They have been employed in drug therapy
since the late 1950s.
Largest group of drug agents used for the
treatment of depression.
Referred as “ tri cyclic ” compounds –three
Due to both accidental and deliberate
Life threatening ,high risk for suicide.
Involve multiple ingestions – ethanol ,
Toxicity due to rapid absorption , tight binding
to plasma proteins , low therapeutic margins.
Decreases the action of acetylcholine
centrally and peripherally.
Enhances dopamine levels.
Reduced serotonin uptake resultant increase
within the synapse.
Respiratory dysfunction and disturbances in
body temp- respiratory center ,
Geriatric patients and alcoholics- confusion,
agitation and nervousness.
Elderly patients –memory deficit.
Amitriptyline- acute dystonia and extra
Occur soon after admission.
Lead to hypotension , cardiovascular
deterioration and death.
Amoxapine , Maprotiline overdose.
PERIPHERAL NERVOUS SYSTEM
Amitriptyline overdose- peripheral
neuropathies and polyradiculoneuropathy.
Seizures and coma
Develop between 5 & 48 hours after
Respiratory distress syndrome and
Immediately evaluate the patient and
Monitor vital signs.
STABILISATION – Insert an intravenous line
and cardiac monitoring.
Altered mental status- naloxone, glucose and
if indicated thiamine.
Adequate ventilation ,prolonged cardiac
SUPPORT VITAL FUNCTIONS:
Respiratory depression – intubation and
Hypotension- Nor epinephrine , Phenyl epinephrine.
Sodium bicarbonate .
Glucagon(10mg bolus followed by
an infusion of 10 mg over 6 hours) .
Dysrhythmias- sodium chloride.
REDUCE TCA ABSORPTION:-
Ipecac or gastric lavage within 6 hrs.
Activated charcoal (1g/kg) in all cases.
INCREASE TCA ELIMINATION:-
Multiple doses of activated charcoal (0.5-1.0