European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·2010
Area of Science:
Pharmacology
Clinical Toxicology
Psychiatry
Background:
Tricyclic antidepressants (TCAs) are commonly prescribed for depression.
A 1-week supply of TCAs is generally considered safe.
Concerns exist regarding the toxicity of even low-dose TCA overdoses.
Purpose of the Study:
To evaluate the toxicity of low-dose amitriptyline overdoses.
To assess the safety of a 1-week supply of TCAs.
To inform prescription guidelines for TCAs.
Main Methods:
Retrospective review of 12 cases of low-dose amitriptyline overdose (500-1000 mg).
Analysis of clinical outcomes, including severity and life-threatening events.
Main Results:
Six out of 12 patients experienced life-threatening outcomes from low-dose amitriptyline overdose.
A 1-week supply of TCAs, previously considered safe, demonstrated severe toxicity in this cohort.
Conclusions:
Low-dose amitriptyline overdose can be severely toxic and life-threatening.
Current prescription guidelines for TCAs may need revision.
Physicians should consider prescribing less than a 1-week supply for at-risk patients, particularly those with suicidal ideation.