Use of CytoSorb in cases of acute amitriptyline intoxication

Intoxications with the tricyclic antidepressant amitriptyline frequently occur in the clinical setting and require immediate treatment. Although various poisonings can be counteracted with specific remedies, treatment options for amitriptyline intoxication remain sparse. Besides conventional approaches, a new haemoadsorption device might represent an opportunity for therapeutic detoxification.

We report on two patients who were admitted as an emergency case with suspected amitriptyline overdose. Due to potentially life-threatening intoxication, the decision was made to initiate continuous renal replacement therapy (CRRT) together with CytoSorb haemoadsorption. As a result, drug-level measurements showed fast and efficient reduction of amitriptyline levels in the blood (case 1 from 186 µg/l to 54.7 µg/l, case 2 from 844 µg/l to 290 µg/l) and helped to stabilize a critical situation.

We were able to quickly and efficiently reduce amitriptyline to non-toxic serum levels and to stabilize a critical situation using the CytoSorb adsorber. Therefore, in the absence of other proven beneficial treatment regimen, the use of CytoSorb haemoadsorption could represent a potential treatment modality for severe amitriptyline intoxication.