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Beta blocker inhibits tricyclic metabolism
1University of New Mexico School of Medicine, Albuquerque.
Journal of the American Academy of Child and Adolescent Psychiatry
|February 1, 1994
Summary
Beta blockers can significantly inhibit tricyclic antidepressant metabolism. This case study highlights two pediatric patients experiencing near-toxic imipramine levels when co-administered with propranolol.
Area of Science:
- Pharmacology
- Clinical Toxicology
- Pediatric Medicine
Background:
- Tricyclic antidepressants (TCAs) are commonly prescribed for various pediatric conditions.
- Beta blockers are frequently used for cardiovascular and other indications in children.
- Drug-drug interactions between TCAs and beta blockers are not well-documented, especially in pediatric populations.
Observation:
- Two pediatric patients experienced adverse events during co-administration of imipramine and propranolol.
- These events included clinical signs suggestive of imipramine toxicity.
- Monitoring of imipramine levels revealed significantly elevated concentrations.
Findings:
- The co-administration of propranolol appeared to inhibit the metabolism of imipramine in these pediatric patients.
- This inhibition led to supratherapeutic and near-toxic serum levels of imipramine.
- The findings suggest a clinically relevant drug interaction between propranolol and imipramine.
Implications:
- Clinicians should exercise caution when prescribing propranolol concurrently with imipramine, particularly in pediatric patients.
- Therapeutic drug monitoring of imipramine levels may be warranted in patients receiving concomitant beta blocker therapy.
- Further research is needed to elucidate the mechanisms and prevalence of this interaction.