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Poisoning & OD | Part Five | Tricyclic Antidepressants

Tricyclic Antidepressants: common are amitriptyline (Elavil), amoxapine (Asendin), clomapramin (Anafranil), doxepin (Sinequan, Adepin), imipramine (Tofranil) and nortriptyline (Aventyl, Pamelor). Block the reuptake of norepinephrine and seratonin in the brain. Some have anticholinergic and cardiac membrane actions. Heat exhaustion and heat stroke. V-Tac dysrythmias. Very dangerous in an overdose because it only takes a few pills. A typical one-month prescription is more than enough to be fatal.

Signs and symptoms vary on the drug, dose and time since ingestion:
Dry mouth
Confusion
Hallucinations
Delirium
Respiratory depression
Hypotension
Hyperthermia
Seizures
Coma

Management: Protect yourself. Maintain ABCs. Hi-flow O2, ventilate/intubate if necessary, IV, prompt transport. Medications: Sodium Bicarbonate, Activated Charcoal, Diazepam (seizures).

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