Severe bradyarrythmia induced by tricyclic antidepressants in an elderly patient

A 66 year-old female patient, with severe chronic pain caused by diabetic radiculopathy, treated with association of amitriptiline and carbamazepine, presented severe sinusal bradycardia with hemodynamic disturbances ensuing junctional rhythm, which required installation of temporary pace-maker. The drugs were withdrawn. Reversion to sinusal rhythm occurred 36 hours after the installation of bradycardia. The pace-maker was withdrawn. It was concluded that the use of tricyclic antidepressive drugs, particularly in the elderly, should be carefully monitored.