What is a primary concern when prescribing TCAs to elderly patients?

When prescribing tricyclic antidepressants (TCAs) to elderly patients, cardiotoxicity is a primary concern due to several factors related to the pharmacodynamics and pharmacokinetics of TCAs in older populations.

Elderly patients often have age-related physiological changes that can affect heart function, including reduced cardiac reserve and possible pre-existing cardiac conditions. TCAs can lead to arrhythmias and significant changes in heart rhythm because they possess anticholinergic properties that can cause tachycardia and other cardiovascular effects. Additionally, the potential for orthostatic hypotension caused by TCAs can increase the risk of falls and subsequently lead to serious injuries in the elderly.

Hence, while there are other considerations when prescribing medication, such as histamine blockage and potential effects on memory, cardiotoxicity is paramount when it comes to the safety and risk management of medication in the elderly population.