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The morning tablet taken twice by mistake, a toddler at an open tube of tablets, three different painkillers with the same active substance — an overdose usually happens by accident and almost always under stress. What matters then are the first few minutes: dialling the right number, having the right details to hand and not reaching for well-meant home remedies. This guide shows you step by step when to call 112, when the poison emergency line is the better place to turn and why vomiting and milk are not antidotes.
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Anyone who realises that too much of a medicine is involved first asks one question: who do I call? The answer does not depend on the number of tablets but on the condition of the person affected. Vital functions — consciousness, breathing, circulation — always take priority. If they are disturbed, the emergency medical services are the right call. If they are (still) unremarkable, the poison emergency line (Giftnotruf) helps you judge whether anything needs to happen at all.
The poison emergency lines are run by the poison information centres of the federal states (Giftinformationszentren); every German federal state is assigned to a centre, and some share one. There, doctors experienced in toxicology give advice around the clock and decide with you whether watching at home is enough. An overview with contact details is published by the Society for Clinical Toxicology (GfKT).¹
| Situation | Who to call | Why |
|---|---|---|
| The person is unresponsive, very drowsy or hard to wake | 112 | Danger to the airway and breathing — every minute counts |
| Breathlessness, slow or shallow breathing, bluish lips | 112 | A sign of respiratory depression, for example from opioids or sedatives |
| Seizure, chest pain, racing heart, marked confusion | 112 | Possible involvement of the heart or nervous system |
| The tablets were taken deliberately | 112 | Even if the person still feels fine — amount and mixture are often unclear |
| The person is awake and unremarkable, but the amount or active substance is a concern | The poison emergency line for your federal state | Expert assessment of whether observation is enough or a hospital is needed |
| A child has got hold of tablets, drops or a patch and seems normal | The poison emergency line — immediately, don’t wait | In children, even small amounts can be dangerous |
| A long-term medicine taken twice by mistake, no symptoms | The poison emergency line; during the day also the pharmacy or your GP practice | Not critical for many active substances, but it is for some — the active substance decides |
When in doubt: better to call 112 once too often than once too late. The emergency control centre and the poison emergency line will refer you to each other if needed.
Until help arrives or until you have the poison emergency line on the phone, a few simple steps count. They are the same in all reputable first-aid recommendations:²
About drinking: after swallowing tablets, drinking is as a rule not necessary. If the person is awake and can swallow safely, a few sips of water or tea at most are fine. Anyone who is drowsy gets nothing to drink at all — there is a risk of it going down the wrong way.
The conversation with the poison information centre follows a fixed pattern. The more precise your details, the more reliable the assessment. So — if possible — have the pack in your hand before you dial. These are the questions you will be asked:²
At the end you will find out whether the amount is harmless, needs observation or needs treatment, and what to watch out for over the next few hours. Stick to it — even if it seems overcautious to you.
Perhaps the most dangerous sentence after an overdose is: “But I feel fine.” With several important active substances, the serious consequences only appear hours or even days later — at a point when the most effective treatment may already have been missed.
Paracetamol is the prime example. After too large an amount, those affected often hardly feel ill on the first day — perhaps a little nausea, pallor, sweating. The liver damage only develops over the following one to three days. At the same time there is an effective antidote, acetylcysteine as an infusion, which works best when it is given early — ideally within the first few hours.⁴ Anyone who waits until symptoms appear throws away exactly this time window. In people who drink alcohol regularly, are severely underweight or have liver disease, even a smaller excess can be critical.
Tablets with delayed release give off their active substance over many hours. After an overdose, the level therefore rises slowly — and the symptoms start late. This applies, for example, to prolonged-release painkillers, blood pressure medicines and antiepileptics.
Opioid pain patches build up a depot of active substance in the skin that goes on acting after the patch has been removed. Heat — an electric blanket, a sauna, fever — can increase absorption, and a forgotten old patch doubles the dose without anyone noticing.
Many active substances that are harmlessly dosed on their own reinforce each other: sleeping pills and sedatives, opioids, some antidepressants, antihistamines — and alcohol. Why this particular combination is so treacherous is explained in the guide Medications and alcohol.
Most overdoses are not dramas but everyday slip-ups. What matters is assessing them correctly.
Distracted in the morning, tablet taken, half an hour later taken again: for many long-term medicines a one-off double dose is not critical. With active substances that have a narrow therapeutic range — that is, a small gap between the effective and the harmful amount — things look different. Don’t simply drop the next regular dose, and don’t take anything “to compensate” either; instead, clarify how to proceed with the poison emergency line, the pharmacy or your GP practice.
| Drug group | Examples | Possible consequence of an overdose |
|---|---|---|
| Blood thinners | Phenprocoumon, direct oral anticoagulants | Increased tendency to bleed; with the vitamin K antagonist, a clotting test may be needed after consultation |
| Blood sugar-lowering medicines | Insulin, glimepiride and other sulfonylureas | Hypoglycaemia (low blood sugar), sometimes delayed and lasting many hours |
| Opioids | Tramadol, tilidine, opioid patches | Drowsiness, respiratory depression, pinpoint pupils |
| Heart and blood pressure medicines | Beta blockers, calcium channel blockers, digitalis preparations | Slow pulse, a sharp drop in blood pressure, heart rhythm disturbances |
| Tricyclic antidepressants | Amitriptyline | Heart rhythm disturbances, seizures, clouding of consciousness |
| Methotrexate (weekly dosing) | Methotrexate | Damage to blood formation and the mucous membranes if taken daily instead of weekly |
| Painkillers | Paracetamol | Liver damage, often without symptoms at first |
The table is not a complete list and does not replace individual advice. Whether anything needs to be done, and what, depends on the active substance, the amount, body weight and pre-existing conditions — exactly what the poison emergency line assesses. The opposite situation, a missed dose, is covered in the guide Missed a medication — and the same applies there: don’t simply take a double dose to catch up.
