Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management

References

• Watson WA, Litovitz TL, Rodgers GC, Klein-Schwartz W, Reid N, Youniss J, Flanagan A, Wruk KM. 2004 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2005; 23: 589–666
   PubMed Web of Science ®Google Scholar
• Freeman JW, Mundy GR, Beattie RR, Ryan C. Cardiac abnormalities in poisoning with tricyclic antidepressants. Br Med J 1969; 2: 610–611
   PubMed Web of Science ®Google Scholar
• Callaham M, Kassel D. Epidemiology of fatal tricyclic antidepressant ingestion: implications for management. Ann Emerg Med 1985; 14: 1–9
   PubMed Web of Science ®Google Scholar
• Jick SS, Dean AD, Jick H. Antidepressants and suicide. BMJ 1995; 310: 215–218
   PubMed Web of Science ®Google Scholar
• Olson KR, Kearney TE, Dyer JE, Benowitz NL, Blanc PD. Seizures associated with poisoning and drug overdose. Am J Emerg Med 1993; 11: 565–568
   PubMed Web of Science ®Google Scholar
• Taboulet P, Michard F, Muszynski J, Galliot-Guilley M, Bismuth C. Cardiovascular repercussions of seizures during cyclic antidepressant poisoning. J Toxicol Clin Toxicol 1995; 33: 205–211
   PubMed Web of Science ®Google Scholar
• Crome P, Newman B. Fatal tricyclic antidepressant poisoning. J R Soc Med 1979; 72: 649–653
   PubMed Web of Science ®Google Scholar
• Henry JA. A fatal toxicity index for antidepressant poisoning. Acta Psychiatr Scand Suppl 1989; 354: 37–45
   PubMedGoogle Scholar
• Henry JA, Alexander CA, Sener EK. Relative mortality from overdose of antidepressants. BMJ 1995; 310: 221–224
   PubMed Web of Science ®Google Scholar
• Farmer RD, Pinder RM. Why do fatal overdose rates vary between antidepressants?. Acta Psychiatr Scand Suppl 1989; 354: 25–35
   PubMedGoogle Scholar
• Wedin GP, Oderda GM, Klein-Schwartz W, Gorman RL. Relative toxicity of cyclic antidepressants. Ann Emerg Med 1986; 15: 797–804
   PubMed Web of Science ®Google Scholar
• Amitai Y, Frischer H. Excess fatality from desipramine and dosage recommendations. Ther Drug Monit 2004; 26: 468–473
   PubMed Web of Science ®Google Scholar
• Amitai Y, Frischer H. Excess fatality from desipramine in children and adolescents. J Am Acad Child Adolesc Psychiatry 2006; 45: 54–60
   PubMed Web of Science ®Google Scholar
• Baldessarini RJ. Drugs and the treatment of psychiatric disorders: depression and anxiety disorders. Goodman & Gilman's the Pharmacological Basis of Therapeutics10th, JG Hardman, LE Limbird. McGraw-Hill, New York 2001; 447–483
   Google Scholar
• Cohen LG, Biederman J, Wilens TE, Spencer TJ, Mick E, Faraone SV, Prince J, Flood JG. Desipramine clearance in children and adolescents: absence of effect of development and gender. J Am Acad Child Adolesc Psychiatry 1999; 38: 79–85
   PubMed Web of Science ®Google Scholar
• Swartz CM, Sherman A. The treatment of tricyclic antidepressant overdose with repeated charcoal. J Clin Psychopharmacol 1984; 4: 336–340
   PubMed Web of Science ®Google Scholar
• Rauber A, Maroncelli R. Prescribing practices and knowledge of tricyclic antidepressants among physicians caring for children. Pediatrics 1984; 73: 107–109
   PubMed Web of Science ®Google Scholar
• Brown-Cartwright D, Brater DC, Barnett CC, Richardson CT. Effect of doxepin on basal gastric acid and salivary secretion in patients with duodenal ulcer. Ann Intern Med 1986; 104: 204–206
   PubMed Web of Science ®Google Scholar
• Poisindex system, RK Klasco. Thomson Micromedex, edition expires, Greenwood Village, CO March, 2004
   Google Scholar
• Miadinich EK, Carlow TJ. Total gaze paresis in amitriptyline overdose. Neurology 1977; 27: 695
   PubMed Web of Science ®Google Scholar
• Smith MS. Amitriptyline ophthalmoplegia. Ann Intern Med 1979; 91: 793
   PubMed Web of Science ®Google Scholar
• Roberge RJ, Martin TG, Hodgman M, Benitez JG. Acute chemical pancreatitis associated with a tricyclic antidepressant (clomipramine) overdose. J Toxicol Clin Toxicol 1994; 32: 425–429
   PubMed Web of Science ®Google Scholar
• Mullins ME, Cristofani CB, Warden CR, Cleary JF. Amitriptyline-associated seizures in a toddler with Munchausen-by-proxy. Pediatr Emerg Care 1999; 15: 202–205
   PubMed Web of Science ®Google Scholar
• Winrow AP. Amitriptyline-associated seizures in a toddler with Munchausen-by-proxy. Pediatr Emerg Care 1999; 15: 462–463
   PubMed Web of Science ®Google Scholar
• Simon FA, Treuting JJ. Nonaccidental poisoning in a two-month-old child. Clin Toxicol 1981; 18: 37–40
   Web of Science ®Google Scholar
• Watson JB, Davies JM, Hunter JL. Nonaccidental poisoning in childhood. Arch Dis Child 1979; 54: 143–144
   PubMed Web of Science ®Google Scholar
• Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA 1999; 281: 1900–1905
   PubMed Web of Science ®Google Scholar
• Shiffman RN, Shekelle P, Overhage JM, Slutsky J, Grimshaw J, Deshpande AM. Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization. Ann Intern Med 2003; 139: 493–498
   PubMed Web of Science ®Google Scholar
• Benowitz N. Antidepressants, tricyclic. Poisoning & Drug Overdose4th, KR Olson. McGraw-Hill, New York 2004; 90–93
   Google Scholar
• Dawson AH. Cyclic antidepressants. Medical Toxicology3rd, RC Dart. Lippincott Williams & Wilkins, Philadelphia 2004; 852–861
   Google Scholar
• Geis GL, Bond GR. Antidepressant overdose: tricyclics, selective serotonin reputake inhibitors, and atypical antidepressants. Pediatric Toxicology: Diagnosis & Management of the Poisoned Child, TR Erickson, WR Ahrens, SE Aks, CR Baum, LJ Ling. McGraw-Hill, New York 2005; 297–302
   Google Scholar
• Liebelt EL, Francis PD. Cyclic antidepressants. Goldfrank's Toxicologic Emergencies7th, LR Goldfrank, MA Howland, NE Flomenbaum, RS Hoffman, NA Lewin, LS Nelson. McGraw-Hill, New York 2002; 847–864
   Google Scholar
• Pentel PR, Keyler DE, Haddad LM. Tricyclic antidepressants and selective serotonin reuptake inhibitors. Clinical Management of Poisoning and Drug Overdose3rd, LM Haddad, MW Shannon, JF Winchester. WB Saunders, Philadelphia 1998; 437–451
   Google Scholar
• http://www.cdc.gov/nchs/data/ad/ad314.pdf, Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, Mei Z, Curtin LR, Roche AF, Johnson CL. CDC growth charts: Unied States. Advance data from vital and health statistics; no. 314. Hyattsville, MD; National Center for Health Statistics, 2004.
