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| Sleep |  |
Antidepressants, Tricyclic
Generic And Brand Names
| Nortriptyline Aventyl Pamelor |
Doxepin Adapin Novo-Doxepin Sinequan Triadapin |
Protriptyline Vivactil Triptil |
| Amoxapine Asendin |
Desipramine Norpramin Pertofrane |
Clomipramine Anafranil |
| Amitryptiline Apo-Amitriptyline Novotriptyn Elavil Endep Levate PMS Amitriptyline |
Imipramine Apo-lmipramine Impril Norfranil Tipramine Tofranil Tofranil-PM Novopramine PMS Impramine |
Trimipramine Apo- Trimip Novo- Tripramine Rhotrimine Surmontil |
Drug class: Antidepressant (tricyclic)
Uses
 | Gradually relieves symptoms of depression. |
| Used to decrease bedwetting in children. |
| Pain relief (sometimes). |
| Clomipramine is used to treat obsessive- compulsive disorder. |
| Treatment for narcolepsy, bulimia, panic attacks, cocaine withdrawal, attention-deficit disorder. |
| May be useful for restless leg syndrome. |
What drug does:
Probably affects part of brain that controls messages between nerve cells.
CNS activity: Norepinephrine (and some serotonin) agonist
Dosage
Common initial dose - 25 mg once or twice daily
Usual maximal dose - 150-300 mg divided (doses this high are rarely required)
Time lapse before drug works:
2 to 4 weeks. May require 4 to 6 weeks for maximum benefit.
Symptoms: Hallucinations, drowsiness, enlarged pupils, respiratory failure, fever, cardiac arrhythmias, convulsions, coma.
What to do in case of overdose:
| Dial 911 (emergency) or O (operator) for an ambulance or medical help. Then give first aid immediately. |
| If patient is unconscious and not breathing, give mouth-to-mouth breathing. If there is no heartbeat, use cardiac massage and mouth-to-mouth breathing (CPR). Don't try to make patient vomit. If you can't get help quickly, take patient to nearest emergency facility. |
Possible Adverse Reactions Or Side Effects
| Symptoms | What To Do |
| Life-threatening: Hallucinations, drowsiness, enlarged pupils, respiratory failure, fever, cardiac arrhythmias, convulsions, coma. |
Overdose. See above |
| Common: Tremor |
Discontinue medication. Call doctor right away. |
| Headache, dry mouth or unpleasant taste, constipation or diarrhea, nausea, indigestion, fatigue, weakness, drowsiness, nervousness, anxiety, excessive sweating. | Continue medication. Call doctor when convenient. |
| Insomnia, "sweet tooth." | Continue medication. Tell doctor at next visit. |
| Infrequent: Convulsions. |
Discontinue medication. Seek emergency treatment. |
| Hallucinations, shakiness, dizziness, fainting, blurred vision, eye pain, vomiting, irregular heartbeat or slow pulse, inflamed tongue, abdominal pain, jaundice, hair loss, rash, fever, chills, joint pain, palpitations, hiccups, visual changes. | Discontinue medication. Call doctor right away. |
| Difficult or frequent urination; decreased sex drive; muscle aches; abnormal dreams; nasal congestion; weakness and faintness when arising from bed or chair; back pain. | Continue medication. Call doctor when convenient. |
| Rare: Itchy skin; sore throat; involuntary movements of jaw, lips and tongue; nightmares; confusion; swollen breasts; swollen testicles. |
Discontinue medication. Call doctor right away. |
If you are over age 60, you are more likely to develop urination difficulty and serious side effects such as seizures, hallucinations, shaking, dizziness, fainting, headache, insomnia.
Warnings & Precautions
Don't take if:
| You are allergic to any tricyclic antidepressant. |
| You drink alcohol in excess. |
| You have had a heart attack within 6 weeks. |
| You have glaucoma. |
| You have taken MAD inhibitors within 2 weeks. |
| Patient is younger than 12. |
Before you start, consult your doctor:
| If you will have surgery within 2 months, including dental surgery, requiring general or spinal anesthesia. |
| If you have an enlarged prostate or glaucoma. |
| If you have heart disease or high blood pressure. |
| If you have stomach or intestinal problems. |
| If you have an overactive thyroid. |
| If you have asthma. |
| If you have liver disease. |
Breast-feeding:
Drug may pass into milk. Avoid drug or discontinue nursing until you finish medicine. Consult doctor about maintaining milk supply.
