Amitriptyline Overdose – Symptoms, Effects, Dossage and Treatments

Amitriptyline is an antidepressant drug, specifically a tricyclic antidepressant medication. It is one of the most widely used TCA drug. It is prescribed for treating depression. The efficacy of Amitriptyline is synonymous to the newer class of antidepressants such as SSRI or selective serotonin reuptake inhibitors. Specifically, Amitriptyline is prescribed for the following indications:

  • Depression
  • Anxiety disorders
  • Migraine prophylaxis
  • Attention Deficit Hyperactivity Disorder
  • Bipolar Disorder
  • Anorexia nervosa or bulimia nervosa
  • Post-herpetic neuralgia
  • Insomnia
  • Pain relief for ankylosing spondylitis
  • Prevention of biliary dyskinesia
  • Nocturnal enuresis in children
  • Post traumatic stress disorder (PTSD)

Other indications of Amitriptyline include:

  • Cyclic vomiting syndrome
  • Tinnitus
  • Carpal tunnel syndrome
  • Chronic cough
  • Fibromyalgia
  • Cystitis
  • Vulvodynia
  • Peripheral neuropathy that may be due to diabetes or Vitamin B overdose
  • Laryngeal sensory neuropathy
  • Painful paresthesia
  • Chronic fatigue syndrome
  • Multiple sclerosis
  • Functional dyspepsia

 The appropriate dosage of Amitriptyline for its depression indication is higher than in the management of pain. The usual dosage for pain treatment is 10 to 50 mg a day. According to studies, tricyclic antidepressants are not considered a first line of therapy for depression because of being high risk for overdose. Other antidepressant medications such as SNRIs and SSRIs are often used initially.

Amitriptyline is available in various brand names, but one of the most popular brands is Elavil. Amitriptyline overdose is related to increased ingestion of Amitriptyline by patients.

Overdose Amount of Amitriptyline

Ingestion of up to 750 mg of Amitriptyline by an adult results in Amitriptyline overdose.

Signs and Symptoms

The signs and symptoms of Amitriptyline overdose is mainly due to the anticholinergic effects of the drug at the different organs in the body as well as the brain. The heart may also suffer symptoms because of quinidine-like effects on the heart muscles. Signs and symptoms of Amitriptyline overdose include:

1. Altered metal Status

Drowsiness is a common symptom of Amitriptyline overdose. This results from the inhibition of the nerve impulse transmission in the central nervous system. Confusion may also be experienced. The presence of altered metal status may also lead to hallucinations by the patient.

2. Seizures

This happens because of the increase in the serotonin and norepinephrine levels at the nerve terminals thereby making the nerved impulse transmission less stable.

3. Heart blocks and arrhythmias

The effects of Amitriptyline overdose in the heart results from the impediment of the cardiac conduction system thereby inhibiting the action potentials from the cardiac pacemaker.

4. Widened QRS complex in ECG tracing

The widened QRS complex results from the reduction in the sodium influx in the myocardium. Widened QRS complex is usually seen in patients having Amitriptyline overdose or toxicity.

5. Hypo-tension

The alpha adrenergic receptors in the blood vessel walls are also blocked by Amitriptyline overdose thereby preventing vasoconstriction and leading to profound vasodilation because of the increased level of Amitriptyline in the blood.

6. Dry skin

This effect of Amitriptyline overdose results from the anticholinergic properties of Amitriptyline overdose.

7. Dilated pupils

This also results from the blockade of the alpha adrenergic receptors leading to dilation of the pupils. Dilated pupils are usually seen in patients with severe Amitriptyline overdose

8. Urinary retention

The anti-cholinergic properties of Amitriptyline overdose lead to the prevention of the acetylcholine to go to the neuromuscular junction for muscle contraction. As a result, the bladder loses its tone leading to urinary retention.

9. Slow respiration

The slowing of the respiration may be due to the CNS depression that results in depression of the respiratory center at the brain-stem  This may also result from the anticholinergic activity of Amitriptyline overdose leading to poor contraction of the respiratory muscles. The patient must be monitored for possible respiratory depression.

10. Hypothermia

Hypothermia is also a possible symptom of Amitriptyline overdose because of the loss of heat through vasodilatation.

Long term effects of Amitriptyline Overdose

1. Respiratory depression

Respiratory depression is a possible long-term effect or complication of Amitriptyline overdose because of the depression of the CNS and the respiratory muscles.