   Google Scholar
• McFee RB, Mofenson HC, Caraccio TR. A nationwide survey of the management of unintentional-low dose tricyclic antidepressant ingestions involving asymptomatic children: implications for the development of an evidence-based clinical guideline. J Toxicol Clin Toxicol 2000; 38: 15–19
   PubMed Web of Science ®Google Scholar
• McFee RB, Mofenson HC, Caraccio TR. A nationwide survey of poison control centers comparing 1999 to 1998 triage and management of asymptomatic children who ingested tricyclic antidepressant. Vet Hum Toxicol 2001; 43: 305–307
   PubMedGoogle Scholar
• Steel CM, O'Duffy J, Brown SS. Clinical effects and treatment of imipramine and amitriptyline poisoning in children. Br Med J 1967; 3: 663–667
   PubMed Web of Science ®Google Scholar
• Goel KM, Shanks RA. Amitriptyline and imipramine poisoning in children. Br Med J 1974; 1: 261–263
   PubMed Web of Science ®Google Scholar
• Berkovitch M, Matsui D, Fogelman R, Komar L, Hamilton R, Johnson D. Assessment of the terminal 40-millisecond QRS vector in children with a history of tricyclic antidepressant ingestion. Pediatr Emerg Care 1995; 11: 75–77
   PubMed Web of Science ®Google Scholar
• Biggs JT, Spiker DG, Petit JM, Ziegler VE. Tricyclic antidepressant overdose: incidence of symptoms. JAMA 1977; 238: 135–138
   PubMed Web of Science ®Google Scholar
• Bouffard Y, Palmier B, Bouletreau P, Motin J. Intoxication aiguë par les antidépresseurs tricycliques. Critères de gravité et traitement. Étude de 16 observations avec manifestations cardio-vasculaires. Ann Med Interne (Paris) 1982; 133: 256–260
   PubMedGoogle Scholar
• Brown TC, Dwyer ME, Stocks JG. Antidepressant overdosage in children--a new menace. Med J Aust 1971; 2: 848–851
   PubMed Web of Science ®Google Scholar
• Christensen KN, Andersen HH. Deliberate poisoning with tricyclic antidepressants treated in an intensive care unit. Acta Pharmacol Toxicol (Copenh) 1977; 41(Suppl 2)511–515
   PubMedGoogle Scholar
• deCastro FJ, Rost K, Jaeger R. Tricyclic antidepressant poisoning: clinical series. Vet Hum Toxicol 1980; 22: 68–69
   Google Scholar
• McFee RB, Caraccio TR, Mofenson HC. Tricyclic antidepressant (TCA) ingestions: pediatric toxicological management considerations by a regional poison control center (RPCC) [abstract]. J Toxicol Clin Toxicol 1998; 36: 518
   Google Scholar
• McFee RB, Caraccio TR, Mofenson HC. Selected tricyclic antidepressant ingestions involving children 6 years old or less. Acad Emerg Med 2001; 8: 139–144
   PubMed Web of Science ®Google Scholar
• Spiller HA, Baker SD, Krenzelok EP, Cutino L. Use of dosage as a triage guideline for unintentional cyclic antidepressant (UCA) ingestions in children. Am J Emerg Med 2003; 21: 422–424
   PubMed Web of Science ®Google Scholar
• Strom J, Sloth Madsen P, Nygaard Nielsen N, Bredgaard Sorensen M. Acute self-poisoning with tricyclic antidepressants in 295 consecutive patients treated in an ICU. Acta Anaesthesiol Scand 1984; 28: 666–670
   PubMed Web of Science ®Google Scholar
• Jue SG. Desipramine--accidental poisoning. Drug Intell Clin Pharm 1976; 10: 52–53
   Google Scholar
• Giles HM. Imipramine poisoning in childhood. Br Med J 1963; 5361: 844–846
   Web of Science ®Google Scholar
• Serafimovski N, Thorball N, Asmussen I, Lunding M. Tricyclic antidepressive poisoning with special reference to cardiac complications. Acta Anaesthesiol Scand Suppl 1975; 57: 55–63
   PubMedGoogle Scholar
• Chamsi-Pasha H, Barnes PC. Myocardial infarction: a complication of amitriptyline overdose. Postgrad Med J 1988; 64: 968–970
   PubMed Web of Science ®Google Scholar
• Bramble MG, Lishman AH, Purdon J, Diffey BL, Hall RJ. An analysis of plasma levels and 24-hour ECG recordings in tricyclic antidepressant poisoning: implications for management. Q J Med 1985; 56: 357–366
   PubMedGoogle Scholar
• Ellison DW, Pentel PR. Clinical features and consequences of seizures due to cyclic antidepressant overdose. Am J Emerg Med 1989; 7: 5–10
   PubMed Web of Science ®Google Scholar
• Noto R, Robert J, Hanote P. Traitement d'urgence et transport des intoxications aiguës par les dérivés imipraminiques (à propos de 70 cas). Agressologie 1970; 11: 515–523
   PubMedGoogle Scholar
• Pellinen TJ, Farkkila M, Heikkila J, Luomanmaki K. Electrocardiographic and clinical features of tricyclic antidepressant intoxication. A survey of 88 cases and outlines of therapy. Ann Clin Res 1987; 19: 12–17
   PubMedGoogle Scholar
• Bye C, Clubley M, Peck AW. Drowsiness, impaired performance and tricyclic antidepressant drugs. Br J Clin Pharmacol 1978; 6: 155–161
   PubMed Web of Science ®Google Scholar
• Karkkainen S, Neuvonen PJ. Pharmacokinetics of amitriptyline influenced by oral charcoal and urine pH. Int J Clin Pharmacol 1986; 24: 326–332
   PubMed Web of Science ®Google Scholar
• Hulten BA, Heath A, Knudsen K, Nyberg G, Starmark JE, Martensson E. Severe amitriptyline overdose: relationship between toxicokinetics and toxicodynamics. J Toxicol Clin Toxicol 1992; 30: 171–179
   PubMed Web of Science ®Google Scholar
• Köppel C, Wiegreffe A, Tenczer J. Clinical course, therapy, outcome and analytical data in amitriptyline and combined amitriptyline/chlordiazepoxide overdose. Hum Exp Toxicol 1992; 11: 458–465
   PubMed Web of Science ®Google Scholar
• Rudorfer MV, Robins E. Amitriptyline overdose: clinical effects on tricyclic antidepressant plasma levels. J Clin Psychiatry 1982; 43: 457–460
   PubMed Web of Science ®Google Scholar
• Siddiqui JH, Vakassi MM, Ghani MF. Cardiac effects of amitriptyline overdosage. Curr Ther Res Clin Exp 1977; 22: 321–325
   Web of Science ®Google Scholar
• Aquilonius SM, Hedstrand U. The use of physostigmine as an antidote in tricyclic anti-depressant intoxication. Acta Anaesthesiol Scand 1978; 22: 40–45
   PubMed Web of Science ®Google Scholar
• Pall H, Czech K, Kotzaurek R, Kleinberger G, Pichler M. Experiences with physostigminesalicylate in tricyclic antidepressant poisoning. Acta Pharmacol Toxicol (Copenh) 1977; 41: 171–178
   PubMedGoogle Scholar
• Vohra J, Burrows G, Hunt D, Sloman G. The effect of toxic and therapeutic doses of tricyclic antidepressant drugs on intracardiac conduction. Eur J Cardiol 1975; 3: 219–227
   PubMedGoogle Scholar
• Dale O, Hole A. Biphasic time-course of serum concentrations of clomipramine and desmethylclomipramine after a near-fatal overdose. Vet Hum Toxicol 1994; 36: 309–310
   PubMedGoogle Scholar
• Bucher HW, Stucki P. Kardial komplikationen bei einer vergiftung mit desipramine (Pertofran). Schweiz Med Wochenschr 1967; 97: 519–521
   PubMedGoogle Scholar
• Callaham M. Admission criteria for tricyclic antidepressant ingestion. West J Med 1982; 137: 425–429
   PubMedGoogle Scholar
• Chahine RA, Castellanos A, Jr. Myocardial toxicity produced by desipramine overdosage. Chest 1971; 59: 566–568
   PubMed Web of Science ®Google Scholar
• Colvard C, Jr. Overdosage of desipramine hydrochloride with marked electrocardiographic abnormalities. South Med J 1968; 61: 1218, passim
