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Phenytoin prophylaxis of cardiotoxicity in experimental amitriptyline poisoning

M Callaham, H Schumaker and P Pentel

Department of Medicine, University of California, San Francisco.

Tricyclic antidepressants (TCA) are drugs with Type IA antiarrhythmic properties that cause severe cardiac conduction blocks, hypotension, and ventricular dysrhythmias at toxic levels. Phenytoin has been proposed as a prophylaxis and treatment of these dysrhythmias, since it is thought to improve conduction in this setting. Anesthetized dogs were given a loading dose of phenytoin, followed by constant amitriptyline infusion until death. Variables known to affect TCA toxicity, such as arterial pH, were carefully controlled. There were no significant differences between the phenytoin and control group in any physiologic parameter, including toxicity, drug levels, or dose to death. However, duration and frequency of episodes of ventricular tachycardia were dramatically increased in the phenytoin group. It is concluded that prophylactic phenytoin in this animal model provides no benefits and may in fact increase the severity of ventricular tachycardia and hypotension. In addition, it is speculated that similar adverse effects of phenytoin might be seen in other Type IA antiarrhythmics if the extremely toxic levels seen in this study with TCA were reached.

Volume 245, Issue 1, pp. 216-220, 04/01/1988
Copyright © 1988 by American Society for Pharmacology and Experimental Therapeutics




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Copyright © 1988 by the American Society for Pharmacology and Experimental Therapeutics.