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 Sleep  Holistic-online.com

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 

bulletGradually relieves symptoms of depression.
bulletUsed to decrease bedwetting in children.
bulletPain relief (sometimes).
bulletClomipramine is used to treat obsessive- compulsive disorder.
bulletTreatment for narcolepsy, bulimia, panic attacks, cocaine withdrawal, attention-deficit disorder.
bulletMay 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. 

Overdose

Symptoms: Hallucinations, drowsiness, enlarged pupils, respiratory failure, fever, cardiac arrhythmias, convulsions, coma.

What to do in case of overdose: 

bulletDial 911 (emergency) or O (operator) for an ambulance or medical help. Then give first aid immediately.
bulletIf 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:

bulletYou are allergic to any tricyclic antidepressant.
bulletYou drink alcohol in excess.
bulletYou have had a heart attack within 6 weeks.
bulletYou have glaucoma.
bulletYou have taken MAD inhibitors within 2 weeks.
bulletPatient is younger than 12.

Before you start, consult your doctor:

bulletIf you will have surgery within 2 months, including dental surgery, requiring general or spinal anesthesia.
bulletIf you have an enlarged prostate or glaucoma.
bulletIf you have heart disease or high blood pressure.
bulletIf you have stomach or intestinal problems.
bulletIf you have an overactive thyroid.
bulletIf you have asthma.
bulletIf 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

bulletDon'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.
bulletWithdrawal symptoms such as convulsions, muscle cramps, nightmares, insomnia, abdominal pain. Call your physician right away if any of these occur.

Miscellaneous

bulletMay affect results in some medical tests.
bulletAdvise any doctor or dentist whom you consult that you take this medicine.
bulletDon't take with any prescription or nonprescription drugs without consulting your doctor or pharmacist.
bulletRisk factors during pregnancy vary for drugs in this group. Consult your doctor if you are or are planning to become pregnant.
bulletTalk 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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