   PubMed Web of Science ®Google Scholar
• Hagerman GA, Hanashiro PK. Reversal of tricyclic-antidepressant-induced cardiac conduction abnormalities by phenytoin. Ann Emerg Med 1981; 10: 82–86
   PubMed Web of Science ®Google Scholar
• Lee WR, Sheikh MU, Covarrubias EA, Slotkoff LM. Variant ventricular tachycardia in desipramine toxicity. South Med J 1981; 74: 1268–1269
   PubMed Web of Science ®Google Scholar
• Shannon M. Toxicology reviews: physostigmine. Pediatr Emerg Care 1998; 14: 224–226
   PubMed Web of Science ®Google Scholar
• Williams AJ. “Desipramine” overdosage. Br Med J 1964; 1: 371–372
   Web of Science ®Google Scholar
• Zuckerman GB, Conway EE, Jr. Pulmonary complications following tricyclic antidepressant overdose in an adolescent. Ann Pharmacother 1993; 27: 572–574
   PubMed Web of Science ®Google Scholar
• Scheinin M, Virtanen R, Iisalo E. Effect of single and repeated doses of activated charcoal on the pharmacokinetics of doxepin. Int J Clin Pharmacol 1985; 23: 38–42
   PubMedGoogle Scholar
• Bastani JR. Physostigmine treatment of tricyclic overdosage in psychosis. Psychosomatics 1979; 20: 847–848
   PubMed Web of Science ®Google Scholar
• Cordonnier J, Heyndrickx A, Jordaens L, Brijs R, De Keyser R. A fatal intoxication due to doxepin. J Anal Toxicol 1983; 7: 161–164
   PubMed Web of Science ®Google Scholar
• Janson PA, Watt JB, Hermos JA. Doxepin overdose: success with physostigmine and failure with neostigmine in reversing toxicity. JAMA 1977; 237: 2632–2633
   PubMed Web of Science ®Google Scholar
• Oliver JS, Watson AA. Doxepin poisoning. Med Sci Law 1974; 14: 280–283
   PubMed Web of Science ®Google Scholar
• Williams JO. Respiratory depression in tricyclic overdose. Br Med J 1972; 1: 631
   PubMed Web of Science ®Google Scholar
• Wrenn K, Smith BA, Slovis CM. Profound alkalemia during treatment of tricyclic antidepressant overdose: a potential hazard of combined hyperventilation and intravenous bicarbonate. Am J Emerg Med 1992; 10: 553–555
   PubMed Web of Science ®Google Scholar
• Goldberg MJ, Park GD, Spector R, Fischer LJ, Feldman RD. Lack of effect of oral activated charcoal on imipramine clearance. Clin Pharmacol Ther 1985; 38: 350–353
   PubMed Web of Science ®Google Scholar
• Vohra J, Hunt D, Burrows G, Sloman G. Intracardiac conduction defects following overdose of tricyclic antidepressant drugs. Eur J Cardiol 1975; 2: 443–452
   PubMedGoogle Scholar
• Stinnett JL, Valentine J, Abrutyn E. Nortriptyline hydrochloride overdosage. JAMA 1968; 204: 69–71
   PubMed Web of Science ®Google Scholar
• Brackenridge RG, Peters TJ, Watson JM. Myocardial damage in amitriptyline and nortriptyline poisoning. Scott Med J 1968; 13: 208–210
   PubMedGoogle Scholar
• Duke WW, Horton JP. Nortriptyline (Aventyl) overdosage. South Med J 1969; 62: 1348–1349
   PubMed Web of Science ®Google Scholar
• Elliott CG, Colby TV, Kelly TM, Hicks HG. Charcoal lung. Bronchiolitis obliterans after aspiration of activated charcoal. Chest 1989; 96: 672–674
   PubMed Web of Science ®Google Scholar
• Lipper B, Bell A, Gaynor B. Recurrent hypotension immediately after seizures in nortriptyline overdose. Am J Emerg Med 1994; 12: 452–453
   PubMed Web of Science ®Google Scholar
• McKinney PE, Rasmussen R. Reversal of severe tricyclic antidepressant-induced cardiotoxicity with intravenous hypertonic saline solution. Ann Emerg Med 2003; 42: 20–24
   PubMed Web of Science ®Google Scholar
• Rudorfer MV, Robins E. Fatal nortriptyline overdose, plasma levels, and in vivo methylation of tricyclic antidepressants. Am J Psychiatry 1981; 138: 982–983
   PubMed Web of Science ®Google Scholar
• Sedal L, Korman MG, Williams PO, Mushin G. Overdosage of tricyclic antidepressants. A report of two deaths and a prospective study of 24 patients. Med J Aust 1972; 2: 74–79
   PubMed Web of Science ®Google Scholar
• Chin LS, Havill JH, Rothwell RP, Bishop BG. Use of physostigmine in tricyclic antidepressant poisoning. Anaesth Intensive Care 1976; 4: 138–140
   PubMedGoogle Scholar
• Forsythe WI, Merrett JD, Redmond A. Controlled clinical trial of trimipramine and placebo in the treatment of enuresis. Br J Clin Pract 1972; 26: 119–121
   PubMedGoogle Scholar
• Bartels MG, Varley CK, Mitchell J, Stamm SJ. Pediatric cardiovascular effects of imipramine and desipramine. J Am Acad Child Adolesc Psychiatry 1991; 30: 100–103
   PubMed Web of Science ®Google Scholar
• Brown D, Winsberg BG, Bailer I, Press M. Imipramine therapy and seizures: three children treated for hyperactive behavioral disorders. Am J Psychiatry 1973; 130: 210–212
   PubMed Web of Science ®Google Scholar
• Petti TA, Campbell M. Imipramine and seizures. Am J Psychiatry 1975; 132: 538–540
   PubMed Web of Science ®Google Scholar
• Leonard HL, Meyer MC, Swedo SE, Richter D, Hamburger SD, Allen AJ, Rapoport JL, Tucker E. Electrocardiographic changes during desipramine and clomipramine treatment in children and adolescents. J Am Acad Child Adolesc Psychiat 1995; 34: 1460–1468
   PubMed Web of Science ®Google Scholar
• Glassman AH, Giardina EV, Perel JM, Bigger JT, Kantor SJ, Perel JM, Davies M. Clinical characteristics of imipramine induced orthostatic hypotension. Lancet 1979; 1: 468–472
   PubMed Web of Science ®Google Scholar
• Wilens TE, Biederman J, Baldessarini RJ, Geller B, Schleifer D, Spencer TJ, Birmaher B, Goldblatt A. Cardiovascular effects of therapeutic doses of tricyclic antidepressants in children and adolescents. J Am Acad Child Adolesc Psychiatry 1996; 35: 1491–1501
   PubMed Web of Science ®Google Scholar
• Biederman J. Sudden death in children treated with a tricyclic antidepressant. J Am Acad Child Adolesc Psychiatry 1991; 30: 495–498
   PubMed Web of Science ®Google Scholar
• Biederman J, Baldessarini RJ, Goldblatt A, Lapey KA, Doyle A, Hesslein PS. A naturalistic study of 24-hour electrocardiographic recordings and echocardiographic findings in children and adolescents treated with desipramine. J Am Acad Child Adolesc Psychiatry 1993; 32: 805–813
   PubMed Web of Science ®Google Scholar
• Miescke KJ, Musa MN. On mixtures of three normal populations caused by monogenic inheritance: application to desipramine metabolism. J Psychiat Neurosci 1994; 19: 295–300
   PubMed Web of Science ®Google Scholar
• Musa MN, Miescke KJ. Pharmacogenetics of desipramine metabolism. Int J Clin Pharmacol Ther 1994; 32: 126–130
   PubMed Web of Science ®Google Scholar
• Varley CK, McClellan J. Case study: two additional sudden deaths with tricyclic antidepressants. J Am Acad Child Adolesc Psychiatry 1997; 36: 390–394
   PubMed Web of Science ®Google Scholar
• Wilens TE, Stern TA, O'Gara PT. Adverse cardiac effects of combined neuroleptic ingestion and tricyclic antidepressant overdose. J Clin Psychopharmacol 1990; 10: 51–54
   PubMed Web of Science ®Google Scholar
• Kaumeier HS, Haase HJ. A double-blind comparison between amoxapine and amitriptyline in depressed in-patients. Int J Clin Pharmacol 1980; 18: 177–184
