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Tricyclic Antidepressant Overdose

Aka: Tricyclic Antidepressant Overdose

See Also
1. Tricyclic Antidepressant
Signs and Symptoms
1. Coma
2. Confusion
3. Delirium
4. Mydriasis (dilated pupils)
5. Dry Mouth
6. Hypotension
7. Seizures
8. Tachycardia
9. Urinary Incontinence
Management: General
1. Avoid Physostigmine
2. Avoid Class IA Antiarrhythmics
3. Avoid Class IC Antiarrhythmics
4. Avoid barbiturates and Phenytoin (see Seizure below)
Management: Seizures
1. Benzodiazepines: Lorazepam (Ativan)
  1. Adult: Lorazepam 2 to 4 mg IV
  2. Child: Lorazepam 0.05 to 0.1 mg/kg
2. Avoid barbiturates
3. Avoid Phenytoin (Dilantin)
Management: Prolonged QRS interval (>120 ms)
1. Alkalinize urine with Sodium Bicarbonate (1 meq/ml solution) to keep Urine pH <7.5
  1. Adult: Sodium Bicarbonate (1 mEq/ml solution) at 50 mEq bolus
  2. Child: 1-2 mEq/kg up to 50 mEq bolus
Management: Hypotension
1. Goal: Low to normal Blood Pressure and adquate critical end-organ perfusion
2. Adult
  1. Dopamine or Norepinephrine 8-12 mcg/min
3. Child
  1. Dopamine 0.1 mcg/kg/min (may titrate for Blood Pressure to a maximum of 6 mcg/min)
References
1. Henry (2006) Pediatr Clin North Am 53(2): 293-315

Family Practice Notebook

Patients should address specific medical concerns with their physicians.

Although access to this page is not restricted, the information found here is intended for use by medical providers.

This page was written by Scott Moses, MD, last revised on 12/21/2011 and last published on 5/17/2012.

This is one of 5740 pages in the Family Practice Notebook