Jefferson J W
Psychosom Med. 1975 Mar-Apr;37(2):160-79. doi: 10.1097/00006842-197503000-00006.
The tricyclic antidepressants have potent and complex effects on the cardiovascular system, both directly and through interactions with other drugs. Through a combination of anticholinergic activity, direct myocardial depressant activity and an effect on the adrenergic neuron, they can cause a combination of arrhythmias, blood pressure abnormalities and congestive heart failure. These changes, although most common with overdose, can occur at therapeutic levels. In addition a number of drug-drug interactions can occur between the tricyclics and agents used in the treatment of cardiovascular disease, as exemplified by tricyclic antagonism of the antihypertensive effect of guanethidine. Awareness of these factors is necessary to insure proper therapeutic utilization of the tricyclics as well as to treat effectively their toxicity.
三环类抗抑郁药对心血管系统具有强大而复杂的作用，既有直接作用，也有通过与其他药物相互作用产生的影响。通过抗胆碱能活性、直接心肌抑制活性以及对肾上腺素能神经元的作用相结合，它们可导致心律失常、血压异常和充血性心力衰竭等多种情况。这些变化虽然在过量用药时最为常见，但在治疗剂量下也可能发生。此外，三环类药物与用于治疗心血管疾病的药物之间可能会发生多种药物相互作用，如三环类药物对胍乙啶降压作用的拮抗作用就是例证。了解这些因素对于确保三环类药物的合理治疗应用以及有效治疗其毒性至关重要。
