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Amoxapine is a tricyclic antidepressant that seems to lack the cardiovascular toxic effects associated with other tricyclics when taken as an overdose. Central nervous system depression and seizures are the primary manifestations of toxic reactions to amoxapine. Because amoxapine seems to be as effective an antidepressant as other tricyclics, the lack of cardiotoxic effects may make it the drug of choice for certain psychiatric disturbances. Five cases of amoxapine overdose are discussed. (JAMA1982;248:1092-1094)

The single-dose pharmacokinetics of amantadine hydrochloride and rimantadine hydrochloride were compared in a randomized, two-period, crossover study involving six young (less than or equal to 35 years) and six elderly (less than or equal to 60 years) adults. Subjects ingested single 200-mg oral doses after an overnight fast, and serial plasma (0 to 96 h), nasal mucus (0 to 8 h), and urine (0 to 24 h) samples were collected for assay of drug concentration by electron capture gas chromatography. For both groups combined, rimantadine differed significantly from amantadine in peak plasma concentration (mean +/- standard deviation, 0.25 +/- 0.06 versus 0.65 +/- 0.22 micrograms/ml), plasma elimination half-life (36.5 +/- 15 versus 16.7 +/- 7.7 h), and percentage of administered dose excreted unchanged in urine (0.6 +/- 0.8 versus 45.7 +/- 15.7%). No significant age-related differences were noted for rimantadine. Urinary excretion (0 to 24 h) of rimantadine and its hydroxylated metabolites averaged 19% of the administered dose. The maximum nasal mucus drug concentration was similar for both drugs (0.42 +/- 0.25 versus 0.45 +/- 0.32 micrograms/g), and the ratio of maximum nasal mucus to plasma concentration was over twofold higher after rimantadine than after amantadine. These findings may in part explain the clinical effectiveness of rimantadine in influenza A virus infections at dosages that have lower toxicity than those of amantadine.

In the JanuaryArchives, Curtis et al 1 , described their study of the efficacy of ipecac alone v activated charcoal plus a cathartic v the three together in the treatment of a simulated aspirin tablet overdose. They accounted for 70% of the ingested aspirin dose in the urine of patients following a standard ipecac regimen, compared with 56% in patients receiving activated charcoal. Their results provided another piece of impressive evidence for the efficacy of activated charcoal in treating the overdose patient. The fine, black, fluffy powder of activated charcoal used as an antidote since the 19th century results from the destructive distillation of organic materials, usually wood pulp. Following activation with steam or strong acid, activated charcoal's surface area (1,000 sq m/mL) and electrostatic properties favor binding with most poisons. CLINICAL EXPERIENCE Linden et al 2 reported on the use of repeated doses of activated charcoal in treating 11