   Google Scholar
• Veith RC, Bloom V, Bielski R, Friedel RO. ECG effects of comparable plasma concentrations of desipramine and amitriptyline. J Clin Psychopharmacol 1982; 2: 394–398
   PubMed Web of Science ®Google Scholar
• Burckhardt D, Raeder E, Muller V, Imhof P, Neubauer H. Cardiovascular effects of tricyclic and tetracyclic antidepressa3nts. JAMA 1978; 239: 213–216
   PubMed Web of Science ®Google Scholar
• Milner G, Buckler EG. Adynamic ileus and amitriptyline: three case reports. Med J Aust 1964; 14: 921–922
   Google Scholar
• Rechlin T. Decreased R-R variation: a criterium for overdosage of tricyclic psychotropic drugs. Intens Care Med 1995; 21: 598–601
   PubMed Web of Science ®Google Scholar
• Vohra J, Burrows GD, Sloman G. Assessment of cardiovascular side effects of therapeutic doses of tricyclic antidepressant drugs. Aust N Z J Med 1975; 5: 7–11
   PubMedGoogle Scholar
• Burkitt EA, Sutcliffe CK. Paralytic ileus after amitriptyline (“Tryptizol”). Brit Med J 1961; 164: 8–1649
   Google Scholar
• Goldsmith HJ. Amitriptyline poisoning. Lancet 1965; 2: 640–641
   PubMed Web of Science ®Google Scholar
• Giller EL, Jr., Bialos DS, Docherty JP, Jatlow P, Harkness L. Chronic amitriptyline toxicity. Am J Psychiatry 1979; 136: 458–459
   PubMed Web of Science ®Google Scholar
• Heiser JF, Wilbert DE. Reversal of delirium induced by tricyclic antidepressant drugs with physostigmine. Am J Psychiatry 1974; 131: 1275–1277
   PubMed Web of Science ®Google Scholar
• Johnson PB. Physostigmine in tricyclic antidepressant overdose. JACEP 1976; 5: 443–445
   PubMedGoogle Scholar
• Brasic JR, Barnett JY, Sheitman BB, Tsaltas MO. Adverse effects of clomipramine. J Am Acad Child Adolesc Psychiatry 1997; 36: 1165–1166
   PubMed Web of Science ®Google Scholar
• Schubert DSP, Miller SI. Are divided doses of tricyclic antidepressants necessary?. J Nerv Ment Dis 1978; 166: 875–877
   PubMed Web of Science ®Google Scholar
• Rapoport JL, Mikkelsen EJ, Zavadil A, Nee L, Gruenau C, Mendelson W, Gillin JC. Childhood enuresis. II. Psychopathology, tricyclic concentration in plasma, and antienuretic effect. Arch Gen Psychiatry 1980; 37: 1146–1152
   PubMed Web of Science ®Google Scholar
• Schroeder JS, Mullin AV, Elliott GR, Steiner H, Nichols M, Gordon A, Paulos M. Cardiovascular effects of desipramine in children. J Am Acad Child Adolesc Psychiatry 1989; 28: 376–379
   PubMed Web of Science ®Google Scholar
• Preskorn SH, Fast GA. Tricyclic antidepressant-induced seizures and plasma drug concentration. J Clin Psychiatry 1992; 53: 160–162
   PubMed Web of Science ®Google Scholar
• Riddle MA, Nelson JC, Kleinman CS, Rasmusson A, Leckman JF, King RA, Cohen DJ. Sudden death in children receiving Norpramin: a review of three reported cases and commentary. J Am Acad Child Adolesc Psychiatry 1991; 30: 104–108
   PubMed Web of Science ®Google Scholar
• Wagner KD, Fershtman M. Potential mechanism of desipramine-related sudden death in children. Psychosomatics 1993; 34: 80–83
   PubMed Web of Science ®Google Scholar
• Varley CK. Sudden death related to selected tricyclic antidepressants in children: epidemiology, mechanisms and clinical implications. Paediatr Drugs 2001; 3: 613–627
   PubMedGoogle Scholar
• Riddle MA, Geller B, Ryan N. Another sudden death in a child treated with desipramine. J Am Acad Child Adolesc Psychiatry 1993; 32: 792–797
   PubMed Web of Science ®Google Scholar
• Fritz GK, Rockney RM, Yeung AS. Plasma levels and efficacy of imipramine treatment for enuresis. J Am Acad Child Adolesc Psychiatryry 1994; 33: 60–64
   PubMed Web of Science ®Google Scholar
• Saraf KR, Klein DF, Gittelman-Klein R, Groff S. Imipramine side effects in children. Psychopharmacologia 1974; 37: 265–274
   PubMed Web of Science ®Google Scholar
• Azima H, Vispo RH. Imipramine; a potent new anti-depressant compound. Am J Psychiatry 1958; 115: 245–246
   PubMed Web of Science ®Google Scholar
• Fletcher SE, Case CL, Sallee FR, Hand LD, Gillette PC. Prospective study of the electrocardiographic effects of imipramine in children. J Pediatr 1993; 122: 652–654
   PubMed Web of Science ®Google Scholar
• Winsberg BG, Goldstein S, Yepes LE, Perel JM. Imipramine and electrocardiographic abnormalities in hyperactive children. Am J Psychiatry 1975; 132: 542–545
   PubMed Web of Science ®Google Scholar
• Saraf K, Klein DF. The safety of a single daily dose schedule for imipramine. Am J Psychiatry 1971; 128: 483–484
   PubMed Web of Science ®Google Scholar
• Brooke G, Weatherly JRC. Imipramine. Lancet 1959; 2: 568–569
   Web of Science ®Google Scholar
• English D. Balanced treatment of depression. Curr Ther Res Clin Exp 1959; 1: 135–138
   PubMedGoogle Scholar
• Mann AM, Catterson AG, Macpherson AS. Toxicity of imipramine: report on serious side effects and massive overdosage. Can Med Assoc J 1959; 81: 23–28
   PubMedGoogle Scholar
• Levene LJ, Lascelles CF. Imipramine. Lancet 1959; 2: 675
   Google Scholar
• Moccetti T, Lichtlen P, Albert H, Meier E, Imbach P. Kardiotoxizität der trizyklischen antidepressiva. Schweiz Med Wochenschr 1971; 101: 1–10
   PubMedGoogle Scholar
• Williams RB, Sherter C. Cardiac complications of tricyclic antidepressant therapy. Ann Intern Med 1971; 74: 395–398
   PubMed Web of Science ®Google Scholar
• Reed K, Smith RC, Schoolar JC, Hu R, Leelavathi DE, Mann E, Lippman L. Cardiovascular effects of nortriptyline in geriatric patients. Am J Psychiatry 1980; 137: 986–988
   PubMed Web of Science ®Google Scholar
• Ziegler VE, Co BT, Biggs JT. Plasma nortriptyline levels and ECG findings. Am J Psychiatry 1977; 134: 441–443
   PubMed Web of Science ®Google Scholar
• Schneider LS. QRS duration in acute overdose of tricyclic antidepressants. N Engl J Med 1986; 314: 989
   Web of Science ®Google Scholar
• Unrecognized, excessive dose of nortriptyline. Int Pharm J 1998; 12: 145–146
   Google Scholar
• Hulten BA, Heath A. Clinical aspects of tricyclic antidepressant poisoning. Acta Med Scand 1983; 213: 275–278
   PubMed Web of Science ®Google Scholar
• Boehnert MT, Lovejoy FH, Jr. Value of the QRS duration versus the serum drug level in predicting seizures and ventricular arrhythmias after an acute overdose of tricyclic antidepressants. N Engl J Med 1985; 313: 474–479
   PubMed Web of Science ®Google Scholar
• Niemann JT, Bessen HA, Rothstein RJ, Laks MM. Electrocardiographic criteria for tricyclic antidepressant cardiotoxicity. Am J Cardiol 1986; 57: 1154–1159
   PubMed Web of Science ®Google Scholar
• Wolfe TR, Caravati EM, Rollins DE. Terminal 40-ms frontal plane QRS axis as a marker for tricyclic antidepressant overdose. Ann Emerg Med 1989; 18: 348–351
   PubMed Web of Science ®Google Scholar
• Liebelt EL, Francis PD, Woolf AD. ECG lead aVR versus QRS interval in predicting seizures and arrhythmias in acute tricyclic antidepressant toxicity. Ann Emerg Med 1995; 26: 195–201
   PubMed Web of Science ®Google Scholar
