Extracorporeal treatment for tricyclic antidepressant poisoning: Recommendations from the EXTRIP workgroup

Christopher Yates, Tais Galvao, Kevin M. Sowinski, Karine Mardini, Tudor Botnaru, Sophie Gosselin, Robert S. Hoffman, Thomas D. Nolin, Valéry Lavergne, Marc Ghannoum, Kurt Anseeuw, Ashish Bhalla, Emmanuel A. Burdmann, Paul I. Dargan, Brian S. Decker, David S. Goldfarb, Lotte C. Hoegberg, David Juurlink, Martin Laliberté, Jan T. KielsteinYi Li, Kathleen D. Liu, Robert MacLaren, Robert Mactier, Bruno Mégarbane, James B. Mowry, Véronique Phan, Darren M. Roberts, Timothy J. Wiegand, James F. Winchester

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


The Extracorporeal Treatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatments (ECTR) in poisoning. Here, the workgroup presents its results for tricyclic antidepressants (TCAs). After an extensive literature search, using a predefined methodology, the subgroup responsible for this poison reviewed the articles, extracted the data, summarized findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and RAND/UCLA Appropriateness Method to quantify disagreement. Blinded votes were compiled, returned, and discussed in person at a meeting. A second vote determined the final recommendations. Seventy-seven articles met inclusion criteria. Only case reports, case series, and one poor-quality observational study were identified yielding a very low quality of evidence for all recommendations. Data on 108 patients, including 12 fatalities, were abstracted. The workgroup concluded that TCAs are not dialyzable and made the following recommendation: ECTR is not recommended in severe TCA poisoning (1D). The workgroup considers that poisoned patients with TCAs are not likely to have a clinical benefit from extracorporeal removal and recommends it NOT to be used in TCA poisoning.

Original languageEnglish (US)
Pages (from-to)381-389
Number of pages9
JournalSeminars in Dialysis
Issue number4
StatePublished - 2014

ASJC Scopus subject areas

  • Nephrology

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