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September 2, 1974

Pheochromocytoma and Tricyclic Antidepressants

Author Affiliations

Bowman Gray School of Medicine Winston-Salem, NC

JAMA. 1974;229(10):1282. doi:10.1001/jama.1974.03230480010002

To the Editor.—  Several cases of pheochromocytoma referred to this hospital were reviewed recently because of their atypical clinical courses. One such patient experienced a hypertensive episode accompanied by grand mal seizures subsequent to imipramine (Tofranil) administration.

Report of a Case.—  A 36-year-old patient was hospitalized during the 32nd week of her third pregnancy because of recurrent left occipital headaches. She had been followed up carefully and at no time had she manifested hypertension, tachycardia, diaphoresis, pallor, proteinuria, or urinary tract infection. Physical examination was normal, including a blood pressure of 125/75 mm Hg. She received meperidine (50 mg) and promethazine (50 mg) several times for relief of pain, and, because of a depressive reaction, she was given imipramine, 25 mg every eight hours, for four doses. Approximately six hours after the last dose of imipramine, she experienced three grand mal seizures over a two- to three-hour period. Blood pressures