Tricyclic antidepressants and related drugs

Question 1

What is it indicated for?

Answer 1

Second-line treatment for moderate-severe depression
Neuropathic pain
Irritable bowel syndrome

Question 2

What other indication can amitriptyline be used for?

Answer 2

prevention of frequent migraine attacks

Question 3

How do they work?

Answer 3

They inhibit reuptake of serotonin and noradrenaline

Question 4

What side effects occur with these drugs?

Answer 4

ENT;
blurred vision
Dry mouth

Genitourinary symptoms: constipation/ urinary retention

Neurological symptoms:
cognitive impairment, sedation, hallucinations, mania, seizures

Cardiovascular:
hypotension, arrhythmias

Sexual changes; sexual dysfunction
breast changes

Question 5

What side effects occur due to sudden withdrawal of this drug?

Answer 5

GI upset
neurological and flu-like symptoms
sleep disturbances

Question 6

Why do they have so many side effects?

Answer 6

They can block many receptors such as histamine α-adrenergic (α1 and α2), and dopamine (D2) receptors.

Question 7

What are the warnings for these drugs/

Answer 7

caution in elderly, epilepsy, cardiovascular disease

May worsen constipation, glaucoma and prostatic enlargement due to antimuscarinic effects

Question 8

What are the important interactions with this drug class and other drugs?

Answer 8

Monoamine oxidase inhibitors- cause hypertension, hyperthermia or serotonin syndrome

They can augment sedation or hypotensive effect of other drugs