Peaked "T" waves with tranylcypromine (parnate) overdose

Area of Science:

• Pharmacology
• Cardiology
• Toxicology

Background:

• Monoamine oxidase inhibitors (MAOI), such as tranylcypromine (Parnate), are increasingly used clinically.
• Overdose of MAOIs can lead to a range of severe toxic effects.

Observation:

• A case of tranylcypromine overdose presented with headache, obtundation, hypertension, and diffusely peaked T-waves on electrocardiogram (ECG).
• The observed ECG changes occurred in the absence of hyperkalemia, a finding not previously linked to MAOI use.

Findings:

• Review of recent literature confirms MAOI overdose can cause hypertension, hypotension, shock, hyperpyrexia, intracranial hemorrhage, agitation, hyperkinesis, coma, and death.
• The novel association of peaked T-waves with tranylcypromine toxicity expands the known spectrum of MAOI-related adverse events.

Implications:

• These ECG abnormalities represent a significant addition to the potential toxicities associated with MAOI overdose.
• Increased clinical use of MAOIs necessitates heightened awareness of their comprehensive toxicity profile, including cardiovascular manifestations.