A retrospective study of serum levels and electrocardiographic effects of nortriptyline in children and adolescents

Journal of the American Academy of Child and Adolescent Psychiatry
T E WilensD E Geist

Abstract

We retrospectively evaluated a large pediatric population treated with nortriptyline (NT) in an outpatient psychopharmacology clinic to assess pharmacokinetic and electrocardiographic (EKG) effects. A systematic search revealed 82 children and adolescents treated naturalistically with NT. All patients with available EKGs and serum NT levels were included in the series with the exception of those receiving concomitant antipsychotic agents. Forty-three percent of subjects were receiving medications in addition to NT. Patients received an average (+/- SE) NT dose of 2.0 +/- 0.1 mg/kg yielding mean serum NT levels of 105.5 +/- 7.4 ng/mL. There was a linear relationship of NT dose (mg/kg) to serum NT levels (r = 0.50, p < 0.0001). NT treatment resulted in small increases in heart rate, and PR, QRS, and QTc intervals (all ps < 0.01), of similar magnitude in children and adolescents. Individuals with the highest baseline EKG indices had the least amount of change in those indices with NT treatment. There were only a few statistically significant associations between NT dose or serum NT levels and EKG parameters. NT treatment was significantly associated with the onset of asymptomatic sinus tachycardia (heart rate > 100 beats per minut...Continue Reading

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Citations

Nov 1, 1995·Journal of the American Academy of Child and Adolescent Psychiatry·H L LeonardE Tucker
Nov 1, 1996·Journal of the American Academy of Child and Adolescent Psychiatry·T E WilensA Goldblatt
Mar 1, 1997·Journal of the American Academy of Child and Adolescent Psychiatry·J BiedermanW Weber
May 20, 1998·Journal of the American Academy of Child and Adolescent Psychiatry·A J ZametkinR Silver
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Oct 24, 2019·European Journal of Clinical Pharmacology·Maike Scherf-ClavelStefan Unterecker
May 19, 2020·Expert Opinion on Drug Safety·Sanne M KloosterboerBirgit C P Koch

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