Charcoal haemoperfusion in amitriptyline poisoning: experience in 20 children

Tricyclic antidepressant (TCA) toxicity is common among children and adults due to widespread use. Amitriptyline (AT) is one of the most commonly prescribed TCAs. Current guidelines do not recommend charcoal haemoperfusion (HP) for AT overdose due to high protein binding and large volume of distribution. However evidence regarding the efficacy of charcoal HP in addition to supportive measures is accumulating in the published reports.

Here we report our experience in 20 children (15 girls, 5 boys) with acute AT overdose aged between 1.5 and 15 years, successfully managed with HP in our institution between January 2000 and February 2007.

The HP indications were mainly severe initial cardiac and respiratory involvement. After HP, all patients recovered dramatically with a mean hospital stay of 4 days (range: 2-12). Only one patient developed neurological sequelae due to prolonged hypoxia secondary to respiratory arrest.

To our knowledge this is the largest case series reporting the efficacy of charcoal HP in acute AT overdose in children. Based on our findings, charcoal HP seems to be an effective treatment modality, especially in prompt correction of severe life-threatening cardiac and respiratory findings in children with serious AT overdose and resulting in a reduction of morbidity and mortality.