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Tricyclic Antidepressant Poisoning

Tricyclic antidepressant overdose causes cardiotoxic and neurotoxic syndromes; QRS widening is a marker of mortality.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Tricyclic Antidepressant Poisoning?

Tricyclic antidepressants (amitriptyline, nortriptyline, imipramine, etc.) block sodium channels and slow cardiac conduction, with anticholinergic, alpha-adrenergic blockade, and GABA antagonism effects. Because of their narrow therapeutic index, overdose carries a high mortality risk.

Clinical manifestations may progress rapidly; patients can deteriorate dramatically within the first 2 hours. On ECG, QRS >100 ms predicts seizures and QRS >160 ms predicts ventricular arrhythmias.

In treatment, sodium bicarbonate bolus (with hypertonic sodium load and alkalinization) reduces cardiotoxicity. Emergency management of hypotension, seizures, and arrhythmias is life-saving.

Symptoms

Anticholinergic findings: dry skin, mydriasis, tachycardia, urinary retention
Neurological: altered consciousness, seizures, coma
Cardiac: wide QRS, hypotension, ventricular arrhythmia
Dry mouth and skin flushing
Reduced bowel sounds (ileus)
Hyperthermia and respiratory depression

Risk Factors

Suicide attempt and multi-drug ingestion
Depression and psychiatric comorbidity
Concurrent alcohol use
Memorable dosing errors in the elderly
Access to medication at home in pediatrics
Use in chronic pain treatment

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Hospital referral is mandatory for any suspected TCA ingestion
  • Even if asymptomatic, the patient requires 6-hour ECG monitoring
  • Bicarbonate should be started immediately for QRS widening
  • Communication with the poison control center is recommended

Treatment Methods

01
Airway safety and assessment of need for rapid intubation
02
Activated charcoal (early phase)
03
IV sodium bicarbonate bolus (for QRS >100 ms or hypotension)
04
Benzodiazepines for seizures, avoiding phenytoin
05
Fluids and norepinephrine for hypotension
06
Magnesium and lidocaine (cautiously) for ventricular arrhythmia

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.