• Bailey B, Buckley NA, Amre DK. A meta-analysis of prognostic indicators to predict seizures, arrhythmias or death after tricyclic antidepressant overdose. J Toxicol Clin Toxicol 2004; 42: 877–888
   PubMed Web of Science ®Google Scholar
• Buckley BM, Boldy DA, Vale JA. The importance of pH and blood gas monitoring after overdoses of tricyclic antidepressants. Br Med J (Clin Res Ed) 1984; 289: 185
   PubMed Web of Science ®Google Scholar
• Cronin AJ, Khalil R, Little TM. Poisoning with tricyclic antidepressants: an avoidable cause of childhood deaths. Br Med J 1979; 1: 722
   PubMed Web of Science ®Google Scholar
• Freeman JW, Loughhead MG. Beta blockade in the treatment of tricyclic antidepressant overdosage. Med J Aust 1973; 1: 1233–1235
   PubMed Web of Science ®Google Scholar
• Harrigan RA, Brady WJ. ECG abnormalities in tricyclic antidepressant ingestion. Am J Emerg Med 1999; 17: 387–393
   PubMed Web of Science ®Google Scholar
• Masters AB. Delayed death in imipramine poisoning. Br Med J 1967; 3: 866–867
   PubMed Web of Science ®Google Scholar
• McAlpine SB, Calabro JJ, Robinson MD, Burkle FM, Jr. Late death in tricyclic antidepressant overdose revisited. Ann Emerg Med 1986; 15: 1349–1352
   PubMed Web of Science ®Google Scholar
• McMahon AJ. Amitriptyline overdose complicated by intestinal pseudo-obstruction and caecal perforation. Postgrad Med J 1989; 65: 948–949
   PubMed Web of Science ®Google Scholar
• Foulke GE, Albertson TE, Walby WF. Tricyclic antidepressant overdose: emergency department findings as predictors of clinical course. Am J Emerg Med 1986; 4: 496–500
   PubMed Web of Science ®Google Scholar
• Hulten BA, Adams R, Askenasi R, Dallos V, Dawling S, Volans G, Heath A. Predicting severity of tricyclic antidepressant overdose. J Toxicol Clin Toxicol 1992; 30: 161–170
   PubMed Web of Science ®Google Scholar
• Starkey IR, Lawson AA. Poisoning with tricyclic and related antidepressants--a ten-year review. Q J Med 1980; 49: 33–49
   PubMedGoogle Scholar
• Greenland P, Howe TA. Cardiac monitoring in tricyclic antidepressant overdose. Heart Lung 1981; 10: 856–859
   PubMed Web of Science ®Google Scholar
• Petit JM, Spiker DG, Ruwitch JF, Ziegler VE, Weiss AN, Biggs JT. Tricyclic antidepressant plasma levels and adverse effects after overdose. Clin Pharmacol Ther 1977; 21: 47–51
   PubMed Web of Science ®Google Scholar
• Tokarski GF, Young MJ. Criteria for admitting patients with tricyclic antidepressant overdose. J Emerg Med 1988; 6: 121–124
   PubMedGoogle Scholar
• Stern TA, O'Gara PT, Mulley AG, Singer DE, Thibault GE. Complications after overdose with tricyclic antidepressants. Crit Care Med 1985; 13: 672–674
   PubMed Web of Science ®Google Scholar
• Fasoli RA, Glauser FL. Cardiac arrhythmias and ECG abnormalities in tricyclic antidepressant overdose. Clin Toxicol 1981; 18: 155–163
   PubMed Web of Science ®Google Scholar
• Emerman CL, Connors AF, Jr., Burma GM. Level of consciousness as a predictor of complications following tricyclic overdose. Ann Emerg Med 1987; 16: 326–330
   PubMed Web of Science ®Google Scholar
• Foulke GE. Identifying toxicity risk early after antidepressant overdose. Am J Emerg Med 1995; 13: 123–126
   PubMed Web of Science ®Google Scholar
• Pentel P, Sioris L. Incidence of late arrhythmias following tricyclic antidepressant overdose. Clin Toxicol 1981; 18: 543–548
   PubMed Web of Science ®Google Scholar
• Callaham M. Tricyclic antidepressant overdose. JACEP 1979; 8: 413–425
   PubMedGoogle Scholar
• Banahan BF, Jr., Schelkun PH. Tricyclic antidepressant overdose: conservative management in a community hospital with cost-saving implications. J Emerg Med 1990; 8: 451–454
   PubMedGoogle Scholar
• Glassman AH, Johnson LL, Giardina EG, Walsh BT, Roose SP, Cooper TB, Bigger JT, Jr. The use of imipramine in depressed patients with congestive heart failure. JAMA 1983; 250: 1997–2001
   PubMed Web of Science ®Google Scholar
• Rosenstein DL, Nelson JC, Jacobs SC. Seizures associated with antidepressants: A review. J Clin Psychiatry 1993; 54: 289–299
   PubMed Web of Science ®Google Scholar
• Molloy DW, Penner SB, Rabson J, Hall KW. Use of sodium bicarbonate to treat tricyclic antidepressant-induced arrhythmias in a patient with alkalosis. Can Med Assoc J 1984; 130: 1457–1459
   PubMed Web of Science ®Google Scholar
• Phillips S, Brent J, Kulig K, Heiligenstein J, Birkett M. Fluoxetine versus tricyclic antidepressants: a prospective multicenter study of antidepressant drug overdoses. The antidepressant study group. J Emerg Med 1997; 15: 439–445
   PubMedGoogle Scholar
• Robins MH. Survival following massive intoxication with Tofranil (imipramine hydrochloride). J Am Osteopath Assoc 1971; 70: 898–902
   PubMedGoogle Scholar
• Shannon M, Lovejoy FH, Jr. Pulmonary consequences of severe tricyclic antidepressant ingestion. J Toxicol Clin Toxicol 1987; 25: 443–461
   PubMed Web of Science ®Google Scholar
• Crome P, Dawling S, Braithwaite RA, Masters J, Walkey R. Effect of activated charcoal on absorption of nortriptyline. Lancet 1977; 2: 1203–1205
   PubMed Web of Science ®Google Scholar
• Bosse GM, Barefoot JA, Pfeifer MP, Rodgers GC. Comparison of three methods of gut decontamination in tricyclic antidepressant overdose. J Emerg Med 1995; 13: 203–209
   PubMedGoogle Scholar
• Hulten BA, Adams R, Askenasi R, Dallos V, Dawling S, Heath A, Volans G. Activated charcoal in tricyclic antidepressant poisoning. Hum Toxicol 1988; 7: 307–310
   PubMedGoogle Scholar
• Hedges J, Otten E, Schroeder T, Tasset J. Correlation of initial amitrpityline concentration reduction with activated-charcoal therapy in overdose patients. Am J Emerg Med 1987; 5: 48–51
   PubMed Web of Science ®Google Scholar
• Crome P, Adams R, Ali C, Dallos V, Dawling S. Activated charcoal in tricyclic antidepressant poisoning: pilot controlled clinical trial. Hum Toxicol 1983; 2: 205–209
   PubMedGoogle Scholar
• Braithwaite RA, Crome P, Dawking S. The in vitro and in vivo evaluation of activated charcoal as an adsorbent of tricyclic antidepressants. [proceedings]. Br J Clin Pharmacol 1978; 7: 368
   Google Scholar
• Dawling S, Crome P, Braithwaite R. Effect of delayed administration of activated charcoal on nortriptyline absorption. Eur J Clin Pharmacol 1978; 14: 445–447
   PubMed Web of Science ®Google Scholar
• Chyka PA, Seger D, Krenzelok EP, Vale JA. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. Position paper: Single-dose activated charcoal. Clin Toxicol (Phila) 2005; 43: 61–87
   PubMed Web of Science ®Google Scholar
• Alaspaa AO, Kuisma MJ, Hoppu K, Neuvonen PJ. Out-of-hospital administration of activated charcoal by emergency medical services. Ann Emerg Med 2005; 45: 207–212
   PubMed Web of Science ®Google Scholar
• Lamminpaa A, Vilska J, Hoppu K. Medical charcoal for a child's poisoning at home: availability and success of administration in Finland. Hum Exp Toxicol 1993; 12: 29–32
   PubMed Web of Science ®Google Scholar
• Wax PM, Cobaugh DJ. Prehospital gastrointestinal decontamination of toxic ingestions: a missed opportunity. Am J Emerg Med 1998; 16: 114–116
