The treatment of tricyclic antidepressant overdose with repeated charcoal

J Clin Psychopharmacol. 1984 Dec;4(6):336-40.


Activated charcoal given repeatedly through a nasogastric tube to three patients in coma from amitriptyline overdose greatly accelerated tricyclic elimination: the apparent half-life fell below 10 hours for each patient to as low as 4 hours. This contrasts with extended half-lives for amitriptyline elimination averaging 36.8 hours and regularly over 60 hours previously reported for overdoses treated without repeated charcoal. The enterohepatic recirculation of amitriptyline and nortriptyline appears to be a major influence on keeping their blood levels up. In one case, intravenous diazepam inhibited tricyclic elimination.

MeSH terms

  • Adolescent
  • Adult
  • Amitriptyline / blood
  • Amitriptyline / poisoning
  • Antidepressive Agents, Tricyclic / blood
  • Antidepressive Agents, Tricyclic / poisoning*
  • Charcoal / therapeutic use*
  • Enterohepatic Circulation
  • Female
  • Half-Life
  • Humans
  • Imipramine / blood
  • Imipramine / poisoning
  • Intubation, Gastrointestinal
  • Kinetics


  • Antidepressive Agents, Tricyclic
  • Charcoal
  • Amitriptyline
  • Imipramine