New South Wales Ambulance Pharmacology Practice Exam 2025 – Complete Prep Guide

Sodium Bicarbonate notably interacts with tricyclic antidepressants (TCAs) by altering their protein binding, which can affect the medication's efficacy and safety profile. TCAs are known to be highly protein-bound, meaning that a considerable portion of the drug that remains bound is inactive and unable to exert its therapeutic effects. When Sodium Bicarbonate is administered, it can lead to changes in the pH and subsequently affect the protein binding sites, potentially increasing the levels of free, unbound TCAs in circulation. This can enhance the therapeutic effects but also raises the risk of side effects and toxicity, such as cardiovascular complications or central nervous system effects.

The other classes of antidepressants, while they may have various interactions with other substances, do not generally have the same significant protein binding alterations when combined with Sodium Bicarbonate. SSRIs, MAO inhibitors, and mixed serotonin-norepinephrine reuptake inhibitors exhibit different pharmacokinetic profiles that are not as influenced by changes in protein binding due to Sodium Bicarbonate as TCAs are. Therefore, understanding the specific interaction of Sodium Bicarbonate with tricyclic antidepressants is crucial for safe and effective pharmacological management of patients requiring these medications.