Tricyclic Antidepressants & Overdose

Key points

• TCAs (amitriptyline, dosulepin): block noradrenaline/serotonin reuptake; anticholinergic side effects (dry mouth, urinary retention, constipation, blurred vision).
• TCA overdose: dangerous — anticholinergic features, dilated pupils, arrhythmias, seizures, hypotension.
• ECG in overdose: sinus tachycardia common; widened QRS predicts seizures/arrhythmias; prolonged QT.
• Management of overdose: supportive, sodium bicarbonate for QRS widening/arrhythmias.
• Dosulepin is particularly cardiotoxic in overdose (avoid in overdose-risk patients).

Decision points in this pathway

• TCA overdose?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.