Journal Published Online: 01 March 1997
Volume 42, Issue 2

Death of Two Subjects Due to Imipramine and Desipramine Metabolite Accumulation During Chronic Therapy: A Review of the Literature and Possible Mechanisms



In two unrelated cases, a 7-year-old boy and a 21-year-old woman died suddenly while receiving chronic imipramine therapy. In the boy, concentrations of imipramine were: Left femoral blood 0.5 mg/L, right femoral blood 1.2 mg/L, aorta blood 1.0 mg/L, liver 68 mg/Kg, and for the active metabolite, desipramine, left femoral blood 6.7 mg/L, right femoral blood 9.9 mg/L, aorta blood 8.7 mg/L, liver 400 mg/Kg. In the woman, the imipramine concentrations were: Femoral blood 0.6 mg/L, liver 37 mg/Kg, and of the active metabolite, desipramine, femoral blood 3.74 mg/L, liver 261 mg/Kg. In both cases, the scene investigation strongly indicated that neither individual had ingested an acute overdose. The very high ratios of desmethyl metabolite to parent drug are consistent with this observation. Impaired metabolism due to a genetically determined “slow metabolizer” phenotype of cytochrome CYP2D6, and/or concurrent therapy with phenothiazines, is suggested as a possible mechanism for the apparent fatal accumulation of these tricyclic antidepressants.

Author Information

Robert Swanson, J
Oregon Health Sciences University, Portland, OR
Jones, GR
Office of the Chief Medical Examiner, Edmonton, Alberta, Canada
Krasselt, W
Denmark, LN
Office of the Chief Medical Examiner, Edmonton, Alberta, Canada
Ratti, F
Lane County Medical Examiners Office, Eugene, OR
Pages: 5
Price: $25.00
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Stock #: JFS14124J
ISSN: 0022-1198
DOI: 10.1520/JFS14124J