The Drug-Induced Respiratory Disease Website

Amitriptyline

Myocarditis (can be fulminate/fulminant)

Typically acute. Can be fulminate/fulminant and fatal (PMID 30242316). General review at PMID 28540649. Recent addition to the lst of causal drugs include immune checkpoint inhibitors (PMID 28833116, 29801747)

Publications

Kassim T, Mahfood Haddad T, Rakhra A, Kabach A, Qurie A, Selim M, Nayfeh AS, Aly A, Holmberg MJ

A Case of Amitriptyline-induced Myocarditis.

Cureus 2018 Jun 19;10;e2840 — 2018 Jun 19 — e2840

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

Diagnosing DIRD

Identify causative drugs

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