Oral
- Amitriptyline
- Syrup (Canada)
- Tablets (U.S. and Canada)
- Amoxapine
- Tablets (U.S. and Canada)
- Clomipramine
- Capsules (U.S.)
- Tablets (Canada)
- Desipramine
- Tablets (U.S. and Canada)
- Doxepin
- Capsules (U.S. and Canada)
- Oral solution (U.S.)
- Imipramine
- Capsules (U.S.)
- Tablets (U.S. and Canada)
- Nortriptyline
- Capsules (U.S. and Canada)
- Oral solution (U.S.)
- Protriptyline
- Tablets (U.S. and Canada)
- Trimipramine
- Capsules (U.S. and Canada)
- Tablets (Canada)
Parenteral
Before Using This Medicine
In deciding to use a medicine, the
risks of taking the medicine must be weighed against the good it will
do. This is a decision you and your doctor will make. For tricyclic
antidepressants, the following should be considered:
Allergies-
Tell your doctor if you have ever had any unusual or allergic
reaction to any tricyclic antidepressant or to carbamazepine,
maprotiline, or trazodone. Also tell your health care professional if
you are allergic to any other substances, such as foods, preservatives,
or dyes.
Pregnancy-
Studies have not been done in pregnant women. However, there have
been reports of newborns suffering from muscle spasms and heart,
breathing, and urinary problems when their mothers had taken tricyclic
antidepressants immediately before delivery. Also, studies in animals
have shown that some tricyclic antidepressants may cause unwanted
effects in the fetus.
Breast-feeding-
Tricyclic antidepressants pass into the breast milk. Doxepin has
been reported to cause drowsiness in the nursing baby.
Children-
Children are especially sensitive to the effects of this medicine.
This may increase the chance of side effects during treatment. However,
side effects in children taking this medicine for bedwetting usually
disappear upon continued use. The most common of these are nervousness,
sleeping problems, tiredness, and mild stomach upset. If these side
effects continue or are bothersome, check with your doctor.
Older adults-
Drowsiness, dizziness, confusion, vision problems, dryness of mouth,
constipation, and problems in urinating are more likely to occur in
elderly patients, who are usually more sensitive than younger adults to
the effects of tricyclic antidepressants.
Other medicines-
Although certain medicines
should not be used together at all, in other cases 2 different medicines
may be used together even if an interaction might occur. In these cases,
your doctor may want to change the dose, or other precautions may be
necessary. When you are taking a tricyclic antidepressant, it is
especially important that your health care professional know if you are
taking any of the following:
- Amphetamines or
- Appetite suppressants (diet pills)
or
- Ephedrine or
- Epinephrine (e.g., Adrenalin) or
- Isoproterenol (e.g., Isuprel) or
- Medicine for asthma or other
breathing problems or
- Medicine for colds, sinus problems,
or hay fever or other allergies or
- Phenylephrine (e.g., Neo-Synephrine)—Using
these medicines with tricyclic antidepressants may increase the risk
of serious effects on the heart
- Antipsychotics (medicine for mental
illness) or
- Clonidine (e.g., Catapres)—Using
these medicines with tricyclic antidepressants may increase the CNS
depressant effects and increase the chance of serious side effects
- Antithyroid agents (medicine for
overactive thyroid) or
- Cimetidine (e.g., Tagamet)—Using
these medicines with tricyclic antidepressants may increase the chance
of serious side effects
- Central nervous system (CNS)
depressants (medicine that causes drowsiness)—Using these medicines
with tricyclic antidepressants may increase the CNS depressant effects
- Guanadrel (e.g., Hylorel) or
- Guanethidine (e.g., Ismelin)—Tricyclic
antidepressants may keep these medicines from working as well
- Methyldopa (e.g., Aldomet) or
- Metoclopramide (e.g., Reglan) or
- Metyrosine (e.g., Demser) or
- Pemoline (e.g., Cylert) or
- Pimozide (e.g., Orap) or
- Promethazine (e.g., Phenergan) or
- Rauwolfia alkaloids (alseroxylon
[e.g., Rauwiloid], deserpidine [e.g., Harmonyl], rauwolfia serpentina
[e.g., Raudixin], reserpine [e.g., Serpasil]) or
- Trimeprazine (e.g., Temaril)—Tricyclic
antidepressants may cause certain side effects to be more severe and
occur more often
- Metrizamide—The risk of seizures may
be increased
- Monoamine oxidase (MAO) inhibitors (furazolidone
[e.g., Furoxone], isocarboxazid [e.g., Marplan], phenelzine [e.g.,
Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl],
tranylcypromine [e.g., Parnate])—Taking tricyclic antidepressants
while you are taking or within 2 weeks of taking MAO inhibitors may
