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TCA toxicity but feeling much better. Do I stay?

Posted by hyperfocus on October 16, 2011, at 14:21:29

I had a very scary episode this morning - probably the first time I thought seriously about my own mortality and how it might come to an end right now. About 2 hrs after I got up the symptoms kicked in: I felt jumpy but confused; I felt extreme agitation but every time I got up I had to lie down again; My skin was hot and my heart felt like it was racing; my ears were buzzing and I kept seeing the color green on the white kitchen tiles; I had a strange cough and felt like I was choking. The most frightening thing was the inability to eat or swallow. I tried eating some bread but I could barely get anything down. it was like my throat and mouth stopped working.

I thought for sure it was extremely low blood pressure since I'd had something like this happen once before. But my brother who has some paramedic training said my blood pressure was actually high and I didn't have any signs of shock - my pupils weren't dilated and my skin wasn't cold. That's when I remembered what the symptoms of TCA toxicity were.

For the past week I've been getting a robust therapeutic response to 600 mg amitriptyline. That's twice what the max dose is supposed to be and 200mg more than the absolute max dose given rarely at hospitals. TCAs (apparently) have a very narrow gap between the max therapeutic dose and toxicity. But I had plateaued with my response at 300 mg amitrip for a while now and I really wanted to see how far I could push the dose and continue the improvements. So after a day on 400mg and another on 500mg with some success, I decided to swing for it and started at 600mg. I read that the minimum acute dosage that would cause toxicity and be considered as an overdose was 750mg. So I figured I would be safe as long as I stayed well below that. What I stupidly didn't realize is that chronic administration of 600mg over a week would build the drug levels in your blood quite quickly to the equivalent of a single 750mg dose and quite possibly much more.

Amitriptyline is a Alpha-1 adrenergic receptor blocker and a sodium channel blocker. I don't know what those things mean except that it makes amitriptyline cardiotoxic at high dosages.

So basically I had an inadvertent moderate overdose. Once I realized what was happening I sort of relaxed and didn't worry about it. I'm scared of something sudden happening in my heart while I'm sleeping though. On the other hand I've tolerated high-dose amitrip for quite a number of years. It's possible my body might adjust to these higher doses.

So the 2 choices I have are:
I. Stay on the 600 mg and hope my body adjusts itself to the high dosages
II. Cut back to something like 450 mg and hope I don't cut back on the therapeutic response.

The funniest thing about all this is how good I felt this morning while scared out of my wits and feeling like I was veering on the brink of unconsciousness. I kept thinking to myself - please don't die, I'm feeling good.

C-PTSD: social phobia, major depression, dissociation.
Currently: 300mg amitriptyline single dose at night.
Also: Allegra, 1000mg Vitamin C.




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