title: Inadvertent fatal imipramine poisoning of a child: what happened to Tommy?
abstract: This column illustrates the importance of considering interindividual variance when prescribing medications. In this tragic case, the failure to consider age and body weight when prescribing a drug, imipramine, with a narrow therapeutic index caused the death of an otherwise physically healthy 6-year-old child. This death could also have been avoided by using therapeutic drug monitoring to properly adjust the dose. This case illustrates the importance of the second (pharmacokinetics) and third (biological variance) variables in the equation frequently cited in this column: clinical response=affinity for and intrinsic activity at site of action x drug concentration at site of action x underlying biology of the patient.
authors: Department of Psychiatry, University of Kansas School of Medicine-Wichita, Wichita, Kansas, USA.
authors: Sheldon H
authors: SH
authors: Preskorn
mesh_terms: D000929:Antidepressive Agents, Tricyclic / Q000506:poisoning*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D002648:Child; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D017809:Fatal Outcome; D006801:Humans; D007099:Imipramine / Q000506:poisoning*; D008297:Male
chemical_list: D000929:Antidepressive Agents, Tricyclic; D007099:Imipramine