---

 
 
 
 
Imipramine
 
 
 
 
Amitriptyline
 
 
 
 
Doxepin
 
 
 
 
Nortriptyline
 
 
 
 
Protriptyline
 
 
 
 
Trimipramine

- Discussion:
 
 
- anticholinergic crisis in w/ antidepressant overdose presents as:
 
 
 
 
 
- mydriasis, blurred vision, urinary retension, dry mucous membranes,
 
 
 
 
 
 
 
 
constipation, ileus, sinus tachycardia, hyperthermia or hypothermia,
 
 
 
 
 
 
 
 
confusion, agitation, and hallucinations;
 
 
 
 
 
- acidosis potentiates TCA toxicity;
 
 
 
 
 
 
 
 
 
- respiratory acidosis is treated w/ intubation and hyperventilation;
 
 
- drug interactions:
 
 
 
 
 
- anesthetic agents:
 
 
 
 
 
 
 
 
- combination of halothane, pancuronium, & tricyclic antidepressants,
 
 
 
 
 
 
 
 
 
 
 
 
can cause severe ventricular arrhythmias;
 
 
 
 
 
- interaction w/ neuroleptic agents,
 
 
 
 
 
 
 
 
- combination of drugs should be especially avoided in the elderly;
 
 
 
 
 
 
 
 
- least potent antipsychotics (Chlorpromazine & Thioridazine tend to
 
 
 
 
 
 
 
 
 
 
 
 
be most sedating and to have most anticholinergic effects;
 
 
 
 
 
 
 
 
- use of such drugs in combination w/ antidepressant that also has
 
 
 
 
 
 
 
 
 
 
 
 
high anticholinergic activity may cause toxic anticholinergic
 
 
 
 
 
 
 
 
 
 
 
 
reactions, including delirium;
 
 
 
 
 
 
 
 
- autonomic side effects are also relatively frequent w/ less
 
 
 
 
 
 
 
 
 
 
 
 
potent neuroleptics, & resultant hypotensive episodes may
 
 
 
 
 
 
 
 
 
 
 
 
predispose to falls, myocardial infarction, or CVA;