2. Coma

Coma is the result of CNS depression that may further lead to the death of the patient suffering from Amitriptyline overdose

Causes and Risk factors

The main cause of Amitriptyline overdose is ingestion of large amounts of Amitriptyline. Overdose is mainly seen in pediatric clients as an accidental ingestion of Amitriptyline pills. Amitriptyline overdose may also be seen in depressed clients who are suicidal because TCAs commonly do not take effect immediately after initiation of the treatment. In this line, monitoring of depressed clients should be ensured in order to prevent Amitriptyline overdose.

Diagnosis of Amitriptyline Overdose

In order to identify TCA overdose diagnostic tests must be carried out; this includes an ECG. Electrocardiogram is necessary in order to monitor the cardiac functioning and identify arrhythmia, heart blocks and ECG changes such as a widened QRS complex. A blood test may also identify the actual TCA level in the blood.

Treatment of Amitriptyline Overdose

Treatment for Amitriptyline overdose include symptomatic relief as well as detoxifying the body from the high amounts of Amitriptyline in the blood. Possible treatments for Amitriptyline overdose include:

1. Administration of Activated Charcoal

Activated charcoal may be given by mouth in conscious clients and by naso-gastric tube in patients with altered metal status. Activated charcoal is given in order to absorb the Amitriptyline present in the stomach and prevent possible absorption in the intestines. A second dose of activated charcoal is sometimes necessary.

2. Sodium bicarbonate infusions

Sodium bicarbonate is given to treat possible acidosis because of Amitriptyline overdose. Patients with arrhythmias and QRS prolongation may also meed sodium bicarbonate.

3. Anticonvulsant medications

Intravenous diazepam may be given in order to control the seizures or convulsions. Phenytoin is not to be given even if it is an anticonvulsant drug because it may lead to further blocking of the sodium channels that may lead to more serious arrhythmias.

4. Oxygen therapy

Oxygen inhalation is necessary in order to prevent respiratory collapse and ease the breathing of the client.

5. Vasopressors

Vasopressor drugs such as Neo-synephrine may be used in order to normalize the blood pressure.

6. Physostigmine

The antidote for anticholinergic toxicity such as Amitriptyline overdose includes physostigmine. This is a cholinesterase inhibitor that increases the amount of acetylcholine in the neuromuscular junction. However, it should not be used in Amitriptyline toxicity because of possible seizures.

15 comments on “Amitriptyline Overdose – Symptoms, Effects, Dossage and Treatments

  1. Kristina Eichstadt says:

    I overdosed on Amitriptyline 3 yrs ago. I was admitted to the hospital for 5 days and I have no memory of the stay or even a week later. I lost those 2 weeks completely. and my children think that since then my memory has really diminished. So we are wanting to know if long term memory problems can be caused from the overdose. Kristina

    • Anonymous says:

      I am wondering the same thing. My memory has diminished significantly, especially if im stressed. I lose things, large amounts of cash even. I have forgotten to pick my kids up, just headed straight home without them. Also, I kind of shut down after a high amount of stress like all emotions and thoughts leave me. If you know someone with an autism spectrum disorder, i feel like someone in the high functioning range. I want to get help, but im afraid of medication and what i might do with it, if it doest work.

      • Anonymous says:

        Has anyone else suffered with long-term personality changes following amitriptyline? Again it’s been three years and I’m still not me…

        • Faye says:

          Hey, a week ago I OD on amitriptyline and have no memory of the entire day I did it and the following two days when I was in hospital. Due to having no memory, I’m not entirely certain as to why I did it. Has anyone else experienced memory loss?

  2. Persephone says:

    Thank you for sharing your experiences. They explained something to me.
    Years ago I OD’d on Amitriptyline, combined with Trilafon, Demerol, & alcohol. The Amitrip alone was probaby more than enough. I changed my mind a half hour later, made myself vomit, and lay down. Someone found me, I couldn’t be woken, spent 3 days in coma in ICU, I think another 8 in coronary care before checking out AMA (they were trying to force me to sign myself in to a psych hospital). Charcoal sucks.

