Antiepileptics such as carbamazepine; Tricyclic antidepressants such as amitriptiline; and most antipsychotics cause blockade of voltage gated sodium channels in the heart associated with QT wave prolongation.
The ECG changes may cause lethal arrhythmias including ventricular tachycardia, fibrillation and increased risk for torsade's de pointe's
In addition, the alfa-adrenoceptor blockade results in orthostatic hypotension and reduced arterial blood pressure.
Sedation is attributed to histaminergic receptor blockade.
HOW TO MANAGE
Vital sign Support; stimulants should not be used.
The ECG changes is ameliorated by saturating the sodium channels with sodium through administration of sodium bicarbonate.
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