Amitriptyline overdose
Amitriptyline is a drug that has antidepressant, sedative, anxiolytic and thymoleptic effects. It is widely used in psychiatric practice in the treatment of the following conditions:
- depression;
- schizophrenic psychoses;
- behavior disorders;
- mixed emotional disorders;
- enuresis in children;
- bulimia nervosa.
It is also sometimes prescribed for the prevention of migraines and in the complex therapy of chronic pain syndrome.
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Amitriptyline is a potent drug. Their treatment should be carried out strictly according to the doctor's prescription and under his supervision, otherwise there is a high likelihood of undesirable effects, including overdose.
How much amitriptyline is needed for an overdose?
Taking Amitriptyline usually starts with a minimum dose of 50 mg per day. Then this dose is increased daily by 25-50 mg, until a stable therapeutic effect is achieved, but no more than 300 mg per day. In the treatment of severe forms of depression and subject to good patient tolerance of Amitriptyline, the daily dose can be increased to 500 mg, but therapy in such doses is carried out exclusively in a hospital setting, with round-the-clock medical supervision.
At the beginning of therapy, Amitriptyline is capable of exhibiting a suicidal effect, which sometimes prompts patients to take an excessively high dose. Another reason for overdose is addiction to the drug, which develops over time, due to which patients independently increase the dose.
Signs of an overdose with Amitriptyline appear when more than 12 tablets (300 mg) are taken per day, and a daily dose of 1200 mg (48 tablets) is fatal.
Signs of overdose
Symptoms of an overdose with Amitriptyline increase gradually, the rate of their manifestation and severity is determined by the amount of the drug taken and the individual characteristics of the organism.
In the first hours after taking a toxic dose, psychomotor agitation may be noted or, conversely, weakness, drowsiness, lethargy. Then hallucinations and other signs appear associated with the m-anticholinergic action of Amitriptyline:
- tachycardia;
- mydriasis;
- dry mucous membranes;
- acute urinary retention;
- increased body temperature;
- seizures;
- weakening of intestinal peristalsis.
A few hours later, the activity of the central nervous system is sharply inhibited, which leads to impairment of consciousness, up to coma. This is accompanied by the following symptoms:
- acute respiratory failure;
- cardiac arrhythmias (ventricular fibrillation and flutter, ventricular tachyarrhythmia);
- acute heart failure;
- severe arterial hypotension.
In the future, metabolic acidosis, cardiogenic shock, hypokalemia develop. The lethal outcome occurs against the background of progressive cardiovascular and respiratory failure.
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First aid for overdose with amitriptyline
First aid should be started by calling the ambulance team, in anticipation of its arrival, rescue measures are carried out.
If the victim is conscious:
- Rinse the stomach: drink 1 liter of activated carbon suspension, then induce vomiting by irritating the root of the tongue. Repeat the procedure 2-3 times.
- Take activated charcoal at the rate of 1.0 g (4 tablets) for each kilogram of body weight.
If the victim is unconscious:
- Give the body the correct position: lay it on its side, which will prevent the tongue from sinking and the aspiration of vomit.
- Provide fresh air: loosen tight clothing, open window.
It is impossible to flush the stomach at the prehospital stage and give medications to unconscious patients, as this can lead to blockage (obstruction) of the airways.
Antidote
There is no specific antidote to Amitriptyline.
When is medical attention needed?
An overdose of amitriptyline can be fatal, so medical attention is needed in 100% of cases.
In the hospital, the victim is connected to a cardiac monitor, which allows you to control the respiratory rate, blood pressure, heart rate and rhythm. Regular laboratory monitoring of the concentration of electrolytes in the blood, as well as the acid-base state (AChS) is carried out. Even with a favorable course, such observation should last at least 3-5 days.
There is no specific treatment for an overdose with Amitriptyline, methods of extracorporeal detoxification are ineffective, therefore symptomatic therapy is carried out:
- with an increase in respiratory failure - tracheal intubation, connecting the victim to a ventilator (artificial lung ventilation);
- with metabolic acidosis - intravenous administration of sodium bicarbonate solution, artificial ventilation of the lungs in the mode of hyperventilation, infusion of hypertonic sodium chloride solution;
- with ventricular arrhythmias, antiarrhythmic agents are prescribed, if this does not lead to a persistent therapeutic effect, cardioversion or defibrillation is performed;
- in case of vascular insufficiency - intravenous administration of saline solutions and colloids. In severe collapse, dopamine infusion may be required;
- for the relief of seizures and psychomotor agitation - Valium or Seduxen.
Possible consequences
Amitriptyline overdose, especially of a severe degree, often ends fatally. If the victim can be saved, early and late complications may develop. The early ones include:
- pneumonia;
- hypocoagulation syndrome, accompanied by massive internal and external bleeding;
- acute renal failure;
- acute liver failure.
Long-term consequences:
- diseases of the nervous system and psyche caused by toxic and / or hypoxic brain damage;
- aggravation of depressive conditions;
- chronic heart, renal and hepatic failure.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
