Tricyclics delay gastric emptying so that lavage, or emesis in a child, followed by activated charcoal may be useful up to 12 hours after ingestion. Charcoal by itself may reduce absorption in patients presenting 12 to 24 hours after ingestion.
ECG monitoring is essential. Broad complex tachycardias may occur. Treatment is supportive in the first instance. Antiarrhythmic agents should be avoided if possible, but if necessary phenytoin has been used.
Fluid replacement and inotropes are used if the patient is hypotensive.
Any acidosis, hypoxia or hypovolaemia must be corrected.
Active elimination by haemoperfusion and haemodialysis is ineffective as only a small amount of the drug remains in the vascular compartment.
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