The toxic effects are accentuated if the drug is rapidly absorbed from the gut and this occurs in the alkaline environment of the small intestine. Preparation as a drink facilitates this, as does the use of an anti-emetic like metoclopramide (Maxolon - see Ch 8) which speeds gastric emptying.
Amitriptyline is one of the most sedating of the TCAs and par- ticularly useful as a lethal drug. The drug is marketed as Endep or Elavil tablets. The amount required is 5gm.
Fig 10.6 The tricyclic antidepressant amitriptyline Preparation of Amitriptyline
The drug is usually packaged as tablets in 10, 25, 50 or 100mg amounts (Fig 10.6). Usually supplied in packets of 50 tablets. Two packets of 50mg tablets is (100 x 50mg) or 5gm of the drug.
Open the blister packs and place 100 of the 50mg tablets in a glass of split 100 capsules emptying the powder into the glass. Add enough water to cover the drug and with gently agitation allow the drug to dissolve.