55 are mainstays of treatment for severe overdoses where there is a decline in gcs in addition to sodium bicarbonate discussed below ventricular arrhythmias caused by amitriptyline toxicity are unlikely to respond to cardioversion or defibrillation.

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Us caution whn using amitiptylin and mthadon concomitantly du ta potntial additiv cts on th QT intval and incasd isk sious cadiovascula cts.

Concomitant tatmnt with MAOIs (monoamin oxidas inhibitos) is conta-indicatd (s sction 4.5).

Clos supvision patints and in paticula thos at high isk should accompany dug thapy spcially in aly tatmnt and ollowing dos changs. Patints (and cagivs patints) should b altd about th nd tmonitany clinical wosning, suicidal bhaviou thoughts and unusual changs in bhaviou and tsk mdical advic immdiatly i ths symptoms psnt.

O cous, dpssion can occu with chonic pain, but it is usually an undstandabl action tth pain and impovs as th chonic pain impovs. Howv, i sv, it tomay qui tatmnt with an antidpssant dug.

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7 conceivably, this patient may have been genetically deficient in this enzyme, which could have resulted in her slow clearance of amitriptyline.