LJ Klein et al. JPGN 2021; 73: 523-528. Electrocardiogram Before Tricyclic Antidepressant Use: Minimal Impact in Pediatric Functional Gastrointestinal Disorders
Key findings from this retrospective review (n=233):
- TCAs were not started in only 1.7% (4/233) due to ECG results
- Eight (3.4%) had a cardiology referral; one (0.4%) had a prolonged QTc interval
- No deaths and no emergency department or hospital visits for arrhythmia or drug overdose occurred
The discussion lists a number of studies generally questioning the utility of pre-medication ECGs while at the same time acknowledging that guidelines in the GI and psychiatric literature support an ECG prior to TCA use. In a large study of sudden cardiac deaths in an adult population, there was no increased risk of death with TCA dosing less than 100 mg/day (Clin Pharmcol Ther 2004; 75: 234-41).
Related blog posts:
- Use of Antidepressant Medications for Recurrent Abdominal Pain
- Brave New World: Psychotropics for Functional GI Disorders
- Advice on Abdominal Pain for Everyone Who Cares for Children | gutsandgrowth
- Dreaded Nausea (2017) | gutsandgrowth
- Will I Have This Stomach Pain Forever? (Part 1) | gutsandgrowth
- How Effective are the Treatments for Functional Abdominal Pain? | gutsandgrowth
My take (borrowed in part from authors): While “the benefit of screening ECGs remains elusive,” it is still needed to try to avoid “extremely rare but catastrophic events.” The authors, however, recommend followup ECGs only on “patients on concomitant QT prolonging medications or increases to higher dosing ranges.”
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