Treat
     Depression
     Fibromyalgia
Adverse effects
     Used infrequently due to their anticholinergic side effects (dry mouth, orthostasis, constipation, urine retention)
     See Drug-induced arrhythmia     
          QT prolongation
               Should be used with caution in patients with underlying heart disease. 
               Use with extreme caution in patients with severe depression because of risk of arrhythmia with overdose.
     Can precipitate an attack of acute angle closure glaucoma
Overdose
     Altered Mental Status
     CNS depression
     Hyperthermia
     Seizures
     Hypotension
     Anticholinergic effects
     See Drug-induced arrhythmia    
     Decreased myocardial conduction velocity leading to QRS prolongation and risk of developing ventricular arrhythmia
     QT prolongation
     EKG with specific attention to QRS duration has best value in predicting likelihood of seizures and ventricular arrhythmia
     Serum and urine TCA levels can confirm TCA overdose but lack therapeutic or predictive value.
          See also: Monitorable drugs
Tx
     Sodium bicarbonate
          Sodium load alleviates depressant action on sodium channels
          Narrows the QRS complex preventing arrhythmia
          Improves blood pressure
         

Content on this page has not been checked for accuracy. The author's credentials have not been confirmed. Always use multiple peer-reviewed scholarly sources and good clinical judgement in your decision making.

The Compendium platform was created by David Kwinter, MD, CCFP(EM).

Dr. Kwinter is a Cayman Family Doctor. He runs a Family Medicine Clinic at Cayman Medical in George Town, Grand Cayman, Cayman Islands.