Amitriptyline Using Tricylics for a Peaceful Death
The TCAs have several characteristics that make them useful as reliable and lethal drugs. In particular, they exhibit cardio- toxic and central nervous system (CNS) effects. While CNS symptoms include sedation and coma, it is the cardiotoxic effects (a reduction of cardiac output, the lowering of blood pressure and a disruption to cardiac rhythm) that bring about death from ischemic hypoxia.
The toxic effects of a TCA are accentuated if the drug is rapidly absorbed from the gut. 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) 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 8 - 10 gm.
The antidepressant amitriptyline marketed as 50mg Endep
Note: While Amitriptyline is an effective single-agent end of life drug, its reliability is greatly enhanced when used in com- bination with other drugs - see the Chapter titled ‘The Lethal Drug Mixtures’.