    My brain wasn’t functioning properly for some period of time after. I sat and stared and did nothing for hours, maybe days, entirely unaware of the passage of time. Family, friends, neighbors, etc badgered me endlessly until I checked into a hospital weeks later. I attributed my mental status to major depression, but I believe you are correct, it was an after-effect of the drugs (or coma). During a psych eval 6 months later, my Stanford-Binet IQ was well over 145, so I don’t think it did any permanent damage. Unsure if there was any lasting cardiac damage. I was diagnosed with long QT syndrome some time after, but it could have existed all along.

    The experience revealed that if you are self-destructive, do not take chances with mixing chemicals if uncertain or seeking assistance in getting help, because your freedom will be taken away leaving you with very expensive hospital bills as providers take the most secure, expensive approach to avoid a repeat performance. Fair-weather friends will RUN away and family members will walk on eggshells for years, but with bottled rage festering from emotional upset, stress, cost, abandonment, manipulation, etc. 20 yrs later, docs will be sketchy about giving you pain killers or muscle relaxants no matter how badly needed due to that history. In some states, 30 yrs later you could still be unable to purchase a rifle for hunting. There is NO shame in admitting you need help and asking for it. In fact, one should be proud of accepting responsibility and asking for help instead of giving up or acting out to get it. If life is truly that unbearable and you can’t perceive any solutions or methods to ease your pain, focus on getting through the next minute, hour, night, etc., if it doesn’t improve you can always give up tomorrow, or the day after, or the day after. Depression REALLY reduces the ability to handle stress and problem solve DRAMATICALLY. Sometimes it only takes a small improvement in mood for you to see options you couldn’t before. It’s quite common that sudden strong suicidal ideation is an indication that the depression is weakening and a person who’d felt immobilized finally felt able to do SOMETHING, even though it wasn’t something productive. Just a little more time often allows solutions to develop and percolate in your brain until you feel capable to recognize and pursue them. Because, REALLY, charcoal and catheters and intubation and locked doors and restraints and being trapped with deeply crazy strangers while at the mercy of often kinda bizarre mental health professions is pretty much the definition of sucking balls.

    • vik says:

      That made the most sense in all i’ve read tonight. Thank you. Am im process of planning suicide and this may make a difference to me. Thank you. x

  3. Samantha Puddifer says:

    My 20 year old daughter hazel has taken 40 strips of 50mg amitriptyline and is laying in hospital right now and this is the third day of her not waking up please tell me how much you took when u overdosed

    • Lee says:

      I overdosed on endep and was in a coma for 3 days. Had I not collapsed on the kitchen floor I believe I would have not survived. When I recovered I was taken to a private psychiatric hospit where I was so sick in the stomach I had to learn how to eat again by myself. It is a dangerous drug. Be very careful with it.

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  5. Danielle says:

    Ive just taken 1g (1000mgs) of the stuff, im 56kgs and normally 20mgs knocks me out, is the amount ive just taken , a dangourous amount ??

    • simon says:

      that would be enough to kill you for sure.
      i take 20mg each night and it has hardly any affect on me. so if i were to OD as a way out id need at lease 2 -3grams im am about 76kg

    • Anonymous says:

      Hey Danielle I took 3000 mg. And was in a coma on a ventilator in Icu for a wk. I have had memory issues as well as some altered personality traits. Damn gta go contact me dave katzenbach on fb if u wna tlk

  6. Anonymous says:

    I overdosed on amitriptyline in late 2005, was comatose in ICU for at least a week, maybe more. My memory was severely compromised — I mean, my memory of anything is greatly diminished, both before and after the overdose. I lost a lot of memories, which is sad, and also reduced my capacity to form new memories. Additionally I have had cardiac consequences, with a tendency towards bradycardia (reduced heart rate).

  7. JeffC says:

    Anyone know why I have permanent heart problems after accidental amitriptyline OD? I get high heart rates and skipping for years. I take atenolol to control it. Cardiologists say there’s nothing wrong. It makes no sense. I have all these heart problems after the OD for years happening every day. I felt my heart beat weaken after the OD in my throat and it’s been wanting to pound for exercise ever since.

  8. anonymous says:

    Does anyone know why I have permanent heart problems after an accidental OD on amitriptyline? My heart has been skipping and going at a high rate since the overdose. It’s been over 6 years since the OD. I use beta blockers to control it. The cardiologists say there’s nothing wrong with my heart even though I have all these crazy issues with it since then. It skips and races like crazy even on beta blockers if I don’t exercise everyday.

    Why are mods deleting my posts?

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