Management overview for TCA poisoning

Tricyclic antidepressant (TCA) drugs include amitriptyline, clomipramine, dosulepin (dothiepin), doxepin, imipramine and nortriptyline.

TCA poisoning is associated with significant morbidity and mortality. Coma, seizures, anticholinergic toxidrome and cardiovascular toxicity (hypotension, sodium channel blockade, QRS widening, arrhythmias) manifest rapidly, and are potentially fatal without intervention.

If TCA poisoning is suspected, urgently contact a clinical toxicologist or poisons information centre (13 11 26). The management priorities are supportive care, gastrointestinal decontamination with activated charcoal and, particularly in severe poisoning, serum alkalinisation.