Selected tricyclic antidepressant ingestions involving children 6 years old or less

Acad Emerg Med. 2001 Feb;8(2):139-44. doi: 10.1111/j.1553-2712.2001.tb01278.x.


Objective: According to the annual report of the American Association of Poison Control Centers, tricyclic antidepressant (TCA) ingestions accounted for 15,708 exposures in 1998, of which 70% (all age groups) were treated at health care facilities (HCFs), with an estimated 2,022 children less than 6 years of age exposed. The study objective was to evaluate the manifestations, referral patterns, HCF management, and medical outcomes in pediatric patients 6 years old or less with TCA ingestions reported to a regional poison control center.

Methods: All TCA (amitriptyline, clomipramine, desipramine, doxepin, imipramine, nortriptyline) ingestions from January 1, 1993, to December 31, 1997, involving patients aged 6 years or less managed by the poison control center were evaluated for dose, symptoms, treatments, disposition, and outcome.

Results: Forty-four of 48 patients (92%) were asymptomatic. All were single-drug exposures. Forty-three patients (90%) ingested a TCA dose that was less than the normally prescribed pediatric dose (5 mg/kg). Of the five children ingesting >5 mg/kg (range 5-9.4 mg/kg), only one (5.3 mg/kg) was mildly symptomatic (drowsy) prior to admission. Thirty-one of the 48 (65%) were sent to the emergency department (dose range 0.59-9.4 mg/kg). Fourteen of the 31 were admitted for 12-24-hour observation and none subsequently developed symptoms. Twenty-three (74%) received activated charcoal (AC). There was no difference in outcome between the children who did and did not receive AC.

Conclusions: No case of significant toxicity occurred in the children who experienced unintentional TCA ingestions in this study population. None of the children in the study had toxicity at doses <5 mg/kg. Further study is necessary to develop clinical guidelines for the appropriate referral of unintentional ingestions of TCA involving children.

MeSH terms

  • Administration, Oral
  • Antidepressive Agents, Tricyclic / poisoning*
  • Charcoal / therapeutic use*
  • Child
  • Child, Preschool
  • Dose-Response Relationship, Drug
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Humans
  • Infant
  • Male
  • Medical Records Systems, Computerized
  • Poison Control Centers / statistics & numerical data
  • Retrospective Studies
  • Treatment Outcome


  • Antidepressive Agents, Tricyclic
  • Charcoal