Background

Amitriptyline (AMT) is used in the management of children with irritable bowel syndrome (IBS), espe-cially in those with refractory abdominal pain. AMT is thought to decrease stress-induced electrical hypersen-sitivity.1 AMT is also pro-arrhythmogenic and increases the risk of sudden cardiac death in patients with under-lying heart disease.2 It is associated with an increased risk of sudden cardiac death at doses above 100 mg.2 AMT activates cardiac ryanodine channels causing efflux of calcium from the sarcoplasmic reticulum.3 James and Kearns4 evaluated the effects of tricyclic antidepressant overdose on the electrocardiograms (EKGs) in 45 children, and 17 patients showed conduc-tion delay and 9 developed prolonged corrected QT (QTc). However, there is not enough data in the litera