Treat
Depression
Fibromyalgia
Adverse effects
Used infrequently due to their anticholinergic side effects (dry mouth, orthostasis, constipation, urine retention)
See Drug-induced arrhythmia
QT prolongation
Should be used with caution in patients with underlying heart disease.
Use with extreme caution in patients with severe depression because of risk of arrhythmia with overdose.
Can precipitate an attack of acute angle closure glaucoma
Overdose
Altered Mental Status
CNS depression
Hyperthermia
Seizures
Hypotension
Anticholinergic effects
See Drug-induced arrhythmia
Decreased myocardial conduction velocity leading to QRS prolongation and risk of developing ventricular arrhythmia
QT prolongation
EKG with specific attention to QRS duration has best value in predicting likelihood of seizures and ventricular arrhythmia
Serum and urine TCA levels can confirm TCA overdose but lack therapeutic or predictive value.
See also: Monitorable drugs
Tx
Sodium bicarbonate
Sodium load alleviates depressant action on sodium channels
Narrows the QRS complex preventing arrhythmia
Improves blood pressure
