Toxicokinetics of nortriptyline and amitriptyline: Two case reports

E. J.F. Franssen*, P. W.A. Kunst, P. M. Bet, R. J.M. Strack van Schijndel, A. C. Van Loenen, A. J. Wilhelm

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Two cases are presented of intentional intoxications with the tricyclic antidepressants (TCAs) nortriptyline (NT) and amitriptyline (AT). The peak plasma concentrations were 2290 μg/L and 2900 μg/L, respectively. The active metabolites E-10-hydroxynortriptyline (EHNT) and Z-10-hydroxynortriptyline (ZHNT) profiles were quite different as monitored for 5 to 10 days after presumed drug intake. In conclusion, these cases illustrate that (1) metabolite formation and elimination after intake of an overdose dose of NT and AT are stereoselective, and (2) NT and EHNT toxicokinetics and toxicodynamics are quite different. It also shows that a patient with a severe TCA overdose can still survive if he or she receives appropriate and quick supportive care, even if the prognostic markers QRS time, coma grade, and serum TCA levels predict poor outcome.

Original languageEnglish
Pages (from-to)248-251
Number of pages4
JournalTherapeutic Drug Monitoring
Issue number2
Publication statusPublished - Apr 2003

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