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Hypertension in neuroblastoma induced by imipramine
Insights
Severe hypertension occurred in a child with neuroblastoma treated with Imipramine. This tricyclic antidepressant may cause dangerous blood pressure increases in children with active neuroblastoma, necessitating caution.
Area of Science:
- Pediatric Oncology
- Pharmacology
- Cardiology
Background:
- Hypertension is a known complication in some neuroblastoma patients.
- The association between Imipramine use and hypertension in neuroblastoma has not been previously documented.
Abstract:
Hypertension is a well-known finding in some patients with neuroblastoma. However, it has not previously been described in association with the use of Imipramine. We report the occurrence of severe hypertension (blood pressure 190/160) in a 4-year-old girl with neuroblastoma who was given Imipramine to control a behavior disorder. It was determined later that this patient's tumor was recurring at the time of her hypertensive episode. Since she had no blood pressure elevation at initial diagnosis and none following discontinuation of the Imipramine (when she was in florid relapse), we believe that this drug rather than her underlying disease alone caused her hypertension. The mechanism for this reaction is believed to be increased levels of vasoactive catecholamines due to interference of their physiologic inactivation by Imipramine. From this experience, we urge extreme caution in the use of tricyclic antidepressants in children with active neuroblastoma.