ToxicologyEmergency
TCA overdose
Cardiovascular and CNS management of tricyclic antidepressant overdose, including sodium bicarbonate therapy.
Source: TOXBASE/NPIS; AACT/EAPCCT position statements; Resuscitation Council UK ALS
Step 1 of ~7
warning
High-risk overdose — early ECG and monitoring
TCA overdose is potentially lethal within hours. Mechanisms: fast Na⁺-channel blockade (wide QRS, VT, asystole), anticholinergic, α-blockade (hypotension), seizures, coma.
ABCDE; continuous ECG, IV access, 12-lead ECG within 10 minutes.
Bloods: VBG, U&E, glucose, paracetamol/salicylate, ECG.
Common ingestions: amitriptyline, dosulepin, clomipramine, nortriptyline, imipramine.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- Sodium Bicarbonate 8.4%RecommendedElectrolyte Buffer
- Amitriptyline HydrochlorideRecommendedTricyclic Antidepressant (TCA)
Same class
Pathways
- Paracetamol overdose · TOXBASE/NPIS; MHRA DSU 2012/2024; SNAP regimen (Lancet 2014); BNF
- Opioid overdose · TOXBASE/NPIS; Resuscitation Council UK; BNF
- Anticholinergic toxidrome · TOXBASE/NPIS; AACT/EAPCCT; BNF
- Benzodiazepine overdose · TOXBASE/NPIS; AACT/EAPCCT; BNF
- β-blocker overdose · TOXBASE/NPIS; AACT/EAPCCT; ESC; BNF
- Calcium channel blocker overdose · TOXBASE/NPIS; AACT/EAPCCT; ESC; BNF
Decision support only. Always apply local guidelines and clinical judgement.