Which emergency treatments are the priority for a client who intentionally took an overdose of a tricyclic antidepressant?

Elavil overdose; Adepril overdose; Endep overdose; Enovil overdose; Trepiline overdose

Poisonous Ingredient

Amitriptyline can be harmful in large amounts.

Where Found

Amitriptyline hydrochloride is a prescription medicine. It is sold under these brand names:

• Adepril
• Emitrip
• Enovil
• Trepiline
• Tryptanol
• Vanatrip

Other medicines may also contain amitriptyline hydrochloride.

Symptoms

Below are symptoms of an amitriptyline hydrochloride overdose in different parts of the body. These symptoms may occur more often or be more severe in people who also take certain other medicines that affect serotonin, a chemical in the brain.

AIRWAYS AND LUNGS

• Slowed, labored breathing

BLADDER AND KIDNEYS

• Cannot urinate
• Urine does not flow easily

EYES, EARS, NOSE, AND THROAT

• Blurred vision
• Dilated (wide) pupils
• Eye pain in people at risk for a type of glaucoma
• Dry mouth

HEART AND BLOOD

• Irregular heart rate
• Low blood pressure
• Rapid heartbeat
• Shock

NERVOUS SYSTEM

• Agitation
• Coma
• Seizures
• Drowsiness
• Hallucinations
• Headache
• Inability to concentrate
• Lack of alertness (stupor)
• Muscle rigidity or stiffness of the limbs
• Restlessness
• Uncoordinated movement

STOMACH AND INTESTINES

• Constipation
• Vomiting

Home Care

This can be a very serious overdose. Seek medical help right away.

Before Calling Emergency

Have this information ready:

• Person's age, weight, and condition
• Name of the product (ingredients and strength, if known)
• Time it was swallowed
• Amount swallowed
• If the medicine was prescribed for the person

Poison Control

Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

What to Expect at the Emergency Room

Take the container to the hospital with you, if possible.

The health care provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure.

Tests that may be done include:

• Blood and urine tests
• CT scan
• Chest x-ray
• ECG (electrocardiogram, or heart tracing)

Treatment may include:

• Fluids through a vein (by IV)
• Medicine called an antidote to reverse the effects of the poison and treat symptoms, such as sodium bicarbonate or lidocaine
• Activated charcoal
• Laxatives
• Breathing support, including a tube through the mouth into the lungs and connected to a breathing machine (ventilator)

Outlook (Prognosis)

An amitriptyline hydrochloride overdose can be very serious.

People who swallow too much of this drug are almost always admitted to the hospital.

How well someone does depends on how much of the drug was swallowed and how quickly treatment is given. The faster a person gets medical help, the better the chance of recovery. Complications such as pneumonia, muscle damage from lying on a hard surface for a long period of time, or brain damage from lack of oxygen may result in permanent disability. Death can occur.

References

Aronson JK. Tricyclic antidepressants. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:146-169.

Levine MD, Ruha AM. Antidepressants. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 146.

Version Info

Last reviewed on: 11/13/2021

Reviewed by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.