Comparison of intravenous lipid emulsion, bicarbonate, and glucagon treatments in a rabbit model of clomipramine toxicity

Background: This experimental study aimed to evaluate intravenous lipid emulsion, sodium bicarbonate, and glucagon as treatment options for the cardiotoxicity associated with clomipramine, a tricyclic antidepressant, and the antidotal effects of these drugs. Methods: In this experimental study, female and male New Zealand rabbits were divided into a sham group, a sodium bicarbonate treatment group, an intravenous lipid emulsion treatment group, and a glucagon treatment group. After the administration of a single dose of oral clomipramine (70 mg/kg), through an orogastric tube, vital parameters such as mean arterial pressure and oxygen saturation were measured, using a bedside monitor. Intoxication was established after the mean arterial pressure decreased to 40%-45%, within approximately 30-45 minutes. Treatments were administered after intoxication was established. Results: Although the mean arterial pressure values significantly changed over time in the sham and glucagon treatment groups, no significant changes were observed in the intravenous lipid emulsion and sodium bicarbonate treatment groups. Significant differences were observed among the values at 0 min compared with 30, 60, and 120 min in both the sham and the glucagon treatment groups. The clomipramine level changed significantly in all groups. Conclusion: Tricyclic antidepressant poisoning remains a difficult therapeutic challenge. Glucagon, a lipophilic drug, appears to be a promising candidate for the treatment of clomipramine-induced cardiotoxicity and should be considered early for the treatment of severe tricyclic antidepressant overdose.