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Tricyclic Antidepressant
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Tricyclic Antidepressant
, Tetracyclic Antidepressant
See Also
Antidepressant
SNRI
Tricyclic Antidepressant Overdose
Preparations
Tricyclic Antidepressants - First generation (Tertiary amines)
Gene
ral
Greater
Analgesic
properties than second generation
Agents
Amitriptyline
(
Elavil
, Endep)
Clomipramine (Anafranil)
Imipramine
(
Tofranil
)
Trimipramine (Surmontil)
Doxepin (Sinequan, Adapin)
Preparations
Tricyclic Antidepressants - Second generation (Secondary amines)
Gene
ral
Less adverse effects than first generation
Agents
Nortriptyline
(
Pamelor
,
Aventyl
)
Desipramine
(
Norpramin
)
Protriptyline (Vivactil)
Preparations
Tetracyclic Antidepressants (rarely used)
Maprotiline (Ludiomil)
Increased seizure
Incidence
Amoxapine (Asendin)
Severe
Extrapyramidal Side Effect
s
Adverse Effects
Gene
ral
Unable to tolerate full dose: 80%
Medication discontinued due to adverse effects: 30%
Secondary amines are much better tolerated
Anticholinergic Symptoms
Dry Mouth
Constipation
Blurred Vision
Antihistamine
rgic effects
Sedation (limits use)
Weight gain
Serotoninergic
Effects
Sexual Dysfunction
Cardiovascular effects:
Orthostatic Hypotension
Pro-Arrhythmic Effects (Class I
Antiarrhythmic
type)
Sinus Tachycardia
Supraventricular Tachycardia
Ventricular Tachycardia
Ventricular Fibrillation
Prolongation of PR, QRS or
QT Interval
ST Segment and
T Wave
changes
Bundle Branch Block
or complete
Heart Block
Antidepressant Withdrawal
Prevent by tapering gradually, even over months
Drug Interactions
Cardiovascular
Absolute Contraindications
Clonidine
(
Hypotension
)
Class I
Antiarrhythmic
s (e.g.
Quinidine
,
Flecainide
)
Prolonged QT
Interval
Other interactions
Coumadin
(increases
ProTime
)
Aspirin
(increases Tricyclic Antidepressant level)
Fluoxetine
(increases Tricyclic Antidepressant level)
Precautions
Overdosage effects
See
Tricyclic Antidepressant Overdose
Cardiotoxicity
Death
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