Bismuth C, Baud F, Pontal P G, Galliot M, Elkhouly M
Nouv Presse Med. 1982 May 29;11(25):1943-4.
A case of severe intoxication by tricyclic antidepressants with persistence during 14 days of abnormally high plasma imipramine levels is reported. The various factors capable of maintaining plasma imipramine at a high level are discussed. They include mechanical factors (intestinal absorption), ventilation under positive end-expiratory pressure, alterations of hepatic metabolism by other drugs such as metronidazole or cimetidine, and changes in tissue distribution. Attention is drawn to the risks inherent in the various treatments used against acute intoxications and in combined chemotherapy during intensive care generally. When such drugs are necessary, the plasma levels of those with higher toxicity should be monitored.
报告了一例三环类抗抑郁药严重中毒病例，其血浆丙咪嗪水平异常升高持续了14天。讨论了能够使血浆丙咪嗪维持在高水平的各种因素。这些因素包括机械因素（肠道吸收）、呼气末正压通气、其他药物如甲硝唑或西咪替丁对肝代谢的改变以及组织分布的变化。还提请注意针对急性中毒所采用的各种治疗方法以及重症监护期间联合化疗普遍存在的风险。当需要使用这类药物时，应监测毒性较高药物的血浆水平。