   PubMed Web of Science ®Google Scholar
• Godambe SA, Mack JW, Chung DS, Lindeman R, Lillehei CW, Colin AA. Iatrogenic pleuropulmonary charcoal instillation in a teenager. Pediatr Pulmonol 2003; 35: 490–493
   PubMed Web of Science ®Google Scholar
• Roy TM, Ossorio MA, Cipolla LM, Fields CL, Snider HL, Anderson WH. Pulmonary complications after tricyclic antidepressant overdose. Chest 1989; 96: 852–856
   PubMed Web of Science ®Google Scholar
• Ross JP, Small TR, Lepage PA. Imipramine overdose complicated by toxic megacolon. Am Surg 1998; 64: 242–244
   PubMed Web of Science ®Google Scholar
• Wallace DE. Bowel ischemia in two patients following tricyclic antidepressant (TCA) overdose [abstract]. Vet Hum Toxicol 1989; 31: 377
   Google Scholar
• Gomez HF, Brent JA, Munoz DCt, Mimmack RF, Ritvo J, Phillips S, McKinney P. Charcoal stercolith with intestinal perforation in a patient treated for amitriptyline ingestion. J Emerg Med 1994; 12: 57–60
   PubMedGoogle Scholar
• Ray MJ, Radin DR, Condie JD, Halls JM, Padin DR. Charcoal bezoar. Small-bowel obstruction secondary to amitriptyline overdose therapy. Dig Dis Sci 1988; 33: 106–107
   PubMed Web of Science ®Google Scholar
• Knudsen K, Abrahamsson J. Epinephrine and sodium bicarbonate independently and additively increase survival in experimental amitriptyline poisoning. Crit Care Med 1997; 25: 669–674
   PubMed Web of Science ®Google Scholar
• Albertson TE, Dawson A, de Latorre F, Hoffman RS, Hollander JE, Jaeger A, Kerns WR, 2nd, Martin TG, Ross MP. TOX-ACLS: Toxicologic-oriented advanced cardiac life support. Ann Emerg Med 2001; 37: S78–90
   PubMed Web of Science ®Google Scholar
• Brown TC. Sodium bicarbonate treatment for tricyclic antidepressant arrhythmias in children. Med J Aust 1976; 2: 380–382
   PubMed Web of Science ®Google Scholar
• Hoffman JR, Votey SR, Bayer M, Silver L. Effect of hypertonic sodium bicarbonate in the treatment of moderate-to-severe cyclic antidepressant overdose. Am J Emerg Med 1993; 11: 336–341
   PubMed Web of Science ®Google Scholar
• Bryan CK, Ludy JA, Hak SH, Roberts R, Marshall WR. Overdoses with tricyclic antidepressants--two case reports. Drug Intell Clin Pharm 1976; 10: 380–384
   Google Scholar
• Citak A, Soysal DD, Ucsel R, Karabocuoglu M, Uzel N. Efficacy of long duration resuscitation and magnesium sulphate treatment in amitriptyline poisoning. Eur J Emerg Med 2002; 9: 63–66
   PubMedGoogle Scholar
• Fouron J, Chicoine R. ECG changes in fatal imipramine (Tofranil) intoxication. Pediatrics 1971; 48: 777–781
   PubMed Web of Science ®Google Scholar
• Givens T, Holloway M, Wason S. Pulmonary aspiration of activated charcoal: a complication of its misuse in overdose management. Pediatr Emerg Care 1992; 8: 137–140
   PubMed Web of Science ®Google Scholar
• Glauser J. Tricyclic antidepressant poisoning. Cleve Clin J Med 2000; 67: 704–706, 709–713,717–709
   PubMed Web of Science ®Google Scholar
• Greenblatt DJ, Koch-Weser J, Shader RI. Multiple complications and death following protriptyline overdose. JAMA 1974; 229: 556–557
   PubMed Web of Science ®Google Scholar
• Guharoy SR. Adult respiratory distress syndrome associated with amitriptyline overdose. Vet Hum Toxicol 1994; 36: 316–317
   PubMedGoogle Scholar
• Hodes D. Sodium bicarbonate and hyperventilation in treating an infant with severe overdose of tricyclic antidepressant. Br Med J (Clin Res Ed) 1984; 288: 1800–1801
   PubMed Web of Science ®Google Scholar
• Kingston ME. Hyperventilation in tricyclic antidepressant poisoning. Crit Care Med 1979; 7: 550–551
   PubMed Web of Science ®Google Scholar
• Lin MH, Hung KL, Wang NK, Shen CT. Cardiotoxicity in imipramine intoxication: report of one case. Acta Paediatr Taiwan 2001; 42: 355–358
   PubMedGoogle Scholar
• Manoguerra AS. Tricyclic antidepressants. Crit Care Q 1982; 4: 43–51
   Google Scholar
• Mehta NJ, Alexandrou NA. Tricyclic antidepressant overdose and electrocardiographic changes. J Emerg Med 2000; 18: 463–464
   PubMed Web of Science ®Google Scholar
• Newton EH, Shih RD, Hoffman RS. Cyclic antidepressant overdose: a review of current management strategies. Am J Emerg Med 1994; 12: 376–379
   PubMed Web of Science ®Google Scholar
• Orr DA, Bramble MG. Tricyclic antidepressant poisoning and prolonged external cardiac massage during asystole. Br Med J (Clin Res Ed) 1981; 283: 1107–1108
   PubMed Web of Science ®Google Scholar
• Perel A, Cotev S. Imipramine (Tofranil) intoxication: a case report and review of management. Crit Care Med 1976; 4: 274–276
   PubMed Web of Science ®Google Scholar
• Ramsay ID. Survival after imipramine poisoning. Lancet 1967; 2: 1308–1309
   PubMed Web of Science ®Google Scholar
• Sandeman DJ, Alahakoon TI, Bentley SC. Tricyclic poisoning--successful management of ventricular fibrillation following massive overdose of imipramine. Anaesth Intensive Care 1997; 25: 542–545
   PubMed Web of Science ®Google Scholar
• Singh N, Singh HK, Khan IA. Serial electrocardiographic changes as a predictor of cardiovascular toxicity in acute tricyclic antidepressant overdose. Am J Ther 2002; 9: 75–79
   PubMedGoogle Scholar
• Treitman P. Desipramine poisoning. JAMA 1972; 220(861)864
   Google Scholar
• Hoegholm A, Clementsen P. Hypertonic sodium chloride in severe antidepressant overdosage. J Toxicol Clin Toxicol 1991; 29: 297–298
   PubMed Web of Science ®Google Scholar
• Lavoie FW, Gansert GG, Weiss RE. Value of initial ECG findings and plasma drug levels in cyclic antidepressant overdose. Ann Emerg Med 1990; 19: 696–700
   PubMed Web of Science ®Google Scholar
• Liebelt EL, Ulrich A, Francis PD, Woolf A. Serial electrocardiogram changes in acute tricyclic antidepressant overdoses. Crit Care Med 1997; 25: 1721–1726
   PubMed Web of Science ®Google Scholar
• Peters RW, Buser GA, Kim HJ, Gold MR. Tricyclic overdose causing sustained monomorphic ventricular tachycardia. Am J Cardiol 1992; 70: 1226–1228
   PubMed Web of Science ®Google Scholar
• Rinder HM, Murphy JW, Higgins GL. Impact of unusual gastrointestinal problems on the treatment of tricyclic antidepressant overdose. Ann Emerg Med 1988; 17: 1079–1081
   PubMed Web of Science ®Google Scholar
• Shannon MW. Duration of QRS disturbances after severe tricyclic antidepressant intoxication. J Toxicol Clin Toxicol 1992; 30: 377–386
   PubMed Web of Science ®Google Scholar
• Southall DP, Kilpatrick SM. Imipramine poisoning: survival of a child after prolonged cardiac massage. Br Med J 1974; 4: 508
   PubMed Web of Science ®Google Scholar
• Teba L, Schiebel F, Dedhia HV, Lazzell VA. Beneficial effect of norepinephrine in the treatment of circulatory shock caused by tricyclic antidepressant overdose. Am J Emerg Med 1988; 6: 566–568
   PubMed Web of Science ®Google Scholar
• Tran TP, Panacek EA, Rhee KJ, Foulke GE. Response to dopamine vs. norepinephrine in tricyclic antidepressant-induced hypotension. Acad Emerg Med 1997; 4: 864–868
   PubMed Web of Science ®Google Scholar
