Substance
Antidepressants: cyclic

[Other Names]
Amitriptyline
Amoxapine
Clomipramine
Desipramine
Doxepin
Imipramine
Nortriptyline
Protriptyline

Pathology
Toxic cardiovascular and CNS effects secondary to anticholinergic activity, inhibited reuptake of neurotransmitters, peripheral alpha-adrenergic blockade, alteration of cardiac cells resulting in conduction disturbances.

Symptoms
Confusion, dizziness, altered mental status (lethargy to coma), hypotension, tachycardia, hyperthermia, mydriasis, dry mucous membranes, prolonged QRS complex, cardiac dysrhythmias, seizures.

Emergency Measures
Cardiac monitoring; assessment of width of QRS complex on the 12–lead ECG; gastric decontamination with activated charcoal; alkalinization of the urine with bicarbonate-containing solutions.

Comments
Patients with wide QRS complexes (>0.12s) or cardiac dysrhythmias are monitored in the CCU or ICU.