Volume 11, Issue 2 (2025)
Pharm Biomed Res 2025, 11(2): 147-158 |
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Zahir Mirdamadi N, Jamshidi H R, Moravej K, Aghazadeh-Habashi K, Rafatmagham S, Farnaghi F, et al . Clinical, Paraclinical, and Prognostic Findings of Iranian Patients Poisoned With Tricyclic Antidepressants: A Cross-sectional Study. Pharm Biomed Res 2025; 11 (2) :147-158
URL: http://pbr.mazums.ac.ir/article-1-662-en.html
URL: http://pbr.mazums.ac.ir/article-1-662-en.html
Negar Zahir Mirdamadi1 
, Hamid Reza Jamshidi2 , Khashayar Moravej3 , Komeil Aghazadeh-Habashi4 , Sareh Rafatmagham5 , Farhad Farnaghi1 , Hamid Reza Ghasemirad2 , Raheleh Kadivari6 , Hamid Owliaey *7
, Hamid Reza Jamshidi2 , Khashayar Moravej3 , Komeil Aghazadeh-Habashi4 , Sareh Rafatmagham5 , Farhad Farnaghi1 , Hamid Reza Ghasemirad2 , Raheleh Kadivari6 , Hamid Owliaey *7
1- Department of Toxicology, School of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
2- Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
3- Faculty of Dentistry, Isfahan Branch, Islamic Azad University, Isfahan, Iran.
4- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
5- Department of Internal Medicine, Fasa University of Medical Sciences, Fasa, Iran.
6- Department of Medical Science, Faculty of Medicine, Yazd Branch, Islamic Azad University, Yazd, Iran.
7- Department of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Yazd Branch, Islamic Azad University, Yazd, Iran.
2- Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
3- Faculty of Dentistry, Isfahan Branch, Islamic Azad University, Isfahan, Iran.
4- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
5- Department of Internal Medicine, Fasa University of Medical Sciences, Fasa, Iran.
6- Department of Medical Science, Faculty of Medicine, Yazd Branch, Islamic Azad University, Yazd, Iran.
7- Department of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Yazd Branch, Islamic Azad University, Yazd, Iran.
Abstract: (62 Views)
Background: Tricyclic antidepressant (TCA) poisoning is a serious medical emergency due to its high toxicity and life-threatening complications.
Objectives: This retrospective cross-sectional study evaluated the frequency of clinical, paraclinical, and prognostic findings of poisoned patients with TCAs who were referred to Shah Vali Hospital, Yazd, Iran, and Shahid Beheshti Hospital, Taft, Yazd, Iran, between 2014 and 2023.
Methods: We collected neurological findings, cardiovascular findings, paraclinical findings, treatment measures, and prognosis of poisoned patients with TCA who were referred to Shah Vali Hospital in Yazd and Shahid Beheshti Hospital in Taft from 2014 to 2023. We examined the patient’s medical records to extract the findings.
Results: Over a decade-long study, 233 cases of poisoning resulting from TCAs were documented, with a mean age of 28.11 years. Most of these cases involved nortriptyline (42.5%) and amitriptyline (32.6%). Notably, 69.1% of the affected individuals were female. Neurological manifestations included agitation (42.9%), mydriasis (39.05%), and dryness of the skin and mucous membranes (52.3%). Additionally, seizures were reported in 10.7% of patients. Cardiovascular symptoms included shock in 6.2% of cases, tachycardia in 24.56%, and QRS complex prolongation in 14.16%. Elevated lead augmented vector right (aVR) was noted in 7.18% of patients, while rhabdomyolysis occurred in 7%. The primary treatment administered was sodium bicarbonate, utilized in 51.1% of cases. Furthermore, 8.2% of patients had a history of suicide attempts, predominantly associated with amitriptyline use. Ultimately, the mortality rate among this cohort was recorded at 1.7%. The findings suggested a significant association between different types of TCAs and factors, such as disease severity, rhabdomyolysis, gender, method of drug administration, and the occurrence of seizures (P=0.001). Additionally, a notable association was observed between mortality rates and QRS complex prolongation and rhabdomyolysis (P<0.001). Furthermore, a significant correlation was found between the frequency of QRS complex prolongation, seizures, and the necessity for tracheal intubation (P<0.01). However, no statistically significant association was found between mortality rates and gender and age (P<0.05).
