Effect of intravenous midazolam on cardiac parameters in acute tricyclic antidepressants poisoning

Midazolam is commonly and safely used in poisoning management and intensive care for the control of the agitated poisoned patients. Despite the introduction of newer and safer antidepressants, tricyclic antidepressants (TCA) are still prescribed and used in many countries due to their cost-effectiveness. Severe morbidity and mortality associated with these drugs arises largely from their well-documented cardiovascular toxicity. In this study we aimed to investigate the probable effect of midazolam on some hemodynamic indices in TCA poisoned patients.
In this clinical study we have evaluated some cardiovascular and hemodynamic indices of 100 TCA poisoned patients whom were randomly allocated for receiving midazolam with a first loading dose of 0.1 mg / kg (2 mg /min.) followed by a 6-hours maintenance infusion of 0.1 mg /kg /h of the drug in dextrose-saline (3.33% of dextrose and 0.33% of NaCl) or placebo (dextrose-saline infusion without midazolam). Pulse rate, systolic/diastolic blood pressure, respiratory rate, neurologic status and the outcome of therapy were recorded at the time of admission and hourly for the next 6 hours.
There was a statistically significant reduction in the heart rate of the midazolam treated group after the first hour of hospital admission. There were no significant differences in the respiratory rate, central nervous system manifestations and other indices between the two groups.
Midazolam may reduce tachycardia (and its fatal consequences) in the first hour of admission in TCA poisoned patients.