Tricyclic Antidepressant, Poisoning

Tricyclic Antidepressant, Poisoning is a topic covered in the 5-Minute Emergency Consult.

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  • Primary mechanism of tricyclic antidepressant (TCA) toxicity:
    • Sodium channel blocking effect (quinidine-like effect)
    • Inhibition of norepinephrine reuptake
    • α-blockade
    • Anticholinergic effect
  • Selective serotonin reuptake inhibitors (SSRIs):
    • Wider margin of safety than TCA
    • Less CNS/cardiovascular toxicity
  • Nonselective serotonin reuptake inhibitors:
    • Serotonin and norepinephrine reuptake inhibitors (SNRIs)
    • Can cause cardiac dysrhythmias or seizures
    • Venlafaxine (Effexor)
    • See “Antidepressants, Poisoning.”


  • TCAs:
    • Amitriptyline
    • Nortriptyline
    • Imipramine
    • Doxepin
  • Newer-generation antidepressants (nontricyclic):
  • Rapid deterioration may occur.

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