Infants & children
Don't give to children younger than 12 except under medical supervision.
Skin & sunlight
One or more drugs in this group may cause rash or intensify sunburn in areas exposed to sun or ultraviolet light (photosensitivity reaction). Avoid overexposure and use sunscreen. Notify doctor if reaction occurs.
Discontinuing
| Don't discontinue without consulting doctor. Dose may require gradual reduction if you have taken drug for a long time. Doses of other drugs may also require adjustment. |
| Withdrawal symptoms such as convulsions, muscle cramps, nightmares, insomnia, abdominal pain. Call your physician right away if any of these occur. |
Miscellaneous
| May affect results in some medical tests. |
| Advise any doctor or dentist whom you consult that you take this medicine. |
| Don't take with any prescription or nonprescription drugs without consulting your doctor or pharmacist. |
| Risk factors during pregnancy vary for drugs in this group. Consult your doctor if you are or are planning to become pregnant. |
| Talk to your doctor about the need for follow-up medical examinations or laboratory studies to check complete blood counts (white blood cell count, platelet count, red blood cell count, hemoglobin, hematocrit), blood pressure, eyes, teeth in case of prolonged use of this drug. |
Interactions
| Possible Interaction With Other Drugs | |
| Generic Name Or Drug Class | Combined Effect |
| Adrenocorticoids, systemic | Increased risk of mental side effects. |
| Anticoagulants, oral | Possible increased anticoagulant effect. |
| Anticholinergics | Increased anticholinergic effect. |
| Antlfungals, azoles | Increased effect of antidepressant. |
| Antihistamines | Increased antihistamine effect. |
| Barbiturates | Decreased antidepressant effect. Increased sedation. |
| Benzodiazepines | Increased sedation. |
| Bupropion | Increased risk of seizures. |
| Central nervous system (CNS) depressants | Excessive sedation. |
| Cimetidine | Possible increased tricyclic antidepressant effect and toxicity. |
| Citalopram | Increased tricyclic antidepressant effect and toxicity. |
| Clonidine | Blood pressure increase. Avoid combination. |
| Clozapine | Toxic effect on the central nervous system. |
| Contraceptives, oral | Increased depression. |
| Dextrothyroxine | Increased antidepressant effect. Irregular heartbeat. |
| Disulfiram | Delirium. |
| Ethchlorvynol | Delirium. |
| Fluoxetine | Increased effect of tricyclic antidepressant. Possible toxicity. |
| Fluvoxamine | Increased antidepressant effect. |
| Furazolidine | Sudden, severe increase in blood pressure. |
| Guanabenz | Decreased guanabenz effect. |
| Guanadrel | Decreased guanadrel effect. |
| Guanethidine | Decreased guanethidine effect. |
| Haloperidol | Decreased lamotrigine effect. |
| Leucovorin | High alcohol content of leucovorin may cause adverse effects. |
| Levodopa | May increase blood pressure. May decrease levodopa effect. |
| Lithium | Possible decreased seizure threshold. |
| Methyldopa | Possible decreased methyldopa effect. |
| Methylphenidate | Possible increased tricyclic antidepressant effect and toxicity. |
| Modafinil | Increased anti- depressant effect. |
| Molindone | Increased molindone effect. |
| Monoamine oxidase (MAO) inhibitors | Fever, delirium, convulsions. |
| Narcotics | Oversedation. |
| Nicotine | Increased effect of antidepressant (with imipramine). |
| Phenothlazines | Possible increased tricyclic antidepressant effect and toxicity. |
| Phenytoin | Decreased phenytoin effect. |
| Procainamide | Possible irregular heartbeat. |
| Quinidine | Possible irregular heartbeat. |
| Sertraline | Increased depressive effects of both drugs. |
| Sympathomimetics | Increased sympathomimetic effect. |
| Thyroid hormones | Irregular heartbeat. |
| Tolcapone | May increase incidence of adverse effects of tolcapone. |
| Zaleplon | Increased effect of either drug. Avoid. |
| Zolpidem | Increased sedative effect. Avoid. |
|
Possible Interaction With Other Substances |
|
| Interacts With | Combined Effect |
| Alcohol: Beverages or medicines with alcohol. |
Excessive intoxication. Avoid. |
| Cocaine | Increased risk of heartbeat irregularity. |
| Marijuana | Excessive drowsiness. Increased risk of side effects. Avoid. |
| Tobacco | Possible decreased tricyclic antidepressant effect. |
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