title: Safety of liver donation after fatal intoxication with the tricyclic antidepressant trimipramine.
abstract: We report the case of a patient receiving long-term treatment with the tricyclic antidepressant trimipramine who died 10 days after a trimipramine overdose. A few hours before death, the serum trimipramine concentration had fallen to 80 microg/L. Similar values are reported for patients taking therapeutic trimipramine doses. At this serum concentration, the liver content of trimipramine and it's 2-hydroxy and N-desmethyl metabolites was 1750 microg/kg, 850 microg/kg, and 225 microg/kg, respectively. The liver was morphologically normal. Back calculations suggest that a liver transplant obtained from a donor dying from a trimipramine overdose should be safe, if the serum trimipramine concentration has fallen below 2000 microg/L. If higher serum trimipramine concentrations are present, harvesting should be delayed to avoid trimipramine toxicity in the recipient.
authors.affiliation: Division of Clinical Pharmacology and Toxicology, Department of Internal Medicine, University Hospital, Zurich, Switzerland.
authors.forename: K E
authors.initials: KE
authors.lastname: Fattinger
authors.forename: K M
authors.initials: KM
authors.lastname: Rentsch
authors.forename: P J
authors.initials: PJ
authors.lastname: Meier
authors.forename: H
authors.initials: H
authors.lastname: Dazzi
authors.forename: S
authors.initials: S
authors.lastname: Krähenbühl
mesh_terms: D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects*; D062787:Drug Overdose; D005260:Female; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000473:pathology; D016031:Liver Transplantation; D014019:Tissue Donors; D014299:Trimipramine / Q000009:adverse effects*
chemical_list: D000929:Antidepressive Agents, Tricyclic; D014299:Trimipramine