Conclusion: In conclusion, this study highlights that poisoning from TCAs remains a significant challenge in the management of poisoned patients across various regions. Nortriptyline and amitriptyline are the most commonly involved drugs in poisoning incidents, likely due to their widespread prescription in Iran. The observed higher prevalence of poisoning among women, coupled with the frequent occurrence of suicide attempts, underscores the necessity for addressing psychological factors and closely monitoring the use of these medications. Cardiac complications, particularly tachycardia and QRS complex prolongation on the ECG, are critical indicators of poisoning. Prompt treatment with sodium bicarbonate, along with effective management of severe conditions, such as seizures and hypotension, is essential to reduce mortality. Furthermore, a significant relationship exists between QRS complex prolongation and rhabdomyolysis about mortality outcomes.
Objectives: This retrospective cross-sectional study evaluated the frequency of clinical, paraclinical, and prognostic findings of poisoned patients with TCAs who were referred to Shah Vali Hospital, Yazd, Iran, and Shahid Beheshti Hospital, Taft, Yazd, Iran, between 2014 and 2023.
Methods: We collected neurological findings, cardiovascular findings, paraclinical findings, treatment measures, and prognosis of poisoned patients with TCA who were referred to Shah Vali Hospital in Yazd and Shahid Beheshti Hospital in Taft from 2014 to 2023. We examined the patient’s medical records to extract the findings.
Results: Over a decade-long study, 233 cases of poisoning resulting from TCAs were documented, with a mean age of 28.11 years. Most of these cases involved nortriptyline (42.5%) and amitriptyline (32.6%). Notably, 69.1% of the affected individuals were female. Neurological manifestations included agitation (42.9%), mydriasis (39.05%), and dryness of the skin and mucous membranes (52.3%). Additionally, seizures were reported in 10.7% of patients. Cardiovascular symptoms included shock in 6.2% of cases, tachycardia in 24.56%, and QRS complex prolongation in 14.16%. Elevated lead augmented vector right (aVR) was noted in 7.18% of patients, while rhabdomyolysis occurred in 7%. The primary treatment administered was sodium bicarbonate, utilized in 51.1% of cases. Furthermore, 8.2% of patients had a history of suicide attempts, predominantly associated with amitriptyline use. Ultimately, the mortality rate among this cohort was recorded at 1.7%. The findings suggested a significant association between different types of TCAs and factors, such as disease severity, rhabdomyolysis, gender, method of drug administration, and the occurrence of seizures (P=0.001). Additionally, a notable association was observed between mortality rates and QRS complex prolongation and rhabdomyolysis (P<0.001). Furthermore, a significant correlation was found between the frequency of QRS complex prolongation, seizures, and the necessity for tracheal intubation (P<0.01). However, no statistically significant association was found between mortality rates and gender and age (P<0.05).
Conclusion: In conclusion, this study highlights that poisoning from TCAs remains a significant challenge in the management of poisoned patients across various regions. Nortriptyline and amitriptyline are the most commonly involved drugs in poisoning incidents, likely due to their widespread prescription in Iran. The observed higher prevalence of poisoning among women, coupled with the frequent occurrence of suicide attempts, underscores the necessity for addressing psychological factors and closely monitoring the use of these medications. Cardiac complications, particularly tachycardia and QRS complex prolongation on the ECG, are critical indicators of poisoning. Prompt treatment with sodium bicarbonate, along with effective management of severe conditions, such as seizures and hypotension, is essential to reduce mortality. Furthermore, a significant relationship exists between QRS complex prolongation and rhabdomyolysis about mortality outcomes.
Keywords: TCA poisoning, Tricyclic Antidepressant (TCA) poisoning, Prognosis suicide, Attempts nortriptyline poisoning
Type of Study: Original Research |
Subject:
Toxicology
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