
- Departments of Cellular and Integrative Physiology (N.C.M., M.A.B., G.G.G., L.C.D.), Psychiatry (W.K.), and Pharmacology (W.K., L.C.D.), University of Texas Health Science Center, San Antonio, Texas
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Clark S, Catt JW, Caffery T. Rapid diagnosis and treatment of severe tricyclic antidepressant toxicity. BMJ Case Rep 2015; 2015:bcr-2015-211428. [PMID: 26468220 DOI: 10.1136/bcr-2015-211428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A woman in her mid-50s contacted her social worker and expressed intent to commit suicide by ingesting prescription medications. On arrival of emergency responders, the patient was found unconscious with an empty bottle of amitriptyline. Time of ingestion was estimated using the social worker's contact with local authorities. The patient's presentation at the emergency department (ED) exemplified tricyclic antidepressant toxidrome with a poor prognosis, based on measurable criteria and physical findings. Respiratory and cardiovascular collapse was managed emergently. Haemodynamic status and EKG findings responded in a stepwise fashion with therapy in the ED and intensive care unit. Full clinical recovery took 7 days, and the patient was subsequently transferred to an in-patient psychiatric facility for further evaluation. Eight days later, she was discharged home with no neurological sequelae.
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Affiliation(s)
- Simon Clark
- Emergency Medicine Residency Program-Baton Rouge, Louisiana State University Health Sciences Center School of Medicine in New Orleans, Baton Rouge, Louisiana, USA
| | - Jerry W Catt
- Emergency Medicine Residency Program-Baton Rouge, Louisiana State University Health Sciences Center School of Medicine in New Orleans, Baton Rouge, Louisiana, USA
| | - Terrell Caffery
- Emergency Medicine Residency Program-Baton Rouge, Louisiana State University Health Sciences Center School of Medicine in New Orleans, Baton Rouge, Louisiana, USA
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Paksu MS, Zengin H, Ilkaya F, Paksu S, Guzel H, Ucar D, Uzun A, Alacam H, Duran L, Murat N, Guzel A. Can empirical hypertonic saline or sodium bicarbonate treatment prevent the development of cardiotoxicity during serious amitriptyline poisoning? Experimental research. Cardiovasc J Afr 2015; 26:134-9. [PMID: 25939777 PMCID: PMC4538909 DOI: 10.5830/cvja-2015-014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/27/2015] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of this experimental study was to investigate whether hypertonic saline or sodium bicarbonate administration prevented the development of cardiotoxicity in rats that received toxic doses of amitriptyline. METHOD Thirty-six Sprague Dawley rats were used in the study. The animals were divided into six groups. Group 1 received toxic doses of i.p. amitriptyline. Groups 2 and 3 toxic doses of i.p. amitriptyline, plus i.v. sodium bicarbonate and i.v. hypertonic saline, respectively. Group 4 received only i.v. sodium bicarbonate, group 5 received only i.v. hypertonic saline, and group 6 was the control. Electrocardiography was recorded in all rats for a maximum of 60 minutes. Blood samples were obtained to measure the serum levels of sodium and ionised calcium. RESULTS The survival time was shorter in group 1. In this group, the animals' heart rates also decreased over time, and their QRS and QTc intervals were significantly prolonged. Groups 2 and 3 showed less severe changes in their ECGs and the rats survived for a longer period. The effects of sodium bicarbonate or hypertonic saline treatments on reducing the development of cardiotoxicity were similar. The serum sodium levels decreased in all the amitriptyline-applied groups. Reduction of serum sodium level was most pronounced in group 1. CONCLUSION Empirical treatment with sodium bicarbonate or hypertonic saline can reduce the development of cardiotoxicity during amitriptyline intoxication. As hypertonic saline has no adverse effects on drug elimination, it should be considered as an alternative to sodium bicarbonate therapy.
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Affiliation(s)
- Muhammet Sukru Paksu
- Paediatric Intensive Care Unit, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Halit Zengin
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
| | - Fatih Ilkaya
- Department of Pharmacology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Sule Paksu
- Department of Paediatrics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Hasan Guzel
- Department of Pharmacology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Durmus Ucar
- Department of Physiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Adem Uzun
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Hasan Alacam
- Department of Biochemistry, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Latif Duran
- Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Naci Murat
- Department of Industrial Engineering, Faculty of Engineering, Ondokuz Mayis University, Samsun, Turkey
| | - Ahmet Guzel
- Department of Paediatric Emergency, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Single-dose, Randomized, Open-label, 2-way Crossover Study of the Pharmacokinetics of Amitriptyline Hydrochloride 10- and 25-mg Tablet in Healthy Male Korean Volunteers. Clin Ther 2015; 37:302-10. [DOI: 10.1016/j.clinthera.2014.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 08/21/2014] [Accepted: 09/06/2014] [Indexed: 11/23/2022]
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