cause sudden high body temperature, extremely high blood pressure,
severe convulsions, and death; however, sometimes certain of these
medicines may be used together under close supervision by your doctor
Other medical problems-
The presence of other medical
problems may affect the use of tricyclic antidepressants. Make sure you
tell your doctor if you have any other medical problems, especially:
- Alcohol abuse (or history
of)—Drinking alcohol may cause increased CNS depressant effects
- Asthma or
- Bipolar disorder (manic-depressive
illness) or
- Blood disorders or
- Convulsions (seizures) or
- Difficult urination or
- Enlarged prostate or
- Glaucoma or increased eye pressure
or
- Heart disease or
- High blood pressure (hypertension)
or
- Schizophrenia—Tricyclic
antidepressants may make the condition worse
- Kidney disease or
- Liver disease—Higher blood levels of
tricyclic antidepressants may result, increasing the chance of side
effects
- Overactive thyroid or
- Stomach or intestinal problems—Tricyclic
antidepressants may cause an increased chance of serious side effects
Proper Use of This Medicine
To lessen stomach upset, take
this medicine with food, even for a daily bedtime dose, unless your
doctor has told you to take it on an empty stomach.
Take this medicine only as directed
by your doctor
Sometimes this medicine must be
taken for several weeks before you begin to feel better
To use doxepin oral solution:
- This medicine is to be taken by
mouth even though it comes in a dropper bottle. The amount you should
take should be measured with the dropper provided with your
prescription and diluted just before you take each dose. Dilute each
dose with about one-half glass (4 ounces) of water, milk, citrus fruit
juice, tomato juice, or prune juice. Do not mix this medicine with
grape juice or carbonated beverages since these may decrease the
medicine's effectiveness.
- Doxepin oral solution must be mixed
immediately before you take it. Do not prepare it ahead of time.
Dosing-
The dose of tricyclic
antidepressants will be different for different patients. Follow your
doctor's orders or the directions on the label. The following
information includes only the average doses of tricyclic
antidepressants. If your dose is different, do not change it
unless your doctor tells you to do so.
The number of capsules or tablets, or
the amount of solution or syrup that you take depends on the strength of
the medicine. Also, the number of doses you take each day, the time
allowed between doses, and the length of time you take the medicine
depend on the medical problem for which you are taking tricyclic
antidepressants.
For amitriptyline
- For tablet dosage form:
- For depression:
- Adults—At first, 25 milligrams
(mg) two to four times a day. Your doctor may increase your dose
gradually as needed. However, the dose is usually not more than
150 mg a day, unless you are in the hospital. Some hospitalized
patients may need higher doses.
- Teenagers—At first, 10 mg three
times a day, and 20 mg at bedtime. Your doctor may increase your
dose gradually as needed. However, the dose is usually not more
than 100 mg a day.
- Children 6 to 12 years of age—10
to 30 mg a day.
- Children up to 6 years of
age—Use and dose must be determined by your doctor.
- Older adults— At first, 25 mg at
bedtime. Your doctor may increase your dose gradually as needed.
However, the dose is usually not more than 100 mg a day.
- For syrup dosage form:
- For depression:
- Adults—At first, 25 mg two to
four times a day. Your doctor may increase your dose gradually as
needed.
- Teenagers—At first, 10 mg three
times a day, and 20 mg at bedtime. Your doctor may increase your
dose gradually as needed. However, the dose is usually not more
than 100 mg a day.
- Children 6 to 12 years of age—10
to 30 mg a day.
- Children up to 6 years of
age—Use and dose must be determined by your doctor.
- Older adults—At first, 10 mg
three times a day, and 20 mg at bedtime. Your doctor may increase
your dose gradually as needed. However, the dose is usually not
more than 100 mg a day.
- For injection dosage form:
- For depression:
- Adults—20 to 30 mg four times a
day, injected into a muscle.
- Children up to 12 years of
age—Use and dose must be determined by your doctor.
For amoxapine
- For tablet dosage form:
- For depression:
- Adults—At first, 50 milligrams
(mg) two to three times a day. Your doctor may increase your dose
gradually as needed.
- Children up to 16 years of
age—Use and dose must be determined by your doctor.
- Older adults—At first, 25 mg two
to three times a day. Your doctor may increase your dose gradually
as needed.
