What is a serious adverse effect of tricyclic antidepressants?

A. Agranulocytosis: Tricyclic antidepressants (TCAs) rarely cause agranulocytosis. While blood dyscrasias are serious, they are not a typical or expected adverse effect of this drug class. Routine monitoring for this is not standard. B. Liver failure: TCAs are metabolized hepatically, but clinically significant liver failure is uncommon. Mild liver enzyme elevations may occur, but hepatotoxicity is not a primary concern. C. Amputation: TCAs have no association with amputation. This outcome is unrelated to their pharmacologic or adverse effect profile. D. Arrhythmias: TCAs can cause cardiac conduction abnormalities, including prolonged QRS interval, QT prolongation, and ventricular arrhythmias, particularly in overdose or in clients with preexisting heart disease. Monitoring for arrhythmias is crucial due to their potentially life-threatening nature.