To the Editor.—
The article by Litovitz and Troutman1 reporting an "alarming contrast" in mortality rates from overdoses with amoxapine (Asendin) compared with those from other cyclic antidepressants could, we believe, mislead the clinician with regard to both the alleged lethality of amoxapine overdosage and the implied safety of overdosage with other antidepressants.The Table compares data from their article with data from the nationwide Drug Abuse Warning Network (DAWN) of the National Institutes of Drug Abuse. The frequency of amoxapine overdosage as a percentage of all antidepressant drug overdoses is essentially the same in both reports and closely parallels the comparative prescribing rates for these medicines. However, the disparity in findings of relative frequency with which fatality is reportedly caused by amoxapine is so large that, even given differences in data collection methods, the Litovitz and Troutman conclusion of greater amoxapine lethality can hardly be well founded.Their
Kiltie H, Brown TE, Bishop MP. Amoxapine Overdosage. JAMA. 1984;251(5):601–602. doi:10.1001/jama.1984.03340290021006
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