Poisonous Ingredient

Amitriptyline

Where Found

Amitriptyline hydrochloride is a prescription medication. Brands include:

• Adepril
• Amitid
• Amitril
• Elavil
• Emitrip
• Endep
• Enovil
• Trepiline
• Tryptanol
• Vanatrip

Note: This list may not be all-inclusive.

Symptoms

• Airways and lungs
  • Slowed, labored breathing
• Bladder and kidneys
  • Inability to urinate
  • Urinary hesitancy
• Eyes, ears, nose, and throat
  • Blurred vision
  • Dry mouth
  • Enlarged pupils
• Heart and blood
  • Low blood pressure
  • Irregular heart rate
  • Shock
• Nervous system
  • Agitation
  • Coma (sudden onset)
  • Convulsions (sudden onset)
  • Drowsiness
  • Hallucinations
  • Headache
  • Inability to concentrate
  • Muscle rigidity
  • Restlessness
  • Seizures
  • Stupor (lack of alertness)
  • Uncoordinated movement
• Stomach and intestines
  • Constipation
  • Increased appetite
  • Weight gain
  • Vomiting

Home Care

This can be a very serious overdose. Seek immediate medical help.

Before Calling Emergency

Determine the following information:

• Patient's age, weight, and condition
• Name of the product (ingredients and strengths, if known)
• Time it was swallowed
• Amount swallowed
• If the medication was prescribed for the patient

Poison Control

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number 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.

See: Poison control center - emergency number

What to Expect at the Emergency Room

The health care provider will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate.

The patient may receive:

• Activated charcoal
• Breathing help, possibly artificial respiration
• Fluids through a vein (by IV)
• Laxative
• Medicine called an antidote (sodium bicarbonate) to reverse the effects of the poison
• Tube through the mouth into the stomach to empty the stomach (gastric lavage)

Outlook (Prognosis)

Amitriptyline hydrochloride can be an extremely serious overdose.

Patients who swallow an excessive amount of this drug are almost always admitted to hospital.

How well a patient does depends on how much of the drug was swallowed and how quickly treatment was received. The faster a patient gets medical help, the better the chance of recovery.

Alternative Names

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

References

Woolf AD, Erdman AR, Nelson LS, et al. American Association of Poison Control Centers. Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol. 2007;45(3):203-233.

Kirk MA, Baer AB. Anticholinergics and antihistamines. In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 39.

Update Date: 1/19/2012

Reviewed by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.