Tricyclic antidepressants on the NCLEX
TCAs: anticholinergic side effects, overdose cardiotoxicity, when still used.
TCAs are older antidepressants now used mainly for neuropathic pain, insomnia, and migraine prophylaxis. The NCLEX tests anticholinergic side effects and overdose toxicity.
Common drugs
Amitriptyline, nortriptyline, imipramine, doxepin, clomipramine.
Anticholinergic side effects
Dry mouth, constipation, urinary retention, blurred vision, sedation, orthostatic hypotension. Confusion in elderly.
Overdose toxicity
Highly cardiotoxic. QRS widening, arrhythmias, seizures. Sodium bicarbonate for QRS prolongation. ICU monitoring.
When still used
Neuropathic pain (amitriptyline, nortriptyline). Migraine prophylaxis. Insomnia (low-dose doxepin). Treatment-resistant depression.
MAOI washout
2 weeks both directions.
Frequently asked
Why TCAs not first-line?
Side effects and lethal overdose. SSRIs safer overall.
Elderly patient on amitriptyline?
Avoid, anticholinergic load, fall risk, confusion. Beers Criteria flag.
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