Effect of intravenous midazolam on cardiac parameters in acute tricyclic antidepressants poisoning.
BACKGROUND
Midazolam is commonly and safely used in poisoning management and intensive care for the control of agitated poisoned patients. Despite the introduction of newer and safer antidepressants, tricyclic antidepressants (TCAs) 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 TCAs-poisoned patients.


METHODS
In this clinical trial, we have evaluated some cardiovascular and hemodynamic indices of 100 TCAs-poisoned patients whom were randomly allocated for receiving midazolam with a first loading dose of 0.1 mg/kg (2 mg/minute) followed by a 6-hour 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 for all patients 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.


CONCLUSIONS
Midazolam may reduce tachycardia (and its fatal consequences) in the first hour of admission in TCAs-poisoned patients.
Department of Clinical Toxicology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Nastaran
N
Eizadi-Mood
Students' Research Committee, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
Elham
E
Aboofazeli
Department of Pharmacology, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
Valiollah
V
Hajhashemi
Isfahan Kidney Diseases Research Center, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Farzad
F
Gheshlaghi
Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Shirinsadat
S
Badri
Department of Clinical Toxicology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Ali Mohammad
AM
Sabzghabaee
Midazolam; Tachycardia; Tricyclic antidepressants (TCAs) Poisoning