• Rubenstein JS, Burg FD. Tricyclic antidepressant poisoning. Drug Therapy 1989; 19: 126–128, 130
   Google Scholar
• Langou RA, Van Dyke C, Tahan SR, Cohen LS. Cardiovascular manifestations of tricyclic antidepressant overdose. Am Heart J 1980; 100: 458–464
   PubMed Web of Science ®Google Scholar
• McDuffee AT, Tobias JD. Seizure after flumazenil administration in a pediatric patient. Pediatr Emerg Care 1995; 11: 186–187
   PubMed Web of Science ®Google Scholar
• Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The American Heart Association in collaboration with the International Liaison Committee on Resuscitation. Circulation 2000; 102(suppl 8)1–370
   PubMed Web of Science ®Google Scholar
• Sunshine P, Yaffe SJ. Amitriptyline poisoning. Clinical and pathological findings in a fatal case. Am J Dis Child 1963; 106: 501–506
   PubMedGoogle Scholar
• Halle MA, Collipp PJ. Amitriptyline hydrochloride poisoning. Unsuccessful treatment by peritoneal dialysis. N Y State J Med 1969; 69: 1434–1436
   PubMedGoogle Scholar
• Rollin P, Antaki AJ. Poisoning due to tricyclic antidepressants in children and adolescents. Can Med Assoc J 1979; 120: 951–956
   PubMed Web of Science ®Google Scholar
• Fendrick GM. Amitriptyline poisoning. N Engl J Med 1962; 267: 1031–1032
   PubMed Web of Science ®Google Scholar
• Brown TC, Barker GA, Dunlop ME, Loughnan PM. The use of sodium bicarbonate in the treatment of tricyclic antidepressant-induced arrhythmias. Anaesth Intensive Care 1973; 1: 203–210
   PubMedGoogle Scholar
• Chambers T, Kindley AD. Amitriptyline poisoning in childhood. Br Med J 1974; 3: 687
   PubMed Web of Science ®Google Scholar
• Noack CH. A death from overdosage of “Tofranil.”. Med J Aust 1960; 47(2)182
   PubMedGoogle Scholar
• Wright SP. Usefulness of physostigmine in imipramine poisoning. A dramatic response in a child resistant to other therapy. Clin Pediatr (Phila) 1976; 15: 1123–1128
   PubMed Web of Science ®Google Scholar
• Young GC, Morgan RT. Rapidity of response to the treatment of enuresis. Dev Med Child Neurol 1973; 15: 488–496
   PubMed Web of Science ®Google Scholar
• Arneson GA. A near fatal case of imipramine overdosage. Am J Psychiatry 1961; 117: 934–936
   PubMed Web of Science ®Google Scholar
• Ryan R, 3rd, Wians FH, Jr., Stigelman WH, Jr., Clark H, McCurdy F. Imipramine poisoning in a child: lack of efficacy of resin hemoperfusion. Pediatr Emerg Care 1985; 1: 201–204
   PubMedGoogle Scholar
• Sueblinvong V, Wilson JF. Myocardial damage due to imipramine intoxication. J Pediatr 1969; 74: 475–478
   PubMed Web of Science ®Google Scholar
• Jacobzinger H, Raybin HW. Imipramine hydrochloride intoxication. N Y State J Med 1963; 63: 1394–1398
   PubMedGoogle Scholar
• Fatteh A, Blanke R, Mann GT. Death from imipramine poisoning. J Forensic Sci 1968; 13: 124–128
   PubMedGoogle Scholar
• Parkin JM, Fraser MS. Poisoning as a complication of enuresis. Dev Med Child Neurol 1972; 14: 727–730
   PubMed Web of Science ®Google Scholar
• Dingell JV, Sulser F, Gillette JR. Species differences in the metabolism of Imipramine and desmethylimipramine (DMI). J Pharmacol Exp Ther 1964; 143: 14–22
   PubMed Web of Science ®Google Scholar
• Thiemann HH, Otto L, Fritz H. Tödliche vergiftung durch imipramin. Dtsch Gesundheitsw 1967; 22: 1719–1722
   PubMedGoogle Scholar
• Prout BJ, Young J, Goddard P. Imipramine poisoning in childhood and suggested treatment. Br Med J 1965; 5440: 972
   Web of Science ®Google Scholar
• Penny R. Imipramine hydrochloride poisoning in childhood. Am J Dis Child 1968; 116: 181–186
   PubMedGoogle Scholar
• Garrison HF, Jr., Moffitt EM. Imipramine hydrochloride intoxication. JAMA 1962; 179: 456–458
   PubMed Web of Science ®Google Scholar
• Brown KG, McMichen HU, Briggs DS. Tachyarrhythmia in severe imipramine overdose controlled by practolol. Arch Dis Child 1972; 47: 104–106
   PubMed Web of Science ®Google Scholar
• Sacks MH, Bonforte RJ, Laser RP, Dimich I. Cardiovascular complications of imipramine intoxication. JAMA 1968; 205: 588–590
   PubMed Web of Science ®Google Scholar
• Côté M, Elias G. Le propranolol dans les arythmes cardiaques par intoxication à l'imipramine (Tofranil) chez l'enfant. Union Med Can 1974; 103: 1223–1225
   PubMedGoogle Scholar
• Burks JS, Walker JE, Rumack BH, Ott JE. Tricyclic antidepressant poisoning. Reversal of coma, choreoathetosis, and myoclonus by physostigmine. JAMA 1974; 230: 1405–1407
   PubMed Web of Science ®Google Scholar
• Sesso AM, Snyder RC, Schott CE. Propranolol in imipramine poisoning. Am J Dis Child 1973; 126: 847–849
   PubMedGoogle Scholar
• Alajem N, Albagli C. Severe imipramine poisoning in an infant. Am J Dis Child 1962; 103: 702–705
   PubMedGoogle Scholar
• Braun L, Brodehl J, Fichsel H, Kallfelz C. Uber mipraminintoxikation im kindesalter. Med Klin 1965; 60: 1737–1742
   PubMedGoogle Scholar
• Connelly JF, Venables AW. A case of poisoning with “Tofranil”. Med J Aust 1961; 1: 109
   Web of Science ®Google Scholar
• Oliver JS, Smith H. A case of fatal imipramine poisoning in an infant. Med Sci Law 1977; 17: 193–194
   PubMed Web of Science ®Google Scholar
• Bickel MH, Brochon R, Friolet B, Herrmann B, Stofer AR. Clinical and biochemical results of a fatal case of desipramine intoxication. Psychopharmacologia 1967; 10: 431–436
   PubMed Web of Science ®Google Scholar
• Yang KL, Dantzker DR. Reversible brain death. A manifestation of amitriptyline overdose. Chest 1991; 99: 1037–1038
   PubMed Web of Science ®Google Scholar
• Lindstrom FD, Flodmark O, Gustafsson B. Respiratory distress syndrome and thrombotic, non-bacterial endocarditis after amitriptyline overdose. Acta Med Scand 1977; 202: 203–212
   PubMed Web of Science ®Google Scholar
• Bessen HA, Niemann JT. Improvement of cardiac conduction after hyperventilation in tricyclic antidepressant overdose. J Toxicol Clin Toxicol 1985; 23: 537–546
   PubMed Web of Science ®Google Scholar
• Manoguerra AS, Steiner RW. Prolonged neuromuscular blockade after administration of physostigmine and succinylcholine. Clin Toxicol 1981; 18: 803–805
   PubMed Web of Science ®Google Scholar
• Gard H, Knapp D, Hanenson I, Walle T, Gaffney T. Studies on the disposition of amitriptyline and other tricyclic antidepressant drugs in man as it relates to the management of the overdosed patient. Adv Biochem Psychopharmacol 1973; 7: 95–105
   PubMedGoogle Scholar
• Bolognesi R, Tsialtas D, Vasini P, Conti M, Manca C. Abnormal ventricular repolarization mimicking myocardial infarction after heterocyclic antidepressant overdose. Am J Cardiol 1997; 79: 242–245
   PubMed Web of Science ®Google Scholar
• Flomenbaum N, Price D. Recognition and management of antidepressant overdoses: tricyclics and trazodone. Neuropsychobiology 1986; 15: 46–51
   PubMed Web of Science ®Google Scholar
• Czech K, Francesconi M, Haimböck E, Hruby K. Die akute vergiftung durch trizyklische antidepressiva und ihre therapie mit physostigminsalizylat. Wien Klin Wochenschr 1977; 89: 265–269
