The use of imipramine in depressed patients with congestive heart failure
A. H. Glassman, L. L. Johnson, E. G. Giardina, B. T. Walsh, S. P. Roose, T. B. Cooper and J. T. Bigger Jr
Previous studies of left ventricular performance (LVP) in depressed
patients receiving tricyclic antidepressants have been performed on
patients without severe heart disease. This study reports the effect of
imipramine hydrochloride on LVP, assessed by radionuclide angiography, in a
group of depressed patients with notable preexisting left ventricular
dysfunction. Ejection fraction was measured at rest by first-pass
radionuclide angiography before and after treatment with imipramine.
Ejection fraction was unchanged during treatment, but seven of 15 patients
experienced orthostatic hypotension of such severity that administration of
the drug had to be discontinued. Plasma concentrations of the drug were
essentially twice those usually seen. It is important to appreciate that
although imipramine does not further impair resting LVP, this does not mean
it is without risk. The physician must watch carefully for orthostatic
hypotension when using imipramine in depressed patients with impaired LVP.
Drug-induced heart failure
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J Am Coll Cardiol 1999;33:1152-1162.
ABSTRACT
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ABSTRACT
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