Excess fatality from desipramine in children and adolescents.
OBJECTIVE
To compare the case fatality rate (CFR) from desipramine ingestion in children and adolescents with that of other tricyclic antidepressants.


METHODS
All mentions of desipramine, amitriptyline, imipramine, nortriptyline, and doxepin in children and adolescents recorded in the American Association of Poison Control Centers Toxic Exposure Surveillance System from 1983 to 2002 were analyzed. The CFR for each drug was defined as the ratio of the number of deaths/number of mentioned exposures.


RESULTS
There were 24 fatalities in children younger than 6 years old (desipramine, n=10; amitriptyline, n=7; doxepin, n=3; imipramine, n=3; nortriptyline, n=1) and 144 fatalities in older children and adolescents (desipramine, n=56; amitriptyline, n=30; doxepin, n=16; imipramine, n=31; nortriptyline, n=11). The CFR from desipramine was significantly higher compared with the other tricyclic antidepressants in children younger than 6 years old (chi=36, p<.001) and in older children and adolescents (chi=155, p<.001). The CFR from desipramine exceeded that of amitriptyline, doxepin, imipramine, and nortriptyline by 7- to 8-, 4-, 6- to 12-, and 7- to 10-fold, respectively.


CONCLUSIONS
The excess CFR from desipramine in children and adolescents and the reports of sudden death in children treated with therapeutic doses call for caution in prescribing desipramine to children and adolescents.
Amitai
Yona
Y
Dr. Amitai is with the Department of Mother, Child and Adolescent Health, Ministry of Health, Jerusalem, Israel; and Dr. Frischer is with Rush University Medical Center, Chicago, IL.. Electronic address: yona.amitai@moh.health.gov.il.
Frischer
Henri
H
Dr. Amitai is with the Department of Mother, Child and Adolescent Health, Ministry of Health, Jerusalem, Israel; and Dr. Frischer is with Rush University Medical Center, Chicago, IL.
D000293:Adolescent; D000639:Amitriptyline; D002648:Child; D003891:Desipramine; D004316:Doxepin; D006801:Humans; D007099:Imipramine; D015994:Incidence; D009026:Mortality; D009661:Nortriptyline; D015995:Prevalence; D019966:Substance-Related Disorders / Q000401:mortality*
D004316:Doxepin; D000639:Amitriptyline; D009661:Nortriptyline; D007099:Imipramine; D003891:Desipramine