Tricyclics block NA and 5HT re-uptake. Also block inactivated fast Na+ channels. They are rapidly absorbed with a large Vd. They are highly protein bound, hepatic ally metabolised with active metaboiites. TCA OD presents with delirium, agitation, seizures and coma. Tachycardia, BP instability broad complex ECG with metabolic acidosis. Resus. intubate if req., ventilate, support BP, benzo for seizures. Risk - dose, timing, co-ingestion. Supportive - as above, Ix - para level. Decont. - activated charcoal once tubed, Enhanced slim - N/A, Antidotes SODIUM BICARBONATE (SEVERAL MECHANISMS - alkalinisation increases protein binding, Na+ load activates channels, intracellular alkalinisation - BOLUSES MAY BE BETTER THAN INFUSION) AIM PH >7.5. CAN ALSO USE HIET