Emerg Med J 20:64 doi:10.1136/emj.20.1.64
  • Best evidence topic reports

Gastric lavage in tricyclic antidepressant overdose

  1. Stewart Teece, Clinical Research Fellow,
  2. Kristen Hogg, Clinical Research Fellow,
  3. K Mackway-Jones
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}


      A short cut review was carried out to establish whether gastric lavage is indicated after tricyclic antidepressant overdose. Altogether 82 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

      Report by Stewart Teece, Clinical Research Fellow
 Checked by Kirsten Hogg, Clinical Research Fellow

      Clinical scenario

      A 23 year old air hostess is brought into the emergency department having been found collapsed next to an empty bottle of amitriptyline. She has a Glasgow Coma Scale score of 7/15, is tachycardic and twitchy. After a rapid sequence induction and intubation you wonder whether there is any benefit from gastric lavage.

      Three part question

      [In overdose of tricyclic antidepressant] is [gastric lavage better than charcoal or nothing] at [reducing toxicity]?

      Search strategy

      Medline 1966–10/02 using the Ovid interface. [(exp gastric lavage OR gastric OR OR exp irrigation or OR gastric AND (exp disipramine OR exp antidepressive agents, tricyclic OR exp antidepressive agents OR exp amitriptyline OR exp imipramine OR tricyc$.mp OR AND (exp poisoning OR OR exp overdose OR] LIMIT to human AND English Language.

      Search outcome

      Altogether 82 papers found, 81 of which were not relevant to the question. The remaining paper is shown in table 4.

      Table 4


      This study shows no statistically significant difference between the three groups. Although it seems small it has 80% power for showing a change of ITU admission time of 12 hours at p=0.05. Furthermore, a study by Watson et al showed that only 8.7% (95% C.I. 0.4 to 21.7%) of the estimated dose of tricyclic was recovered by gastric lavage.


      There is no evidence for gastric lavage in tricyclic antidepressant overdose.

      Report by Stewart Teece, Clinical Research Fellow
 Checked by Kirsten Hogg, Clinical Research Fellow


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