Known brand names include Elavil.
A tricyclic antidepressant taken by mouth as tablets to relieve symptoms of depression. It is sedating and has strong atropine-like effects such as dry mouth and constipation, and an overdose can cause deadly heart rhythm problems and seizures. Like other antidepressants, it carries a boxed warning about suicidal thoughts in children, teens, and young adults.
Oral tricyclic antidepressants are not on the ISMP acute care high-alert list.
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The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.
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In short-term trials in major depressive disorder and other psychiatric disorders, antidepressants raised the risk of suicidal thinking and behavior in children, adolescents, and young adults. No increase was seen in adults over 24, and risk fell in adults 65 and older. Monitor all patients closely for clinical worsening, suicidality, or unusual behavior changes, and enlist families and caregivers. Not approved for pediatric patients.
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No specific antidote; overdose can be fatal and needs hospital care, ideally with poison control input. Get an ECG and start cardiac monitoring at once; a limb-lead QRS of 0.10 seconds or more may be the best sign of a severe overdose. Give IV sodium bicarbonate to keep serum pH at 7.45 to 7.55 for conduction problems and dysrhythmias, treat seizures with benzodiazepines, and avoid class 1A and 1C antiarrhythmics; inducing vomiting is contraindicated, and physostigmine is only for life-threatening symptoms unresponsive to other therapy. Observe with cardiac monitoring for at least 6 hours.
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Doses come from the FDA label. Study tool, not for clinical decisions.
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Its mechanism in humans is unknown. It inhibits the membrane pump that takes norepinephrine and serotonin back into nerve terminals, which may potentiate or prolong their activity. It is not an MAO inhibitor or a primary CNS stimulant, and it has sedative and atropine-like (anticholinergic) effects. It is rapidly absorbed and metabolized by N-demethylation and hydroxylation; CYP2D6 poor metabolizers and 2D6 inhibitors can raise TCA exposure up to 8-fold. At high doses, TCAs prolong cardiac conduction time and cause arrhythmias.