[2 fatal cases of reaction due to the combination of MAO inhibitors and tricyclic antidepressants. Medico-legal aspects].

Abstract

The authors describe two patients who died during hyperthermic reaction following the administration of MAO inhibitors and tricyclic antidepressants in therapeutic doses. In both cases, there was a high increase of temperature, rigidity of skeletal muscles and impairment consciousness with some analog with the syndrome following an overdose of the same drugs taken simultaneously, or with an acute intoxication by MAO inhibitors. The pharmacological aspects point out the synergistic mechanism between drugs of the two groups and the possible onset of the syndrome, not only after simultaneous administration, but also when the tricyclic antidepressants are prescribed without an adequate interval following a therapeutic cycle with MAO inhibitors. The possible professional responsibility is discussed and the authors emphasize that the pharmacological association must be used with caution and only after establishing the inefficacy of one single drug, starting anyhow with low doses, constantly looking after the patient and avoiding the parenteral administration.