Amitriptyline and perphenazine overdose

Alternative Names

Etrafon overdose; Triavil overdose; Triptazine overdose

Definition

Amitriptyline and perphenazine is a combination drug that is sometimes prescribed for patients with depression, agitation, or anxiety.

Amitriptyline and perphenazine overdose occurs when someone accidentally or intentionally takes more than the normal or recommended amount of this medication.

This is for information only and not for use in the treatment or management of an actual poison exposure. If you have an exposure, you should call your local emergency number (such as 911) or the National Poison Control Center at 1-800-222-1222.

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
Low blood pressure (severe)
Rapid heartbeat
Shock

Muscles and joints:

Nervous system:

Agitation
Coma (decreased level of consciousness and lack of responsiveness)
Convulsions
Disorientation
Drowsiness
Fever
Lack of alertness (stupor)
Lower than normal body temperature (hypothermia)
Restlessness
Seizures
Uncoordinated movement
Tremor
Weakness

Reproductive system:

Change in menstrual patterns

Skin:

Itchy skin
Rash

Stomach and intestines:

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 What to Expect at the Emergency Room

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

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
Breathing support, including a tube through the mouth and breathing machine (ventilator)
Chest x-ray
EKG (heart tracing)
Fluids through a vein (by IV)
Laxative
Medicine called an antidote (sodium bicarbonate) to reverse the effects of the medication
Tube through the mouth into the stomach to empty the stomach (gastric lavage)

Outlook (Prognosis)

Amitriptyline and perphenazine can be an extremely serious overdose.

Patients who swallow an excessive amount of this drug are almost always admitted to the hospital.

How well a patient does depends on how much of the drug was swallowed and how quickly treatment was received. The faster a patient gets medical help, the better the chance of recovery. Complications such as pneumonia, muscle damage from lying on a hard surface for a long period of time, or brain damage from lack of oxygen may result in permanent disability. Death can occur.

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.

Velez LI, Feng S-Y. Anticholinergics. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 150.