Evidence-based flowchart 28 Guideline for the Management of Tricyclic Antidepressant Overdose 7 6
To understand the complications and management of TCA overdose, it’s helpful to consider the mechanisms of action of TCAs 1,2 : sodium channel blockade => QRS widening, dysrhythmias, decreased inotropy leading to decreased cardiac output and hypotension
The rabbit heart re- sponse to TCA overdose is similar to the human response,12,13 and was Allosteric modulation of the TCA binding site may occur in the setting of phenytoin use
Phenytoin (eg, Dilantin) is an anticonvulsant medication used to treat many seizure disorders
6
There have been sporadic case reports of the successful use of intravenous phenytoin for the treatment of patients with severe TCA overdose who have developed cardiac conduction abnormalities
Food and Drug
Both flumazenil and TCA’s affect the GABA- chloride ionophore in the CNS
Currently being more widely prescribed for pain syndromes, peripheral neuropathy, migraine prophylaxis, panic and phobic disorders, and obsessive-compulsive disorder
[] There were 3987 deaths involving TCAs in England between 1993 and 2002; however, reduced TCA-related
[]Despite the introduction of newer classes of antidepressants, the importance of these agents as a cause of morbidity and mortality continues to be recognised
Psychiatric assessment and management of deliberate self-poisoning