For clomipramine
- For capsule or tablet dosage
forms:
- For obsessive-compulsive
disorders:
- Adults—At first, 25 milligrams
(mg) once a day. Your doctor may increase your dose gradually as
needed. However, the dose is usually not more than 250 mg a day,
unless you are in the hospital. Some hospitalized patients may
need higher doses.
- Teenagers and children 10 years
of age and over—At first, 25 mg once a day. Your doctor may
increase your dose gradually as needed. However, the dose is
usually not more than 200 mg a day.
- Children up to 10 years of
age—Use and dose must be determined by your doctor.
- Older adults—At first, 20 to 30
mg a day. Your doctor may increase your dose gradually as needed.
For desipramine
- For tablet dosage form:
- For depression:
- Adults—100 to 200 milligrams
(mg) a day. Your doctor may increase your dose gradually as
needed. However, the dose is usually not more than 300 mg a day.
- Teenagers—25 to 50 mg a day.
Your doctor may increase your dose gradually as needed. However,
the dose is usually not more than 100 mg a day.
- Children 6 to 12 years of age—10
to 30 mg a day.
- Older adults—25 to 50 mg a day.
Your doctor may increase your dose gradually as needed. However,
the dose is usually not more than 150 mg a day.
For doxepin
- For capsule or solution
dosage forms:
- For depression:
- Adults—At first, 25 milligrams
(mg) three times a day. Your doctor may increase your dose
gradually as needed. However, the dose is usually not more than
150 mg a day, unless you are in the hospital. Some hospitalized
patients may need higher doses.
- Children up to 12 years of
age—Use and dose must be determined by your doctor.
- Older adults—At first, 25 to 50
mg a day. Your doctor may increase your dose gradually as needed.
For imipramine
- For tablet dosage form:
- For depression:
- Adults—25 to 50 milligrams (mg)
three to four times a day. Your doctor may increase your dose
gradually as needed. However, the dose is usually not more than
200 mg a day, unless you are in the hospital. Some hospitalized
patients may need higher doses.
- Adolescents—25 to 50 mg a day.
Your doctor may increase your dose gradually as needed. However,
the dose is usually not more than 100 mg a day.
- Children 6 to 12 years of age—10
to 30 mg a day.
- Children up to 6 years of
age—Use and dose must be determined by your doctor.
- Older adults—At first, 25 mg at
bedtime. Your doctor may increase your dose gradually as needed.
However, the dose is usually not more than 100 mg a day.
- For bedwetting:
- Children—25 mg once a day, taken
one hour before bedtime. Your doctor may increase the dose as
needed, based on the child's age.
- For capsule dosage form:
- For depression:
- Adults—At first, 75 mg a day
taken at bedtime. Your doctor may increase your dose gradually as
needed. However, the dose is usually not more than 200 mg a day,
unless you are in the hospital. Some hospitalized patients may
need higher doses.
- Children up to 12 years of
age—Use and dose must be determined by your doctor.
- For injection dosage form:
- For depression:
- Adults—Dose must be determined
by your doctor. It is injected into a muscle. The dose is usually
not more than 300 mg a day.
- Children up to 12 years of
age—Use and dose must be determined by your doctor.
For nortriptyline
- For capsule or solution
dosage forms:
- For depression:
- Adults—25 milligrams (mg) three
to four times a day. Your doctor may increase your dose gradually
as needed. However, the dose is usually not more than 150 mg a
day.
- Teenagers—25 to 50 mg a day.
Your doctor may increase your dose gradually as needed.
- Children 6 to 12 years of age—10
to 20 mg a day.
- Older adults—30 to 50 mg a day.
Your doctor may increase your dose gradually as needed.
For protriptyline
- For tablet dosage form:
- For depression:
- Adults—At first, 5 to 10
milligrams (mg) three to four times a day. Your doctor may
increase your dose gradually as needed. However, the dose is
usually not more than 60 mg a day.
- Teenagers—At first, 5 mg three
times a day. Your doctor may increase your dose gradually as
needed.
- Children up to 12 years of
age—Use and dose must be determined by your doctor.
- Older adults—At first, 5 mg
three times a day. Your doctor may increase your dose gradually as
needed.
For trimipramine
- For capsule or tablet dosage
forms:
- For depression:
- Adults—At first, 75 milligrams
(mg) a day. Your doctor may increase your dose as needed. However,
the dose is usually not more than 200 mg a day, unless you are
hospitalized. Some hospitalized patients may need higher doses.
