[Prolonged high plasma imipramine levels after acute intoxication (author's transl)]

A case of severe intoxication by tricyclic antidepressants with persistence during 14 days of abnormally high plasma imipramine levels is reported. The various factors capable of maintaining plasma imipramine at a high level are discussed. They include mechanical factors (intestinal absorption), ventilation under positive end-expiratory pressure, alterations of hepatic metabolism by other drugs such as metronidazole or cimetidine, and changes in tissue distribution. Attention is drawn to the risks inherent in the various treatments used against acute intoxications and in combined chemotherapy during intensive care generally. When such drugs are necessary, the plasma levels of those with higher toxicity should be monitored.