   PubMed Web of Science ®Google Scholar
• Borden EC, Rostand SG. Recovery from massive amitriptyline overdosage. Lancet 1968; 1: 1256
   PubMed Web of Science ®Google Scholar
• Oreopoulos DG, Lal S. Recovery from massive amitriptyline overdosage. Lancet 1968; 2: 221
   PubMed Web of Science ®Google Scholar
• LeWitt PA, Forno LS. Peripheral neuropathy following amitriptyline overdose. Muscle Nerve 1985; 8: 723–724
   PubMed Web of Science ®Google Scholar
• Forbes G, Pollock Weir W, Smith H, Bogan J. Amitriptyline poisoning. J Forensic Sci Soc 1965; 5: 183–187
   PubMedGoogle Scholar
• Hong WK, Mauer P, Hochman R, Caslowitz JG, Paraskos JA. Amitriptyline cardiotoxicity. Chest 1974; 66: 304–306
   PubMed Web of Science ®Google Scholar
• Ward FG, Tin-Myint B. Amitriptyline poisoning. Lancet 1965; 2: 910
   PubMed Web of Science ®Google Scholar
• Dequin PF, Lanotte R, Furet Y, Legras A, Perrotin D. Association bicarbonate molaire et adrénaline au cours d'une intoxication tricyclique grave chez une femme gastrectomisée. Presse Med 1994; 23: 540–541
   PubMed Web of Science ®Google Scholar
• Stark JE, Bethune DW. Amitriptyline poisoning. Lancet 1965; 2: 390
   PubMed Web of Science ®Google Scholar
• Sunshine I, Baeumler J. A fatal case of poisoning with amitriptyline. Nature 1963; 199: 1103–1104
   PubMed Web of Science ®Google Scholar
• Prenzel E, Krohs G. Intoxikationen mit trizyklischen antidepressiva und phenothiazinen sowie deren therapie mit physostigmin. Anaesthesiol Reanim 1986; 11: 227–234
   PubMedGoogle Scholar
• Walsh DM. Cyclic antidepressant overdose in children: a proposed treatment protocol. Pediatr Emerg Care 1986; 2: 28–35
   PubMedGoogle Scholar
• Lloyd TW, Hart DR. Amitriptyline poisoning. Lancet 1965; 2: 544
   PubMed Web of Science ®Google Scholar
• Jeong YG, Caccamo LP. Amitriptyline poisoning causing left bundle branch block. Ohio State Med J 1976; 72: 217–219
   PubMedGoogle Scholar
• Mehrotra TN. Amitriptyline poisoning. Lancet 1965; 2: 544–545
   PubMed Web of Science ®Google Scholar
• Davies DM, Allaye R. Amitriptyline poisoning. Lancet 1963; 2: 543
   PubMed Web of Science ®Google Scholar
• Leys D, Pasquier F, Lamblin MD, Dubois F, Petit H. Acute polyradiculoneuropathy after amitriptyline overdose. Br Med J (Clin Res Ed) 1987; 294: 608
   PubMed Web of Science ®Google Scholar
• Ordiway MV. Treating tricyclic overdose with physostigmine. Am J Psychiatry 1978; 135: 1114
   PubMed Web of Science ®Google Scholar
• Hurst HE, Jarboe CH. Clinical findings, elimination pharmacokinetics, and tissue drug concentrations following a fatal amitriptyline intoxication. Clin Toxicol 1981; 18: 119–125
   PubMed Web of Science ®Google Scholar
• Babb SV, Dunlop SR. Case report of sudden and unexpected death after tricyclic overdose. Am J Psychiatry 1985; 142: 275–276
   PubMed Web of Science ®Google Scholar
• Roberge RJ, Krenzelok EP. Prolonged coma and loss of brainstem reflexes following amitriptyline overdose. Vet Hum Toxicol 2001; 43: 42–44
   PubMedGoogle Scholar
• Knudsen K, Abrahamsson J. Magnesium sulphate in the treatment of ventricular fibrillation in amitriptyline poisoning. Eur Heart J 1997; 18: 881–882
   PubMed Web of Science ®Google Scholar
• Nicholls HK. Amitriptyline overdose and the ECG: report of a case. NZ Med J 1965; 64: 651–652
   PubMedGoogle Scholar
• Holinger PC, Klawans HL. Reversal of tricyclic-overdosage-induced central anticholinergic syndrome by physostigmine. Am J Psychiatry 1976; 133: 1018–1023
   PubMed Web of Science ®Google Scholar
• Bain DJ, Turner T. Imipramine poisoning. Arch Dis Child 1971; 46: 887
   PubMed Web of Science ®Google Scholar
• Bailey RR, Sharman JR, O'Rourke J, Buttimore AL. Haemodialysis and forced diuresis for tricyclic antidepressant poisoning. Br Med J 1974; 4: 230–231
   PubMed Web of Science ®Google Scholar
• Johnson DA, Knepp IG, Whelan TV. Toxic tricyclic antidepressant levels and the ECG. JAMA 1983; 250: 1027
   PubMed Web of Science ®Google Scholar
• Harthorne JW, Marcus AM, Kaye M. Management of massive imipramine overdosage with mannitol and artificial dialysis. N Engl J Med 1963; 268: 33–36
   PubMed Web of Science ®Google Scholar
• Rasmussen J. Amitriptyline and imipramine poisoning [letter]. Lancet 1965; 2: 850–851
   PubMed Web of Science ®Google Scholar
• Rushnak MJ, McGovern DP. Reversal of imipramine cardiotoxicity with physostigmine. J Med Soc N J 1977; 74: 155–157
   PubMedGoogle Scholar
• Reed K, McKim HR. ECG changes in pure impramine overdose as function of plasma level. Can Psychiatr Assoc J 1978; 23: 573–577
   PubMedGoogle Scholar
• Freimuth HC. Poisoning by new drugs – report of a fatality due to suicidal ingestion of tofranil. J Forensic Sci 1961; 6: 68–75
   Google Scholar
• Lancaster NP, Foster AR. Suicidal attempt by imipramine overdosage. Br Med J 1959; 5164: 1458
   Web of Science ®Google Scholar
• Dubuc M, Friborg J, Houde M, Laplante L. Traitement de l'intoxication médicamenteuse aux agents antidépresseurs tricycliques: pour ou contre l'utilisation de la physostigmine. Union Med Can 1981; 110: 555–557
   PubMedGoogle Scholar
• Dolara P, Franconi F. Hypertonic sodium chloride and lidocaine in a case of imipramine intoxication. Clin Toxicol 1977; 10: 395–398
   PubMed Web of Science ®Google Scholar
• Herson VC, Schmitt BD, Rumack BH. Magical thinking and imipramine poisoning in two school-age children. JAMA 1979; 241: 1926–1927
   PubMed Web of Science ®Google Scholar
• Denton S. “Tofranil” (imipramine) in toxicological analysis. Analyst 1962; 87: 234–236
   Web of Science ®Google Scholar
• Edwards J. Fatal imipramine overdosage. Med J Aust 1966; 1: 839–840
   PubMedGoogle Scholar
• Louis C, Olbing H, Bohlmann HG, Philippou A, Heimsoth V. Zur behandlung der imipramin-vergiftung beim kind. Dtsch Med Wochenschr 1970; 95: 2078–2082
   PubMed Web of Science ®Google Scholar
• Lee FI. Imipramine overdosage--report of a fatal case. Br Med J 1961; 5222: 338–339
   Web of Science ®Google Scholar
• Hoffman JR, McElroy CR. Bicarbonate therapy for dysrhythmia and hypotension in tricyclic antidepressant overdose. West J Med 1981; 134: 60–64
   PubMedGoogle Scholar
• Pearson JD, Jones ES, Gabbe DM. Cardiac arrest and arrhythmias due to self-poisoning with imipramine. Anaesthesia 1969; 24: 69–71
   PubMed Web of Science ®Google Scholar
• Bismuth C, Pontal PG, Baud F, Galliot M, Elkhouly M. Prolonged high plasma imipramine levels after acute intoxication. Vet Hum Toxicol 1982; 24: 69–70
   Google Scholar
• Kirchmair H, Goldberg K. Suicidver such mit Tofranil in kombination mit schlafmitteln. Med Libre 1960; 55: 1474–1475
   Google Scholar
• Bindler RM, Howry LB. Prentice Hall Pediatric Drug Guide. Pearson/Prentice Hall, Upper Saddle River, NJ 2005
   Google Scholar
• Physicians' Desk Reference: PDR60th. Thomson Healthcare, Montvale, NJ 2006
   Google Scholar
• Takemoto CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook12th. Lexi-Comp, Hudson, OH 2005
   Google Scholar