In a patient with suspected low-dose amitriptyline poisoning, what is the first priority intervention?

• A. Perform gastric lavage
• B. Administer activated charcoal
• C. Provide emetics to induce vomiting
• D. Initiate cardiopulmonary resuscitation

Answer: (B)

Ingestion of amitriptyline can lead to significant toxicity, so the first goal is to limit how much drug enters the bloodstream. Activated charcoal binds the drug in the gut, reducing absorption and lowering peak plasma levels when given promptly after ingestion. It’s most effective within about one to two hours and is appropriate when the patient can protect their airway and isn’t at high risk for aspiration. Other options are less favorable in the early phase: inducing vomiting risks aspiration and is unreliable; gastric lavage is invasive and usually reserved for specific, life-threatening cases; CPR is only for someone who is in cardiac or respiratory arrest. Therefore, giving activated charcoal as soon as feasible is the best initial step to minimize toxicity while ongoing supportive care is arranged.