A tablet for a headache, a hot cold-and-flu drink in the evening, a combination product at night — and you have taken the same active substance three times without noticing. Paracetamol is found in many cold and combination remedies, and ibuprofen is sold under numerous brand names. The solution: always look at the active substance, not the brand name. Why the same substance carries so many names is explained in the guide Active ingredient vs. brand name.
For rheumatism, psoriasis or chronic inflammatory bowel disease, methotrexate is taken in a low dose once a week. If it is taken daily by mistake, this can become life-threatening. The European Medicines Agency therefore introduced additional safety measures in 2019, such as clearer warnings on the pack and a patient card.⁵ If you notice that methotrexate has been taken on several days in a row, contact your GP practice or the poison emergency line immediately — even without symptoms.
A tablespoon instead of the measuring spoon, millilitres confused with milligrams, the dropper from another product: always use the dosing aid supplied and keep it with the medicine it belongs to. More on this under Medications for children.
The interaction check in brite shows you when two products contain the same active substance.
Toddlers explore the world with their mouths. Colourful tablets look like sweets, and a handbag on the sofa or the grandparents’ weekly pill organiser on the kitchen table is quickly within reach. Medicines are therefore among the common causes of poisoning accidents in childhood.⁶
The treacherous part: some groups of active substances can become dangerous for a toddler even in small amounts — for example certain antidepressants, opioids, some heart and blood pressure medicines, blood sugar-lowering tablets and iron supplements. A used pain patch also still contains active substance; if it is put in the mouth or stuck onto the skin, that can be life-threatening for a child.
Prevention is almost everything here: medicines belong in a lockable cabinet or at least out of reach and out of sight. Close child-resistant packaging again after every use, don’t decant tablets loosely into tins, fold used patches together with the sticky side inwards and dispose of them safely. And a visit to the grandparents means keeping an eye on their weekly pill organisers and handbags. A good starting point is the home pharmacy checklist, supplemented by the tips in Storing medications correctly.
In older people an overdose often does not arise from a single mistake but slowly — with the number of tablets unchanged. The causes are usually unspectacular:
The warning signs are non-specific and easily put down to age: tiredness, confusion, falls, dizziness, loss of appetite, a strikingly slow pulse. If they appear for the first time, it is worth taking a look at the medicines. More on this in the guide Medications in old age. Anyone taking five or more long-term medicines can also make use of a medication review at the pharmacy, in which duplicate active substances and unfavourable doses are picked up systematically.
Sometimes an overdose is not a slip-up but the expression of a mental health crisis. This can also affect people nobody would have expected it of. Here the rule applies without any exception: this is always an emergency — even if the person still seems fine at the moment. The amount and mixture are often unclear, and some active substances only take effect hours later.
After the acute treatment there is usually a psychiatric or psychotherapeutic assessment. For relatives this phase is often hard to bear. It can help to think through with the treating practice how access to larger quantities of medicines can be limited for a while — for example through smaller packs or by having a trusted person keep them. Background on warning signs and treatment can be found in the article Depression.
Anyone who arrives in the emergency department after an overdose is first stabilised and monitored: breathing, pulse, blood pressure, consciousness and, for many active substances, an ECG as well. Depending on the active substance, blood tests follow — with paracetamol, for example, the level in the blood is measured to decide whether the antidote is needed.⁴
Which further measures make sense is decided by the treatment team — often in consultation with the poison information centre: for example medical charcoal, if the timing and the active substance speak in favour of it, antidotes such as acetylcysteine for paracetamol or naloxone for opioids, monitoring over several hours for prolonged-release products and, in rare, severe cases, blood cleansing (dialysis).
You help the team most if you bring: all packs and blisters, the current medication plan, a list of pre-existing conditions and the times you noted down. Anyone who takes medicines regularly should have this information to hand anyway — the guide Medical emergency card shows how to carry it in your wallet or on your phone.
Most accidental overdoses follow recurring patterns — and can be prevented with simple routines:
If dosing mistakes keep happening — for example with the onset of forgetfulness — raise it at your GP practice or pharmacy. Sometimes the regimen can be simplified, or a home care service takes over setting out the medicines; the treating practice decides that together with you.
With the digital medication plan in brite, you have everything the poison emergency line wants to know to hand straight away in an emergency.
An app replaces neither the poison emergency line nor the emergency services — it helps where most dosing mistakes happen.
Medication reminder
Reminds you at the right time and records what you have taken — so the question “Taken it or not?” is answered at a glance.
Interaction check
Points out duplicate active substances and risky combinations — for example when a cold remedy contains the same painkiller you are already taking.
Medication plan
Active substance, strength, dosing rhythm — everything the poison emergency line asks at a glance. Relatives can find their way around it too.
Health history
Documents symptoms and readings such as blood sugar or pulse — helpful when someone needs to be observed over several hours after a dosing mistake.
