What is the recommended treatment for TCA overdose?

In the case of a tricyclic antidepressant (TCA) overdose, the recommended treatment is sodium bicarbonate. This approach is particularly important because TCA overdoses can lead to serious cardiac complications, including arrhythmias due to sodium channel blockade. Sodium bicarbonate acts as an alkalizing agent and can help mitigate the cardiotoxic effects of the overdose by improving the binding of the drug to its site of action and increasing the urinary excretion of TCAs.

Additionally, administering sodium bicarbonate can help to reverse the metabolic acidosis that may occur with severe overdose. The alkalosis produced by sodium bicarbonate shifts the equilibrium and can improve cardiac conduction by stabilizing the cardiac membrane.

Other treatments may be employed in specific clinical scenarios, but sodium bicarbonate stands out as a critical intervention that directly addresses the toxic effects of TCA overdose, particularly with its ability to protect the heart and enhance elimination of the drug.