TRICYCLIC ANTIDEPRESSANTS

Brand & Generic Names

Adapin	Norfranil
AMITRYPTILINE	Norpramin
AMOXAPINE	NORTRIPTYLINE
Anafranil	Novo-Doxepin
Apo-Amitriptyline	Novopramine
Apo-Imipramine	Novo-Tripramine
Apo-Trimip	Novotriptyn
Asendin	Pamelor
Aventyl	Pertofrane
CLOMIPRAMINE	PMS Amitriptyline
DESIPRAMINE	PMS Impramine
DOXEPIN	PROTIPTYLINE
Elavil	Rhotrimine
Emitrip	Sinequan
Endep	Surmontil
Enovil	Tipramine
IMIPRAMINE	Tofranil
Impril	Tofranil-PM
Janimine	Triadapin
Levate	TRIMIPRAMINE
Limbitrol	Triptil
Limbitrol DS	Vivactil

Basic Information

• Habit forming? No
• Prescription needed? Yes
• Available as generic? Yes
• Drug class: Antidepressant (tricyclic)

Uses

• Gradually relieves, but doesn't cure, symptoms of depression.
• Used to decrease bedwetting.
• Pain relief (sometimes).
• Clomipramine is used to treat obsessive-compulsive disorder.
• Protriptyline may be used to treat attention-deficit disorder.
• Treatment for narcolepsy, ulcers, bulimia, panic attacks, cocaine withdrawal, attention deficit disorder.

Dosage & Usage Information

How to take:
Tablet, capsule or syrup--Swallow with liquid.

When to take:
At the same time each day, usually at bedtime.

If you forget a dose:
Bedtime dose--If you forget your once-a- day bedtime dose, don't take it more than 3 hours late. If more than 3 hours, wait for next scheduled dose. Don't double this dose.

What drug does:
Probably affects part of brain that controls messages between nerve cells.

Time lapse before drug works:
Begins in 1 to 2 weeks. May require 4 to 6 weeks for maximum benefit.

Don't take with:
Any other medicine without consulting your doctor or pharmacist.

Overdose

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

WHAT TO DO:

• 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.
• See EMERGENCY Information.

Possible Adverse Reactions or Side Effects

Life-threatening:

In case of overdose, see Overdose section.

Common:

• Tremor.
• Headache, dry mouth or unpleasant taste, constipation or diarrhea, nausea, indigestion, fatigue, weakness, drowsiness, nervousness, anxiety, excessive sweating
• Insomnia, "sweet tooth."

Infrequent:

• Convulsions.
• 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.
• Difficult or frequent urination; decreased sex drive; muscle aches; abnormal dreams; nasal congestion; weakness and faintness when arising from bed or chair; back pain.

Rare:

Itchy skin; sore throat; involuntary movements of jaw, lips and tongue; nightmares; confusion; swollen breasts; swollen testicles.

Warnings & Precautions

Don't take if:

• You are allergic to any tricyclic antidepressant.
• You drink alcohol.
• You have had a heart attack within 6 weeks.
• You have glaucoma.
• You have taken MAO 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.
• 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.

Over age 60:
More likely to develop urination difficulty and side effects such as seizures, hallucinations, shaking, dizziness, fainting, headache, insomnia.

Pregnancy:
Studies inconclusive on harm to unborn child. Animal studies show fetal abnormalities. Decide with your doctor whether drug benefits justify risk to unborn child.

Breast-feeding:
Drug passes 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.

Prolonged use:
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.

Skin & sunlight:
May cause rash or intensify sunburn in areas exposed to sun or sunlamp.

Driving, piloting or hazardous work:
Don't drive or pilot aircraft until you learn how medicine affects you. Don't work around dangerous machinery. Don't climb ladders or work in high places. Danger increases if you drink alcohol or take medicine affecting alertness and reflexes.

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.

Others:
May affect results in some medical tests.

Possible Interaction with Other Drugs

GENERIC NAME	COMBINED EFFECT
------------------------	-----------------------
Anticoagulants*,	Possible increased
oral	anticoagulant effect.
Anticholinergics*	Increased anticholinergic effect.
Antihistamines*	Increased antihistamine effect.
Barbiturates*	Decreased antidepressant effect.
	Increased sedation.
Benzodiazepines*	Increased sedation.
Bupropion	Increased risk of major seizures.
Central nervous system	Excessive sedation.
Cimetidine	Possible increased tricyclic
	antidepressant effect and toxicity.
Clonidine	Possible decreased clonidine
	effect.
Clozapine	Toxic effect on the central nervous
	system.
Contraceptives*,	Increased depression.
Dextrothyroxine	Increased antidepressant effect.
	Irregular heartbeat.
Disulfiram	Delirium.
Ethchlorvynol	Delirium.
Ethinamate	Dangerous increased effects of
	ethinamate. Avoid combining.
Fluoxetine	Increased depressant effects of
	both drugs.
Furazolidine	Sudden, severe increase in
	blood pressure.
Guanabenz	Decreased guanabenz effect.
Guanadrel	Decreased guanadrel effect.
Guanethidine	Decreased guanethidine effect.
Leucovorin	High alcohol content of leucovorin
	may cause adverse effects.
Levodopa	May increase blood pressure.
Lithium	Possible decreased seizure
	threshold.
MAO inhibitors*	Fever, delirium, convulsions.
Methyldopa	Possible decreased methyldopa
	effect.
Methylphenidate	Possible increased tricyclic
	antidepressant effect and toxicity.
Methyprylon	Increased sedative effect, perhaps
	to dangerous level. Avoid.
Metyrosine	Increased sedative effect.
Molindone	Increased molindone effect.
Nabilone	Greater depression of central
	nervous system.
Narcotics*	Oversedation.
Nicotine	Increased effect of antidepressant
	(with imipramine).
Phenothiazines*	Possible increased tricyclic
	antidepressant effect and toxicity.
Phenytoin	Decreased phenytoin effect.
Procainamide	Possible irregular heartbeat.
Quinidine	Possible irregular heartbeat.
Sedatives*	Dangerous oversedation.
Sertraline	Increased depressive effects
	of both drugs.
Sympathomimetics*	Increased sympathomimetic effect.
Thyroid hormones*	Irregular heartbeat.
Zolpidem	Increased sedative effect. Avoid.

Possible Interaction with Other Substances

INTERACTS WITH	COMBINED EFFECT
---------------	---------------
Beverages or medicines	Excessive intoxication.
with alcohol.	Avoid.
Beverages:	None expected.
Cocaine:	Increased risk of heartbeat
	irregularity.
Breads, crackers,	Decreased effectiveness of
cookies, cheeses,	the antidepressant.
Marijuana:	Excessive drowsiness. Avoid.
Tobacco:	Possible decreased tricyclic
	antidepressant effect.