Tricyclic antidepressants

Question 1

Generic drug names
Tricyclic antidepressants

Answer 1

Amitriptyline
Clomipramine
Dosulepin
Doxepin
Imipramine
Nortriptyline

Question 2

“triptyline”, “pramine”, “epin” Suffix

Answer 2

Tricyclic antidepressants

Question 3

Tricyclic antidepressants Suffix

Answer 3

“triptyline”, “pramine”, “epin”

Question 4

Indication
Tricyclic antidepressants

Answer 4

Major depression

Question 5

MOA
Tricyclic antidepressants

Answer 5

TCAs inhibit reuptake of noradrenaline and serotonin into presynaptic terminals

Question 6

Precautions
Tricyclic antidepressants

Answer 6

• Epilepsy, history of seizures or other risks for reduced seizure threshold, including treatment with drugs that may increase the risk of seizures
• Overdose carries high risk of fatality; avoid TCAs if there is a high risk for overdose/suicide.

Question 7

Adverse effects
Tricyclic antidepressants

Answer 7

sedation, dry mouth, blurred vision, constipation, weight gain, orthostatic hypotension

Question 8

Counselling
Tricyclic antidepressants

Answer 8

• You may get side effects such as blurred vision, drowsiness and dry mouth. They may be troublesome but may lessen or disappear after about 7 days.
• Try taking this medicine at night to reduce daytime drowsiness
• Do not stop suddenly
• More affected by alcohol

Question 9

Practice points
Tricyclic antidepressants

Answer 9

• check BP
• May experience side effect right away, therapeutic effect is delayed (2wks)
• Increased risk of suicidal thoughts
• Overdose is fatal

Question 10

Drug class and indication

Amitriptyline

Answer 10

Tricyclic antidepressants
Major depression

Question 11

Drug class and indication

Clomipramine

Answer 11

Tricyclic antidepressants
OCD
Major depression
Cataplexy associated with narcolepsy

Question 12

Drug class and indication

Dosulepin

Answer 12

Tricyclic antidepressants
Major depression

Question 13

Drug class and indication

Doxepin

Answer 13

Tricyclic antidepressants
Major depression

Question 14

Drug class and indication

Imipramine

Answer 14

Tricyclic antidepressants
Major depression

Question 15

Drug class and indication

Nortriptyline

Answer 15

Tricyclic antidepressant
Major depression

Question 16

Drug interactions
Tricyclic antidepressants

Answer 16

• TCAs have anticholinergic effects; combinations with other drugs with anticholinergic effects
• They have sympathomimetic effects; use combinations with other drugs* with sympathomimetic effects (eg pseudoephedrine, adrenaline) cautiously
• They cause CNS depression and orthostatic hypotension; administration with drugs* that also depress the CNS or reduce BP may add to these adverse effects; use such combinations cautiously.
• clonidine + tricyclic antidepressants = Low BP
• SSRIs + tricyclic antidepressants = other antidepressants