Amitriptyline and perphenazine overdose

Poisonous Ingredient

Amitriptyline and perphenazine

Where Found

• Etrafon
• PMS-Levazine
• Triavil
• Triptazine

Note: This list may not be all-inclusive.

Symptoms

• Airways and lungs
  • Breathing - slowed and labored
• Bladder and kidneys
  • Urinary hesitancy
  • Inability to completely empty the bladder
• Eyes, ears, nose, throat, and mouth
  • Blurred vision
  • Dry mouth
  • Enlarged pupils
  • Nasal congestion
  • Unpleasant taste
• Heart and blood
  • Irregular heartbeat
  • Heartbeat - rapid
  • Low blood pressure (severe)
  • Shock
• Muscles and joints
  • Muscle rigidity
  • Muscle spasms
  • Stiff muscles in neck, face, or back
• Nervous system
  • Agitation
  • Coma
  • Convulsions
  • Disorientation
  • Drowsiness
  • Fever
  • Hypothermia (body temperature is lower than normal)
  • Restlessness
  • Seizures
  • Stupor (lack of alertness)
  • Uncoordinated movement
  • Tremor
  • Weakness
• Reproductive system
  • Change in menstrual patterns
• Skin
  • Itchy skin
  • Rash
• Stomach and intestines
  • Constipation
  • Loss of appetite
  • Nausea
  • Vomiting

Before Calling Emergency

Determine the following information:

• Patient's age, weight, and condition
• Name of the product (ingredients and strengths, if known)
• Time it was swallowed
• Amount swallowed
• If the medication was prescribed for the patient

Poison Control

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

See: Poison control center - emergency number

What to Expect at the Emergency Room

The health care provider will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate.

The patient may receive:

• Activated charcoal
• Medicine (sodium bicarbonate) to reverse the effects of the overdose
• Breathing support, including a breathing tube
• Fluids through a vein (by IV)
• Laxative
• Tube from the mouth into the stomach to empty the stomach (gastric lavage)

Outlook (Prognosis)

This can be an extremely serious overdose. Death is possible. How well a patient does depends on how much of the drug was swallowed and how quickly medical treatment was received. The faster a patient receives medical help, the better the chance for recovery.

Survival past 2 weeks is usually a good sign.

Alternative Names

Etrafon overdose; Triavil overdose; Triptazine overdose

References

Brush DE, Aaron CK. Tricyclic and other cyclic antidepressants. In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 27.

Update Date: 1/20/2010

Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.