TCAs, MAOIs Flashcards
TCAs: main side FX and at what rate to increase dose
Sedation (give at HS)
Increase dose by 25-50mg every 3-4 days as tolerated until a therapeutic dose is reached.
Why are TCAs more dangerous in overdose compared to SSRIs?
What are the main side FX? (3 groups)
The TCAs are MUCH more dangerous in overdose than SSRIs due to their binding to voltage-gated sodium channels. This activity could cause seizures or cardiac arrhythmias.
Also, TCAs have more side effects because in addition to binding to serotonin and norepinephrine receptors, they also have anti-alpha1 effects (hypotension, dizziness), anti-histamine effects (sedation, weight gain), and anticholinergic effects (constipation, dry mouth, drowsiness).
Amitryptilline
TCA - (ELAVIL) – start 25mg (target 150-300mg) commonly used for neuropathic pain. Anticholinergic
Clomipramine
TCA - (ANAFRANIL) – start 25mg (target 100-250mg) the original Gold Standard for OCD
Desipramine
TCA - (NORPRAMIN) – start 25mg (target 100-300mg)
Nortryptiline
TCA - (AVENTYL) – start 25mg (target 50mg-150mg)
MAOIs: Side FX
Commonly causes hypotension. Also dry mouth, GI side effects, urinary hesitancy, myoclonic jerks.
Patients need to watch the tyramine levels in the food they eat or they risk running into a hypertensive crisis. High in tyramine: tap beers (usually bottled/canned is ok), smoked meat or fish, fava beans, aged cheeses (processed cheese and mozzarella on pizza is ok), sauerkraut, soy).
MAOis are sometimes seen as the clozapine of antidepressants and may work when other meds have not. This being said I rarely see them used.
Moclobemide
RIMA (selective and Reversible Inhibitor of MAOa) - (MANERIX) – start 150mg BID, max dose 600mg. Because of the reversible binding, lower risk of hypertensive crisis from tyramine ingestion. Not approved in the US.
Tranylcypromine
(PARNATE) (irreversible)
Phenelzine
(NARDIL) (irreversible)
