Document Type : Short Communication
Department of Clinical Toxicology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Students’ Research Committee, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
Department of Pharmacology, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
Isfahan Kidney Diseases Research Center, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
BACKGROUND: Midazolam is commonly and safely used in poisoning management and intensive care for the control of the agitated poisoned patients. Despite the introduction of newer and safer antidepressants, tricyclic antidepressants (TCA) are still prescribed and used in many countries due to their cost-effectiveness. Severe morbidity and mortality associated with these drugs arises largely from their well-documented cardiovascular toxicity. In this study we aimed to investigate the probable effect of midazolam on some hemodynamic indices in TCA poisoned patients. METHODS: In this clinical study we have evaluated some cardiovascular and hemodynamic indices of 100 TCA poisoned patients whom were randomly allocated for receiving midazolam with a first loading dose of 0.1 mg / kg (2 mg /min.) followed by a 6-hours maintenance infusion of 0.1 mg /kg /h of the drug in dextrose-saline (3.33% of dextrose and 0.33% of NaCl) or placebo (dextrose-saline infusion without midazolam). Pulse rate, systolic/diastolic blood pressure, respiratory rate, neurologic status and the outcome of therapy were recorded at the time of admission and hourly for the next 6 hours. RESULTS: There was a statistically significant reduction in the heart rate of the midazolam treated group after the first hour of hospital admission. There were no significant differences in the respiratory rate, central nervous system manifestations and other indices between the two groups. CONCLUSION: Midazolam may reduce tachycardia (and its fatal consequences) in the first hour of admission in TCA poisoned patients.
- Bordson SJ, Atayee RS, Ma JD, Best BM. Tricyclic antidepressants: is your patient taking them? Observations on adherence and unreported use using prescriber-reported medication lists and urine drug testing. Pain Med 2014; 15(3): 355-63.
- von Wolff A, Holzel LP, Westphal A, Harter M, Kriston L. Selective serotonin reuptake inhibitors and tricyclic antidepressants in the acute treatment of chronic depression and dysthymia: a systematic review and meta-analysis. J Affect Disord 2013; 144(1-2): 7-15.
- Koegelenberg CF, Joubert ZJ, Irusen EM. Tricyclic antidepressant overdose necessitating ICU admission. S Afr Med J 2012; 102(5): 293-4.
- Jones CM, Mack KA, Paulozzi LJ. Pharmaceutical overdose deaths, United States, 2010. JAMA 2013; 309(7): 657-9.
- Bronstein AC, Spyker DA, Cantilena LR, Rumack BH, Dart RC. 2011 Annual report of the American association of poison control centers ' National Poison Data System (NPDS): 29th Annual Report. Clin Toxicol 2012; 50(10): 911-1164.
- Shah R, Uren Z, Baker A, Majeed A. Deaths from antidepressants in England and Wales 1993-1997: analysis of a new national database. Psychol Med 2001; 31(7): 1203-10.
- Choi KH, Lee KU. Serial monitoring of lead aVR in patients with prolonged unconsciousness following tricyclic antidepressant overdose. Psychiatry Investig 2008; 5(4): 247-50.
- Thanacoody HK, Thomas SH. Tricyclic antidepressant poisoning: cardiovascular toxicity. Toxicol Rev 2005; 24(3): 205-14.
- Hubert P, Parain D, Vallee L. Management of convulsive status epilepticus in infants and children. Rev Neurol (Paris) 2009; 165(4): 390-7.
- Goodkin HP, Kapur J. The impact of diazepam's discovery on the treatment and understanding of status epilepticus. Epilepsia 2009; 50(9): 2011-8.
- Eizadi-Mood N, Sabzghabaee AM, Saghaei M, Gheshlaghi F, Mohammad-Ebrahimi B. Benzodiazepines co-ingestion in reducing tricyclic antidepressant toxicity. Med Arh 2012; 66(1): 49-52.
- Dianat S, Zarei MR, Hassanian-Moghaddam H, Rashidi-Ranjbar N, Rahimian R, Rasouli MR. Tricyclic antidepressants intoxication in Tehran, Iran: epidemiology and associated factors. Hum Exp Toxicol 2011; 30(4): 283-8.
- Zamani N, Mehrpour O. Outpatient treatment of the poisoned patients in Iran; May it be a feasible plan? Daru 2013; 21(1): 45.
- Naderi-Heiden A, Shadnia S, Salimi AR, Naderi A, Naderi MM, Schmid D, et al. Self-poisonings with tricyclic antidepressants and selective serotonin reuptake inhibitors in Tehran, Iran. World J Biol Psychiatry 2009; 10(4): 302-12.
- Eizadi-Mood N, Akouchekian S, Yaraghi A, Hakamian M, Soltani R, Sabzghabaee AM. Memory impairment following acute tricyclic antidepressants overdose. Depress Res Treat 2015; 2015: 835786.
- Yaraghi A, Eizadi-Mood N, Katani M, Farsaei S, Hedaiaty M, Mirhosseini SM, et al. Arterial blood gas analysis and the outcome of treatment in tricyclic antidepressants poisoned patients with benzodiazepine coingestion. Anesthesiol Res Pract 2015; 2015: 232401.
- Caravati EM, Bossart PJ. Demographic and electrocardiographic factors associated with severe tricyclic antidepressant toxicity. J Toxicol Clin Toxicol 1991; 29(1): 31-43.
- Glauser J. Tricyclic antidepressant poisoning. Cleve Clin J Med 2000; 67(10): 704-13, 717.
- Taboulet P, Michard F, Muszynski J, Galliot-Guilley M, Bismuth C. Cardiovascular repercussions of seizures during cyclic antidepressant poisoning. J Toxicol Clin Toxicol 1995; 33(3): 205-11.
- Gheshlaghi F, Mehrizi MK, Yaraghi A, Sabzghabaee AM, Soltaninejad F, Eizadi-Mood N. ST-T segment changes in patients with tricyclic antidepressant poisoning. J Res Pharm Pract 2013; 2(3): 110-3.
- Mandour RA. Antidepressants medications and the relative risk of suicide attempt. Toxicol Int 2012; 19(1): 42-6.
- UpToDate. Midazolam drug information [Online]. [cited 2013]; Available from: URL: http://www.uptodate.com/contents/midazolam-drug-information
- Frolich MA, Arabshahi A, Katholi C, Prasain J, Barnes S. Hemodynamic characteristics of
- midazolam, propofol, and dexmedetomidine in healthy volunteers. J Clin Anesth 2011; 23(3): 218-23.
- Mandel JE, Hutchinson MD, Marchlinski FE. Remifentanil-midazolam sedation provides hemodynamic stability and comfort during epicardial ablation of ventricular tachycardia. J Cardiovasc Electrophysiol 2011; 22(4): 464-6.
- Hoffman RS. Treatment of patients with cocaine-induced arrhythmias: bringing the bench to the bedside. Br J Clin Pharmacol 2010; 69(5): 448-57.
- Hart A. Common statistical mistakes. Matern Child Nutr 2012; 8(4): 421-2.