- Teenagers—At first, 50 mg a day.
Your doctor may increase your dose gradually as needed. However,
the dose is usually not more than 100 mg a day.
- Children up to 12 years of
age—Use and dose must be determined by your doctor.
- Older adults—At first, 50 mg a
day. Your doctor may increase your dose gradually as needed.
However, the dose is usually not more than 100 mg a day.
Missed dose-
If you miss a dose of this medicine
and your dosing schedule is:
- One dose a day at bedtime—Do not
take the missed dose in the morning since it may cause disturbing side
effects during waking hours. Instead, check with your doctor.
- More than one dose a day—Take the
missed dose as soon as possible. However, if it is almost time for
your next dose, skip the missed dose, and go back to your regular
dosing schedule. Do not double doses.
If you have any questions about this,
check with your doctor.
Storage-
To store this medicine:
- Keep out of the reach of children.
Overdose of this medicine is very dangerous in young children.
- Store away from heat and direct
light.
- Do not store the tablet or capsule
form of this medicine in the bathroom, near the kitchen sink, or in
other damp places. Heat or moisture may cause the medicine to break
down.
- Keep the liquid form of this
medicine from freezing.
- Do not keep outdated medicine or
medicine no longer needed. Be sure that any discarded medicine is out
of the reach of children.
Precautions While Using This Medicine
It is very important that your
doctor check your progress at regular visits to allow dosage adjustments
and to help reduce side effects.
This medicine will add to the effects
of alcohol and other CNS depressants (medicines that make you drowsy or
less alert). Some examples of CNS depressants are antihistamines or
medicine for hay fever, other allergies, or colds; sedatives,
tranquilizers, or sleeping medicine; prescription pain medicine or
narcotics; barbiturates; medicine for seizures; muscle relaxants; or
anesthetics, including some dental anesthetics. Check with your
medical doctor or dentist before taking any of the above while you are
taking this medicine .
This medicine may cause some people to
become drowsy. If this occurs, do not drive, use machines, or do
anything else that could be dangerous if you are not alert.
Dizziness, lightheadedness, or
fainting may occur
This medicine may cause dryness of
the mouth. For temporary relief, use sugarless gum or candy, melt bits
of ice in your mouth, or use a saliva substitute
Tricyclic antidepressants may cause
your skin to be more sensitive to sunlight than it is normally. Exposure
to sunlight, even for brief periods of time, may cause a skin rash,
itching, redness or other discoloration of the skin, or a severe
sunburn. When you begin taking this medicine:
- Stay out of direct sunlight,
especially between the hours of 10:00 a.m. and 3:00 p.m., if possible.
- Wear protective clothing, including
a hat. Also, wear sunglasses.
- Apply a sun block product that has a
skin protection factor (SPF) of at least 15. Some patients may require
a product with a higher SPF number, especially if they have a fair
complexion. If you have any questions about this, check with your
health care professional.
- Apply a sun block lipstick that has
an SPF of at least 15 to protect your lips.
- Do not use a sunlamp or tanning bed
or booth.
If you have a severe reaction from
the sun, check with your doctor
Before you have any medical tests, tell
the medical doctor in charge that you are taking this medicine. The
results of the metyrapone test may be affected by this medicine.
Before having any kind of surgery,
dental treatment, or emergency treatment, tell the medical doctor or
dentist in charge that you are using this medicine
For diabetic patients
- This medicine may affect blood sugar
levels. If you notice a change in the results of your blood or urine
sugar tests or if you have any questions, check with your doctor.
Do not stop taking this medicine
without first checking with your doctor
The effects of this medicine may
last for 3 to 7 days after you have stopped taking it
For patients taking protriptyline
- If taken late in the day,
protriptyline may interfere with nighttime sleep.
Side Effects of This Medicine
Along with its needed effects,
a medicine may cause some unwanted effects. Although not all of these
side effects may occur, if they do occur they may need medical
attention.
