TCA Antidepressants

Question 1

Doxepine (Adapine, Sinequan)

Answer 1

Comment: highly anticholinergic, very sedating

Half-life: 16hr

Side effects: anticholinergic: dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic blockage), tachycardia, prolongation of QT interval, weight gain

Comments: concern about a risk of falling in elderly patients.

Question 2

Imipramine (Tofranil)

Answer 2

Comment: highly anticholinergic

Half-life: 20hr

Side effects: anticholinergic: dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic blockage), tachycardia, prolongation of QT interval, weight gain

Comments: concern about a risk of falling in elderly patients.

Question 3

Clomipramine (Anafranil)

Answer 3

Comment: highly anticholinergic, very sedating, OCD responds specifically to clomipramine, may be useful with depression with marked obsessive features

Half-life: 21hr

Side effects: anticholinergic: dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic blockage), tachycardia, prolongation of QT interval, weight gain

Comments: concern about a risk of falling in elderly patients.

Question 4

Trimipramine (Surmontil)

Answer 4

Comment: highly anticholinergic, very sedating

Half-life: 22hr

Side effects: anticholinergic: dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic blockage), tachycardia, prolongation of QT interval, weight gain

Comments: concern about a risk of falling in elderly patients.

Question 5

Despramine (Norpramine)

Answer 5

Comment: least anticholinergic, not sedating, good for elderly

Half-life: 24hr

Side effects: anticholinergic: dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic blockage), tachycardia, prolongation of QT interval, weight gain

Comments: concern about a risk of falling in elderly patients.

Question 6

Nortryptaline (Pamelor)

Answer 6

Comment: used in neuropathic pain, less anticholinergic, used in elderly

Half-life: 12hr

Side effects: anticholinergic: dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic blockage), tachycardia, prolongation of QT interval, weight gain

Comments: concern about a risk of falling in elderly patients.

Question 7

Protryptiline (Vivactil)

Answer 7

Side effects: psychomotor stimulation

Comment: less anticholinergic, not sedating

Half-life: 6hr

Side effects: anticholinergic: dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic blockage), tachycardia, prolongation of QT interval, weight gain

Comments: concern about a risk of falling in elderly patients.

Question 8

Amoxapine (Asendin, Asendas)

Answer 8

Side effects: may cause extrapyramidal symptoms and NMS (metabolite of loxapine)

Comment: less anticholinergic

Half-life: 30hr

Side effects: anticholinergic: dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic blockage), tachycardia, prolongation of QT interval, weight gain

Comments: concern about a risk of falling in elderly patients.

Question 9

Amitryptyline (Elavil)

Answer 9

Comment: highly anticholinergic - can be used for enuresis, very sedating

Half-life: 20hr

Side effects: anticholinergic: dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic blockage), tachycardia, prolongation of QT interval, weight gain

Comments: concern about a risk of falling in elderly patients.