In 22 prepubertal depressed children, the total plasma concentration of
imipramine and its major metabolite, desipramine, varied by more than
sevenfold. The plasma drug concentrations correlated with slowing of
intracardiac conduction, elevation of diastolic blood pressure, and
increase in heart rate. These drug-induced changes were uniformly observed
when the total tricyclic level exceeded 225 ng/ml. However, subjective
reporting of nuisance side effects was not related to plasma drug
concentration. These findings suggest that children can be safely treated
when their plasma levels are below 225 ng/ml. If higher plasma levels are
attained, closer monitoring is warranted.
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