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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 Chapter 9) 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.
Preparation of Amitriptyline
The drug is usually packaged as tablets in 10, 25, 50 or 100mg amounts (Fig 12.1) and is usually supplied in packets of 50 tablets. Two packets of 50mg tablets is (100 x 50mg) or 5gm of the drug.
Fig 12.2 Amitriptyline with metocloptamide, oxazepam and Gin