Estudo das alterações eletrocardiográficas com o uso de antidepressivos tricíclicos em pacientes com dor crônica
A study on electrocardiographic changes secondary to the use of tricyclic antidepressants in patients with chronic pain
Ricardo Joaquim da Cunha Jr.; Louis Barrucand; Nubia Verçosa
Resumo
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Abstract
BACKGROUND AND OBJECTIVES: Tricyclic antidepressants (TCAs) are widely used as analgesics in chronic lumbar pain and neuropathic pain. The objective of this study was to evaluate the electrocardiographic changes in patients with chronic pain treated with amitriptyline or imipramine. METHODS: Forty patients, ages 26 to 81 years (57.27 ± 13.65 years) of both genders (female 19, male 21), with neuropathic syndromes (lumbosciatalgia, postlaminectomy syndromes, and post-herpetic neuritis, among others) participated in this study; 60% had cardiovascular diseases; 30% had changes in the ECG (RBBB, LBBB, first-degree AVB, LAHB, or PVCs). Three ECGs were done in each patient: one ECG was done before beginning treatment, and 30 and 60 days after beginning treatment evaluating PR, QRS, QT, QTc, DQT, DQTc, and HR. Thirty-two patients were on amitriptyline and eight on imipramine. The mean dose at the end of the study was 54.29 mg of amitriptyline and 46.87 mg of imipramine. RESULTS: Analysis of electrocardiographic parameters after the use of TCAs showed that amitriptyline caused a transitory increase in heart rate in females (p = 0.049), and the duration of the QRS in patients 60 years or older and patients with cardiopathies (p = 0.01). In patients who received 75 mg of amitriptyline, the QTc interval was greater when compared to that of patients who received 25 mg of the drug (p = 0.0044). The increase in those parameters demonstrated the effects of amitriptyline on cardiac conduction; however, clinical compromise was not seen, since they remained within normal limits (QRS < 110 msec and QTc < 470 msec). CONCLUSIONS: The chronic use of TACs proved to be safe and effective, and it did not show changes in cardiac conduction with clinical repercussion.
Referencias
Furukawa AT, McGuire H, Barbui C. Meta-analysis of effects and side effects of low dosage tricyclic antidepressants in depression: systematic review. BMJ. 2002;325:991-995.
Moore A, Edwards J, Barden J. Bandolier's Little Book of Pain. 2003.
Baldessarini RJ. Antidepressivos. As Bases Farmacológicas da Terapêutica. 2003:339-364.
Teixeira MJ, Teixeira WJ, Kraychete DC. Epidemiologia Geral da Dor. Dor: contexto interdisciplinar. Maio:53-66.
Kareholp I, Brattberg G. Pain and mortality risk among elderly persons in Sweden. Pain. 1998;77:271-278.
Decacche W. ECG para o Clínico. 2004.
Lepeschkin E, Surawicz B. The measurement of the QT interval of electrocardiogram. Circulation. 1952;6:378-388.
Funck-Brentano C, Jaillon P. Rate-corrected QT interval: Techniques and limitations. Am J Cardiol. 1993;72:17b-22b.
Watson CP, Evans RJ, Reed K. Amitriptyline versus placebo in postherpetic neuralgia. Neurology. 1982;32:671-673.
Max MB, Culnane M, Schafer SC. Amitriptyline relieves diabetic neuropathy pain in patients with normal or depressed mood. Neurology. 1987;37:589-596.
Leijon G, Boive J. Central post-stroke pain: a controlled trial of amitriptyline and carbamazepine. Pain. 1989;36:27-36.
Glassman AH, Rodrigues AI, Shapiro PA. The use of antidepressant drugs in patients with heart disease. J Clin Psychiatry. 1998;59(^s10):16-21.
Ray WA, Meredith S, Thapa PB. Cyclic antidepressants and the risk of sudden cardiac death. Clin Pharmacol Ther. 2004;75:234-241.
Berger A, Dukes E, Edelsberg J. Use of tricyclic antidepressants in older patients with diabetic peripheral neuropathy. Clin J Pain. 2007;23:251-258.
Chen H, Lamer TJ, Rho RH. Contemporary management of neuropathic pain for the primary care physician. Mayo Clin Proc. 2004;79:1533-1545.
Cohen HW, Gibson G, Alderman MH. Excess risk of myocardial infarction in patients treated with antidepressant medications: association with use of tricyclic agents. Am J Med. 2000;108:2-8.
Bingefors K, Isacson D, Knorring LV. Antidepressant-treated patients in ambulatory care mortality during a nine-year period after first treatment. Br J Psychiatry. 1996;169:647-654.
Glasmann AH. Cardiovascular effects of antidepressant drugs update. J Clin Psychiatry. 1998;59(^s15):13-18.
Buckley NA, Chevalier S, Leditschke IA. The limited utility of electrocardiography variables used to predict arrhythmia in psychotropic drug overdose. Critical Care. 2003;7:101-107.
Roose SP, Glassman AH, Dalack GW. Depression, heat disease and tricyclic antidepressants. J Clin Psychiatry. 1989;50:12-18.
Antzelevitch C. Arrhythmogenic mechanisms pf QT prolonging drugs: is QT prolongation really the problem?. J Electrocardiol. 2004;37(^ssuppl):15-24.
Sadanaga T. Abnormal QT prolongation and psychotropic drug therapy in psychiatric patients: significance of bradycardia-dependent QT prolongation. J Electrocardiol. 2004;37:267-273.
Chow BJ, Gollob M, Birnie D. Brugada syndrome precipitated by a tricyclic antidepressant. Heart. 2005;91:651.
Morganroth J. A definitive or thorough phase 1 QT ECG trial as a requirement for drug safety assessment. J Electrocardiol. 2004;37:25-29.
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