(Ref.) TCAs (alone or in combination) are identified in the Beers Criteria as a
potentially inappropriate medication to be avoided in patients 65 years and
older (independent of diagnosis or condition) due to their strong
anticholinergic properties and potential for sedation and orthostatic
hypotension. In addition, use TCAs with caution due to their potential to cause
or exacerbate syndrome of inappropriate antidiuretic hormone secretion
(SIADH) or hyponatremia; monitor sodium closely with initiation or dosage
adjustments in older adults (Beers Criteria [AGS 2019]).