Ephedrine Amitriptyline

A 61-year-old woman taking amitriptyline 25 mg/day underwent oophorectomy for ovarian cancer under combined general and epidural lumbar anesthesia. After the administration of the local anesthetic she developed hypotension refractory to high doses of ephedrine and dopaminergic drugs. Control was achieved with noradrenaline 200 pg. 

Very few fatalities have ever been reported (or studied), but it appears that the therapeutic index for ephedrine is very great. A 1997 case report described a 28-year-old woman with two prior suicide attempts, who died after ingesting amitriptyline and ephedrine. The blood ephedrine concentration was 11,000 ng/mL, and the liver concentration was twice that value (kidney, 14 mg/kg brain, 8.9 mg/kg). The amitriptyline concentration was 0.33 mg/kg in blood and 7.8 mg/kg in liver (131). Values in a second case report (where methylephedrine concentrations were nearly 6000 ng/mL) may or may not be relevant to the problem of ephedrine toxicity, as the individual in question took massive quantities of a calcium channel blocker, and it is not known whether methylephedrine exerts all the same effects as ephedrine (132). Baselt and Cravey mention the case of a young woman who died several hours after ingesting 2.1 g of ephedrine combined with 7.0 g of caffeine, but tissue findings were not described. Her blood ephedrine level was 5 mg/L, whereas the concentration in the liver was 15 mg/kg (133). 

Clinically important, potentially hazardous interactions with amitriptyline, amoxapine, benzphetamine, chlorpromazine, clomipramine, desipramine, doxepin, ephedra, ephedrine, imipramine, insulin, insulin glargine, minoxidil, nortriptyline, oxprenolol, protriptyline, tricyclic antidepressants, trimipramine, zuclopenthixol, zuclopenthixol acetate, zuclopenthixol decanoate, zuclopenthixol dihydrochloride... 

Clinically important, potentially hazardous interactions with amitriptyline, amoxapine, amphetamines, bupropion, citalopram, clomipramine, cyproheptadine, desipramine, dextroamphetamine, dextromethorphan, diethylpropion, dopamine, doxepin, entacapone, ephedrine, epinephrine, fluoxetine, fluvoxamine, imipramine, levodopa, mazindol, meperidine, methamphetamine, nefazodone, nortriptyline, paroxetine, phendimetrazine, phentermine, phenylephrine, phenylpropanolamine, pizotifen, protriptyline, pseudoephedrine, rizatriptan, sertraline, sibutramine, sumatriptan, sympathomimetics, tramadol, tricyclic antidepressants, trimipramine, tryptophan, tyramine-containing foods, venlafaxine, zolmitriptan... 

Very few fatalities have ever been reported (or studied), but it appears that the therapeutic index for ephedrine is very great indeed. A 1997 case report described a 28-yr-old woman with two prior suicide attempts, who died after ingesting amitriptyline and ephedrine. The blood ephedrine concentration was... 

Lurie, I.S. McGuiness, K. The quantitation of heroin and selected basic impur-ties via reversed phase HPLC. II. The analysis of adulterated samples. J.Liq.Chromatogr., 1987, 10, 2189—2204 [also impurities, acetaminophen, acetylcodeine, acetylmorphine, acetylprocaine, aminopyrene, amitriptyline, antipyrene, aspirin, barbital, benztropine, caffeine, cocaine, codeine, diamorphine, diazepam, diphenhydramine, dipyrone, ephedrine, ethylmorphine, lidocaine, meconin, methamphetamine, meth-ap Tilene, methaqualone, monoacetylmorphine, morphine, nalorphine, niacinamide, nicotinamide, noscapine, papaverine, phenacetin, phenmetrazine, phenobarbital, phenolphthalein, procaine, pro-panophenone, propoxyphene, P5rilamine, quinidine, quinine, salic lamide, saUsalicylic acid, secobarbital, strychnine, tetracaine, thebaine, tripelennamine, tropacocaine, vitamin B3, vitamin B5 electrochemical detection]... 

Noninterfering amitriptyline, benztropine methanesulfonate, butaperazine, butriptyline, carphenazine, chlorpromazine, clomipramine, cyclobenzaprine, dextropropoxyphene, dronabinol, ephedrine, ethchlorvynol, fluoxetine, fluphenazine, imipramine, meprobamate, methadone, methamphetamine, nicotine, norfluoxetine, nortriptyline, PCP, pheno-thiazine, pseudoephedrine... 

Simultaneous dihydrocodeine, hydrocodone, 6-monoacetylmorphine, morphine, ojgrcodone Noninterfering acetylcodeine, amitriptyline, amphetamine, diamorphine, dieizepeun, doth-iepin, doxepin, ephedrine, ephedrine, hydromorphone, mesoridazine, methadone, meth-amphetamine, 3-monoacetylmorphine, nordiazepam, norpropo oq)hene, nortriptyline, oxazepam, propojg hene, pseudoephedrine, quinidine, quinine, sulfamethoxazole, sulfor-idazine, thioridazine... 

Noninterfering acetaminophen, aspirin, amitriptyline, huprenorphine, caffeine, carba-mazepine, chlorpromazine, desipramine, dextromethorphan, doxepin, ephedrine, fenfluramine, imipramine, lidocaine, loxapine, meperidine, methadone, methaqualone, naloxone, naltrexone, nicotine, orphenadrine, oxycodone, papaverine, pentazocine, phendimetra-zine, phenmetrazine, phentermine, phenylpropanolamine, phenytoin, primidone, procaine, promethazine, propoxyphene, propyphenazone, theobromine, theophylline, trazodone, triflupromazine, trimethoprim, trimipramine... 

Extracted amitriptyline, amphetamine, benzoylecgonine, caffeine, cotinine, desipramine, diazepam, diphenhydramine, ephedrine, flurazepam, hydrocodone, hydromorphone, imip-ramine, lidocaine, methadone, methamphetamine, morphine, nordiazepam, nortriptyline, oxazepam, pentazocine, phenmetrazine, phenoharbital, phentermine, phenylpropanolamine, secobarbital Interfering chlorpheniramine... 

Also analyzed amitriptyline, amphetamine, chlorpromazine, desipramine, desmethyldox-epin, diethylpropion, doxepin, ephedrine, fenfluramine, imipramine, mesoridazine, meth-amphetamine, nortriptyline, phentermine, phenylpropanolamine, promazine, thioridazine, thiothixene, trifluoperazine... 

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