The treatment of tricyclic antidepressant overdose is generally similar to treatment for any poisoned patient. The initial treatment is to stabilize the vital signs.

  1. Initial treatment of an acute overdose includes gastric decontamination of the patient. This is achieved by administering activated charcoal which adsorbs the drug in the gastrointestinal tract either orally or via a nasogastric tube.
  2. Supportive therapy is given if necessary, including respiratory assistance, maintenance of body temperature, and administration of sodium bicarbonate as an antidote.
  3. Sodium bicarbonate is given intravenously and it has been shown to be an effective treatment for resolving the metabolic acidosis and cardiovascular complications of TCA poisoning.
  4. If sodium bicarbonate therapy fails to improve cardiac symptoms, conventional antidyshythmic drugs such as phenytoin and magnesium can be used to reverse any cardiac abnormalities.