Introduction
Tricyclic antidepressant (TCA) poisoning, including nortriptyline (NT)
and amitriptyline, is among the highly prevalent toxicities. They are
second-line drugs next to Selective serotonin reuptake inhibitors
(SSRIs) in the management of depression. They carry a higher case
fatality, of 7.1% deaths per overdose, with more toxic effects than
most other antidepressants [1]. Despite the potentially dangerous
toxicity of TCAs, they remained commonly prescribed for various forms of
depression, anxiety conditions, and chronic neuropathic pains. Common
adverse effects of TCA therapy include blurred vision, dry mouth,
tachycardia, orthostatic
hypotension, cardiac arrhythmia,
sedation, constipation, and urinary retention [2].
Silymarin with the trade name of
Livergol® is a Silybum marianum seed derivative with antioxidant
properties. Silymarin has been highlighted because of its various
biological activities such as immune modulator, hypolipidemic,
anti-depressant, antifibrotic, anti-inflammatory, sedative, and
antitumor properties. Additionally, it is widely used for its well-known
hepatoprotective effect. There are very limited reports on the toxicity
of silymarin in human studies, so this substance is accepted as a safe
herbal product. The most common adverse effects reported on its use
include gastrointestinal symptoms, headaches, and dermatological
reactions, but little is known about its potential for drug interaction
[3, 4].