Amitriptyline Overdose: Symptoms And Treatment

Last Updated: February 7, 2020

Authored by Sharon Levy, MD, MPH

When taken as prescribed, there is little risk of someone experiencing an overdose from Elavil. However, amitriptyline overdose can occur if someone takes too large of a dose or mixes it with other substances. Here is what users need to know about Elavil overdose.

Can One Overdose On Amitriptyline?

Amitriptyline (Elavil) is a prescription medication, and as with any medicine, there is concern about potentially overdosing on it. The question is if an overdose is possible on this specific drug. The answer is yes.

Generally speaking, prescribed doses are low enough that accidentally taking to much medicine is unlikely. For example, the amitriptyline dosage for nerve pain is low enough that even accidentally doubling a dose is unlikely to cause toxicity. The risk of Elavil overdose greatly increases when the medication is taken incorrectly. For example, snorting amitriptyline is incredibly dangerous.

women with Elavil overdose symptoms

Amitriptyline Overdose Symptoms

Even if someone is not abusing Elavil, they should be aware of the amitriptyline overdose symptoms. Being able to spot these in themselves and others is critical to avoiding the worst possible circumstances. Keep in mind that in some cases, these symptoms can mimic amitriptyline adverse effects but are much more dangerous.

Signs someone is experiencing an overdose of amitriptyline include:

  • Irregular heartbeat
  • Slow pulse
  • Extreme drowsiness
  • Feelings of confusion and agitation
  • Vomiting
  • Hallucinations, both visual and audio
  • Sensations of being very hot or very cold
  • Muscle stiffness
  • Seizures
  • Fainting
  • Coma

Amitriptyline Suicide

Elavil was designed to treat depression, so it is shocking for many to learn that the medication is actually linked to suicide via intentional overdose of amitriptyline.

It is unknown why the medication seems to be more likely than others to give users suicidal thoughts and tendencies, but the reason it results in more overdoses and deaths is that it has one of the highest toxicity levels of any antidepressant. In other words, it is easier to get too much Elavil, no matter the motivation.

Because of the risks associated with it, there are numerous amitriptyline warnings. This includes an FDA black box warning.

lethal overdose on Elavil

How Much Amitriptyline Is Fatal

There is no one specific dosage that is fatal to all people. For example, a small child could experience an amitriptyline overdose with a single pill, and an adult with poor organ function could get sick on half of what a healthy person would need to die from amitriptyline alone.

The problem with thinking about the fatal amount in this manner is that people are rarely overdosing on a single substance. Most people are taking multiple medications or using other substances, and this can lower the threshold for a lethal case, not even considering how this threshold is naturally much lower in certain populations. As a result, the LD50 should never be used to judge how much someone can take while avoiding a lethal overdose of amitriptyline.

how to treat Elavil overdose

Amitriptyline Overdose Treatment

The moment an overdose of amitriptyline is suspected, help must be sought. If taking too much medication is suspected right after the medication is taken, it is possible that calling Poison Control could be the first step taken. However, if the symptoms are progressing, the time for calling the hotline will have passed.

Once in the emergency room, the doctors and nurses will administer amitriptyline overdose treatment. This can include a wide variety of methods, such as:

Treating the short term side effects of too high dose, however, is only the first step that must be taken. Once the patient is stable, there will be amitriptyline withdrawal side effects to contend with, which might require additional treatment. There are also the long term effects of amitriptyline, such as damage to the organs, including the brain. Even once the danger seems to be over, there is a long road to recovery.

Getting Help With Amitriptyline Misuse

The best-case scenario for someone misusing Elavil is to stop before it is too late. Drug rehabilitation facilities offer the right treatments for stopping use and staying safe. Here, the patient can get suitable treatment fo their problems with a particular drug abuse/misuse. It is possible to live a clean and sober life.

Page Sources

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  3. Odigwe CC, Tariq M, Kotecha T, et al. Tricyclic antidepressant overdose treated with adjunctive lipid rescue and plasmapheresis. Proceedings (Baylor University. Medical Center). 2016; 29(3): 284–287. doi:10.1080/08998280.2016.11929437.
  4. Mirrakhimov AE, Ayach T, Barbaryan A, Talari G, Chadha R, Gray A. The Role of Sodium Bicarbonate in the Management of Some Toxic Ingestions. International Journal of Nephrology and Renovascular Disease. 2017; 2017: 7831358. doi:10.1155/2017/7831358.
  5. Johnson PB. Physostigmine in tricyclic antidepressant overdose. JACEP. 1976; 5(6): 443–445. doi:10.1016/s0361-1124(76)80255-9.
  6. Amitriptyline hydrochloride overdose. MedlinePlus.
  7. Güloğlu C, Orak M, Üstündağ M, et al. Analysis of amitriptyline overdose in emergency medicine. Emergency Medicine Journal 2011; 28: 296-299.

Published on: February 7th, 2020

Updated on: February 7th, 2020

About Author

Sharon Levy, MD, MPH

After successful graduation from Boston University, MA, Sharon gained a Master’s degree in Public Health. Since then, Sharon devoted herself entirely to the medical niche. Sharon Levy is also a certified addiction recovery coach.


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