Amitriptyline poisoning with

Heard K et al Treatment of amitriptyline poisoning with ovine antibody to tricyclic antidepressants. r.anceM999 354(9190) 1614-1615. [PMID 10560683] (Experimental anti-TCA antibodies were successful in a 48-year-old man, but are not available yet for clinical use.)... 

Calvert GM, Hryhorczuk DO, Leikin JB (1987) Treatment of ciguatera fish poisoning with amitriptyline and nifedipine. Clin Toxicol 25(5) 423-428. 

A survey in Britain covering the decade of the 1980s demonstrated large numbers of successful suicides using BZs, either alone or in combination with alcohol (Serfaty et al., 1993 see also Buckley et al., 1995). Serfaty and Masterton (1993) found 891 fatalities with BZs alone and 591 in combination with alcohol. The total of all poisonings attributed to BZs was 1,576 during the 10-year period, putting them ahead of aspirin/ salicylates at 1,308 as well as amitriptyline (1,083) and dothiepin at 981. 

One of the putative benefits of mianserin is its alleged safety in overdose, which may be related to a reduced risk of cardiovascular adverse effects and convulsions. Data from the UK Committee on Safety of Medicines suggest that mianserin accounts for 11% of reported convulsions and 5.8% of use, putting it intermediate between amitriptyline and maprotiline (15). On the other hand, in the London Poisons Unit survey, involving 84 patients who took mianserin alone (up to 1000 mg), there were no deaths and no patients with convulsions, although this could represent a frequency of up to 3.6% (12). 

Tricyclic antidepressants are commoniy taken in overdose by suicidal patients and represent a major cause of poisoning hospitaiizations and deaths. Currently available tricyclic antidepressants are described in Table 11-7. Amitriptyline is also marketed in combination with chlordiazepoxide (Limbitrol ) or perphenazine (Etrafon or Tria-viF ). Cyclobenzaprine (FlexerilTW), a centrally acting muscle relaxant (see p 339), is structurally related to the tricyclic antidepressants but exhibits minimal cardiotoxic and variable CNS effects. Newer, noncyclic antidepressants are discussed on p 88. Monoamine oxidase inhibitors are discussed on page 269. 

A study involving 332 fatal poisonings in Finland found that alcohol was present in 67% of cases involving amitriptyline, and when alcohol was present, relatively small overdoses of amitriptyline could result in fatal poisoning. It appears that amitriptyline may be more toxic when given with alcohol and it has been suggested that a less dangerous alternative could be chosen when indications of alcohol abuse or suicide risk are present. ... 

Davis RT, Villar LA (1986) Symptomatic improvement with amitriptyline in ciguatera fish poisoning. N Engl J Med 315 65. 

---