Stop taking this medicine and get
emergency help immediately if any of the following side effects
occur:
- Reported for amoxapine only--rare
- Convulsions (seizures); difficult
or fast breathing; fever with increased sweating; high or low
(irregular) blood pressure; loss of bladder control; muscle
stiffness (severe); pale skin; unusual tiredness or weakness
- Check with your doctor as soon as
possible if any of the following side effects occur:
- Less common:
Blurred vision; confusion or delirium constipation (especially in
the elderly); decreased sexual ability (more common with amoxapine
and clomipramine); difficulty in speaking or swallowing; eye pain;
fainting; fast or irregular heartbeat (pounding, racing, skipping);
hallucinations; loss of balance control; mask-like face; nervousness
or restlessness; problems in urinating; shakiness or trembling;
shuffling walk; slowed movements; stiffness of arms and legs
- Reported for amoxapine only (in
addition to the above)
- less common: Lip smacking
or puckering; puffing of cheeks; rapid or worm-like movements of
tongue; uncontrolled chewing movements; uncontrolled movements of
hands, arms, or legs
- Rare: Anxiety; breast
enlargement in both males and females; hair loss; inappropriate
secretion of milk—in females; increased sensitivity to sunlight;
irritability; muscle twitching; red or brownish spots on
skin; ringing, buzzing, or other unexplained sounds in the
ears; seizures (more common with clomipramine); skin rash and
itching; sore throat and fever; swelling of face and tongue;
swelling of testicles (more common with amoxapine); trouble with
teeth or gums (more common with clomipramine); weakness; yellow eyes
or skin
- Symptoms of acute overdose:
Confusion; convulsions (seizures); disturbed concentration; drowsiness
(severe); enlarged pupils; fast, slow, or irregular heartbeat; fever;
hallucinations (seeing, hearing, or feeling things that are not
there); restlessness and agitation; shortness of breath or troubled
breathing; unusual tiredness or weakness (severe); vomiting
Other side effects may occur that
usually do not need medical attention. These side effects may go away
during treatment as your body adjusts to the medicine. However, check
with your doctor if any of the following side effects continue or are
bothersome:
- More common: Dizziness;
drowsiness; dryness of mouth; headache; increased appetite (may
include craving for sweets); nausea; tiredness or weakness (mild);
unpleasant taste; weight gain
- Less common: Diarrhea;
heartburn; increased sweating; trouble in sleeping (more common with
protriptyline, especially when taken late in the day); vomiting
Certain side effects of this medicine
may occur after you have stopped taking it. Check with your doctor if
you notice any of the following effects:
- Headache; irritability; nausea,
vomiting, or diarrhea; restlessness; trouble in sleeping, with vivid
dreams; unusual excitement
- Reported for amoxapine only (in
addition to the above): Lip smacking or puckering; puffing of
cheeks; rapid or worm-like movements of the tongue; uncontrolled
chewing movements; uncontrolled movements of arms or legs
Other side effects not listed above
also may occur in some patients. If you notice any other effects, check
with your doctor.
Additional Information:
Once a medicine has been
approved for marketing for a certain use, experience may show that it is
also useful for other medical problems. Although these uses are not
included in product labeling, tricyclic antidepressants are used in
certain patients with the following medical conditions:
- Attention deficit hyperactivity
disorder (hyperactivity in children) (desipramine, imipramine, and
protriptyline)
- Bulimia (uncontrolled eating,
followed by vomiting) (amitriptyline, clomipramine, desipramine, and
imipramine)
- Cocaine withdrawal (desipramine and
imipramine)
- Headache prevention (for certain
types of frequent or continuing headaches) (most tricyclic
antidepressants)
- Itching with hives due to cold
temperature exposure (doxepin)
- Narcolepsy (extreme tendency to fall
asleep suddenly) (clomipramine, desipramine, imipramine, and
protriptyline)
- Neurogenic pain (a type of
continuing pain) (amitriptyline, clomipramine, desipramine, doxepin,
imipramine, nortriptyline, and trimipramine)
- Panic disorder (clomipramine,
desipramine, doxepin, nortriptyline, and trimipramine)
- Stomach ulcer (amitriptyline,
doxepin, and trimipramine)
- Urinary incontinence (imipramine)
Some commonly used brand names are:
In the U.S.-
- Anafranil
- Asendin
- Aventyl
- Elavil
- Endep
- Norfranil
- Norpramin
|
- Pamelor
- Sinequan
- Surmontil
- Tipramine
- Tofranil
- Tofranil-PM
- Vivactil
|
In Canada-
- Anafranil
- Apo-Amitriptyline
- Apo-Imipramine
- Apo-Trimip
- Asendin
- Aventyl
- Elavil
- Impril
- Levate
- Norpramin
- Novo-Doxepi
|
- Novopramine
- Novo-Tripramine
- Novotriptyn
- Pertofrane
- Rhotrimine
- Sinequan
- Surmontil
- Tofranil
- Triadapin
- Triptil
|
|
