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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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Rosen, Peter, et al., editors. "Tricyclic Antidepressant, Poisoning." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307505/all/Tricyclic_Antidepressant__Poisoning.
Tricyclic Antidepressant, Poisoning. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307505/all/Tricyclic_Antidepressant__Poisoning. Accessed April 23, 2019.
Tricyclic Antidepressant, Poisoning. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307505/all/Tricyclic_Antidepressant__Poisoning
Tricyclic Antidepressant, Poisoning [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307505/all/Tricyclic_Antidepressant__Poisoning.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Tricyclic Antidepressant, Poisoning ID - 307505 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307505/all/Tricyclic_Antidepressant__Poisoning PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -