DEPRESSION: TCAS Flashcards
MoA
Inhibits the reuptake of 5-HT + NA
Also blocks a wide array of receptors (M, H1, alpha1/2 and D2)
Sedating TCAs
Amitriptyline (also used in neuropathic pain)
Clomipramine
Dosulepin (dangerous in overdose - specialist use)
Doxepin
Trimipramine
Mianserin
Trazadone
When would you give a sedating TCA?
Give in anxious, agitated patients
Less sedating TCAs
Imipramine (most antimuscarinic effects)
Lofepramine (rarely causes hepatotoxicity)
Nortriptyline (also used in neuropathic pain)
When would you give a less sedating TCA
Given in withdrawn, apathetic patients
How are amitriptyline SEs reduced?
Side-effects are reduced by titrating slowly to the minimum effective dose (every 2-3 days)
Amitriptylline overdose
o dry mouth, coma, hypotension, hypothermia hyperreflexia, extensor plantar responses, convuslions, respiratory failure, cardiac conduction defects and arrhythmias
Side effects
More sedating, epileptogenic (seizures), cardiotoxic and antimuscarinic than SSRIs.
They are also more toxic in overdose.
Cardiac side effects
QT prolongation
Arrhythmias
Heart block
Hypertension
Antimuscarinic side effects
Dry mouth
Blurred vision
Constipation
Tachycardia
Urinary retention
Pupil dilation
Raised intraocular pressure
Angle closure glaucoma
Other side effects
Hallucinations
Mania (increased 5-HT/NA)
Hypotension (alpha blockade)
Sexual dysfunction
Breast changes
Extrapyramidal SE (d blockade)
Interactions - increased risk of hyponatraemia
Diuretics (loop/thiazide)
Desmopressin
Carbamazepine
Interactions - increased plasma concentrations
Cimetidine (enzyme inhibitors)
Interactions - increased risk of QT prolongation (clomipramine)
Amiodarone
Sotalol
Antipsychotics
Citalopram/escitalopram
Loop/thiazide diuretics
B2 agonists
Corticosteroids
Theophylline
Interactions - increased risk of hypotension
Antihypertensive
- Alpha blockers
- Beta blockers
- ACEi
- CCBs
Antipsychotics
Levodopa/dopaminergic
NSAIDs
SGLT2 inhibitors (gliflozin)
Diuretics
Phosphodiesterase type-5 inhibitors (sildenafil)
