Agents (Selected Agents)
- Amitriptyline (Tryptomer, Elavil) (see Amitriptyline, [[Amitriptyline]])
- Clomipramine (Anafranil) (see Clomipramine, [[Clomipramine]])
- Desipramine (Norpramin, Pertofrane) (see Desipramine, [[Desipramine]])
- Doxepin (Adapin, Sinequan) (see Doxepin, [[Doxepin]])
- Imipramine (Tofranil, Janimine, Praminil) (see Imipramine, [[Imipramine]])
- Nortriptyline (Pamelor, Aventyl, Norpress) (see Nortriptyline, [[Nortriptyline]])
- Protriptyline (Vivactil) (see Protriptyline, [[Protriptyline]])
- Trimipramine (Surmontil) (see Trimipramine, [[Trimipramine]])
Adverse Effects
Cardiovascular Adverse Effects
- QT Prolongation with Variable Association with Torsade (see Torsade, [[Torsade]]): all tricyclic antidepressants cause QT prolongation, but only a few have been definitively associated with torsade
- Desipramine (Norpramin, Pertofrane) (see Desipramine, [[Desipramine]])
- Doxepin (Adapin, Sinequan) (see Doxepin, [[Doxepin]])
- Imipramine (Tofranil, Janimine, Praminil) (see Imipramine, [[Imipramine]])
Neurologic Adverse Effects
- xxxx
- xxxx
- xxxx
Other Adverse Effects
- xxx
- xxxx
- xxxx
- xxxx
Tricyclic Antidepressant (TCA) Intoxication
Epidemiology
- Tricyclic overdose is one of the most common drug emergencies in the ED
- Higher drug levels correlate with higher risk of pulmonary complications
- 33% of pulmonary complications in tricyclic overdose are either ALI-ARDS or aspiration pneumonia
- 80% of cases have widened A-a gradient on presentation
- 50% of cases have an abnormal CXR
Physiology
- Quinidine-Like Effect
- Anticholinergic Effec
- Blockade of Norepinephrine Re-Uptake
- Antihistamine-Like Effect
Clinical Manifestations
Cardiovascular Manifestations
- Hypotension (see Hypotension, [[Hypotension]])
- Decreased Myocardial Contractility/Congestive Heart Failure (CHF) (see Congestive Heart Failure, [[Congestive Heart Failure]])
- Bradycardia (see Bradycardia, [[Bradycardia]])
- Widened QRS
- P-R Prolongation
- Q-T Prolongation
- Ventricular Arrhythmias
Neurologic Manifestations
- Obtundation/Coma (see Obtundation-Coma, [[Obtundation-Coma]])
- xx
Pulmonary Manifestations
- Acute Respiratory Failure (see Respiratory Failure, [[Respiratory Failure]])
- Epidemiology: mechanical ventilation is required in 75% of tricyclic overdoses
- Acute Lung Injury-ARDS (see Acute Lung Injury-ARDS, [[Acute Lung Injury-ARDS]])
- Epidemiology: occurs in 10% of TCA overdoses
- Aspiration Pneumonia (see Aspiration Pneumonia, [[Aspiration Pneumonia]])
- Epidemiology: common in tricyclic overdose
Treatment
- Activated Charcoal
- xxxx
References
- xxx