Background and Importance Tricyclic antidepressants (TCAs) block sodium channels in the heart, which can prolong the QT interval and cause arrhythmias. Patients over 64 years of age are at increased risk of these side effects.
Aim and Objectives To conduct a systematic review of the cardiac effects of TCAs in patients older than 64 years. As a secondary objective, the frequency of TCAs prescriptions in patients older than 64 years with cardiac conduction disorders (CCD) was analysed, reviewing concomitant treatments.
Material and Methods A systematic review of the published scientific literature was conducted following PRISMA Declaration. In addition, a descriptive cross-sectional study was carried out, including all patients over 64 years of age receiving TCAs treatment. An anonymised database containing the variables age, sex, and prescribed medications was used.
Results After the search, 5 articles were included in the qualitative synthesis. A study concludes that TCAs cause CCD, but without clinical compromise. The second shows an association between the use of TCAs and sudden death in patients with previous heart disease (HD). Another study concludes that normal doses of TCAs in patients with severe HD are equivalent to toxic doses in patients without HD. The fourth shows no correlation between serum sodium levels, electrocardiogram changes, and severity of TCAs toxicity. The latest study shows that prolonged exposure to TCAs is also related to the occurrence of coronary disease events in patients without known HD. The prescriptions of 63 patients receiving TCAs with a median age of 70 (65-88) years were reviewed. No patient had prescribed treatments for CCD, however, 49,2% of patients had prescribed ³1 drug that prolongs the QT interval.
Conclusion and Relevance The literature reviewed reveals CCD caused by TCAs. In the data sheet of TCAs, their use is contraindicated in patients with previous HD. In our sample, the prescription of TCAs is appropriate; however, we recommend that in patients over 64 years of age without CCD, electrocardiograms be performed before starting treatment with TCAs and periodically. In addition, after verifying the high frequency of prescription of drugs that prolong the QT interval, we believe that it is essential to review the concomitant medication, looking for therapeutic alternatives for these drugs.
Conflict of Interest No conflict of interest