• Introduction • Using Tricyclics for a Peaceful Death • Preparation of Amitriptyline • Availability • The RPA Test for Amitriptyline
Introduction
Amitriptyline is the most useful in a class of drugs known as ‘tricyclic anti-depressants’ (TCAs). These drugs can be lethal if taken in a certain way.
The TCAs date back to the early 1960s when they established themselves as useful anti-depressants. However, their narrow therapeutic margin (the dose needed for therapy as an anti-de- pressant and that which is toxic) is close, meant that there were dangers in prescribing these drugs, especially to depressed peo- ple, in terms of either accidental or intentional overdose.
The implication of the TCAs in a large number of deaths from overdose meant that other classes of safer anti-depressants (such as the seratonin re-uptake inhibitors - SSRIs like fluoxetine aka Prozac) found favour and largely displaced the TCAs.
Since this time the TCAs have undergone something of a resur- gence for the treatment of intractable neuropathic pain (such as trigeminal neuralgia) and migraine.
