Tripgen Overdosage

The basis of the management of tricyclic antidepressant poisoning is intensive supportive care and symptomatic therapy. Since tricyclic antidepressants slow gastrointestinal transit time, absorption may be delayed in overdosage. Activated charcoal may be given by mouth or nasogastric tube if more than 4 mg/kg of a tricyclic antidepressant has been ingested and the patient presents within 1 hour; a second dose may be considered after 2 hours in patients with central features of toxicity. Gastric lavage is rarely used but may be considered in life-threatening overdoses. Multiple doses of charcoal may be appropriate in patients who have ingested modified-release preparations.
The patient should be monitored for cardiac arrhythmias. UK authorities consider that although cardiac arrhythmias are of concern they are best treated by correction of hypoxia and acidosis with intravenous sodium bicarbonate; the use of antiarrhythmic drugs is best avoided. Intravenous sodium bicarbonate should also be given to treat arrhythmias or significant ECG abnormalities even in the absence of acidosis.
Convulsions can be managed by giving diazepam or lorazepam intravenously. Phenytoin should be avoided because it may increase the risk of arrhythmias. Diazepam by mouth is usually adequate to sedate delirious patients, although large doses may be needed. Peritoneal dialysis, haemodialysis, and measures to increase urine production are not of value in tricyclic antidepressant poisoning, and charcoal haemoperfusion is of doubtful benefit.