Key result
Adding neuroleptics to TCA overdose is linked to significantly higher rates of conduction abnormalities.
Why the study?
The cardiac effects of combined neuroleptic ingestion and tricyclic antidepressant overdose compared to TCA overdose alone were not well characterized.
Does the coingestion of neuroleptics and TCAs increase the risk of adverse cardiac consequences compared to TCA overdose alone in ICU patients?
Cohort (n=70)
Does the coingestion of neuroleptics and TCAs increase the risk of adverse cardiac consequences compared to TCA overdose alone in ICU patients?
p-value: p=<0.001
Coingestion of neuroleptics and TCAs significantly increases the risk of adverse electrocardiographic changes, including AV block and QRS/QTc prolongation, compared to TCA overdose alone.
May warrant ECG monitoring with neuroleptic-TCA coingestion; observational data leaves open need for prospective confirmation before practice change.
During a retrospective review of 70 consecutive intensive care unit admissions for tricyclic antidepressant (TCA) overdose, we identified 12 patients (17%) who had simultaneously ingested a neuroleptic agent. We then compared several clinical and laboratory features of patients who had ingested TCAs alone with those patients who had also taken a neuroleptic drug. The 12 patients in the TCA-neuroleptic group, when compared with patients in the TCA-only group, showed a markedly higher prevalence of first-degree atrioventricular block (p less than 0.001), a significantly higher prevalence of prolongation of the QRS duration (greater than 0.10 sec) (p less than 0.05), and a threefold increase in the prevalence of QTc prolongation (p less than 0.05). Our data indicate that coingestion of neuroleptics and TCAs, when compared with the ingestion of TCA alone, may significantly increase the risk of adverse cardiac consequences. We discuss the possible mechanisms for these electrocardiographic changes as well as their potential implications.
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Wilens et al. (1990) conducted a cohort in Tricyclic antidepressant (TCA) overdose (n=70). Coingestion of neuroleptics and TCAs vs. Ingestion of TCAs alone was evaluated on First-degree atrioventricular block, prolongation of the QRS duration, and QTc prolongation (p=<0.001). Coingestion of neuroleptics and TCAs, compared with TCA alone, significantly increased the prevalence of first-degree AV block (P<0.001), QRS prolongation (P<0.05), and QTc prolongation (P<0.05).
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