Antidepressants, Tricyclic (Systemic)

Depression, mental, Also used to manage some types of chronic, severe, neurogenic pain and in the treatment of panic disorder.

FDA Pregnancy Category C

Pediatrics

Although tricyclic antidepressants are generally not recommended for depression in children under 12 years of age, especially nortriptyline, is used in children over the age of 6 years for recognized major depressive illness.

Geriatrics

Elderly patients often require lower dosage and more gradual dose increases to avoid toxicity.

Dental

The peripheral anticholinergic effects of tricyclic antidepressants may decrease or inhibit salivary flow, especially in middle-aged or elderly patients, thus contributing to the development of caries, periodontal disease, oral candidiasis, and discomfort.

Contraindications

Risk-benefit should be considered when the following medical problems exist:

Alcoholism, active (CNS depression may be potentiated), Asthma(may be aggravated), Bipolar disorder,Blood disorders(may be potentiated) ,Cardiovascular disorders,especially in children and the elderly,Gastrointestinal disorders, Genitourinary disease, Glaucoma, narrow-angle, predisposition , Increased intraocular pressure,  Hepatic function impairment, Hyperthyroidism, Prostatic hypertrophy, Renal function impairment, Schizophrenia, Seizure disorders, Sensitivity to tricyclic antidepressants, carbamazepine, maprotiline, or trazodone, Urinary retention

Drug Interactions

Alcohol, CNS depression-producing medications,other, Amantadine, Anticholinergics or other medications with anticholinergic activity, Antidyskinetics, Antihistamines, Anticoagulants, Coumarin- or indandione-derivative, Anticonvulsants, Antithyroid agents, Barbiturates, Carbamazepine, Bupropion ,Clozapine ,Cyclobenzaprine ,Haloperidol, Loxapine, Maprotiline ,Molindone, Phenothiazines ,Thioxanthenes, Cimetidine,  Clonidine, Guanodrel, Guanethidine, Cocaine, Contraceptives, oral, estrogen-containing, Estramustine ,Estrogens, Corticosteroids, glucocorticoid, Disulfiram, Ethchlorvynol, Electroconvulsive therapy, Extrapyramidal reaction-causing medications, Fluoxetine, Methylphenidate, Metrizamide, Monoamine oxidase (MAO) inhibitors, Naphazoline, ophthalmic, Oxymetazoline, nasal or ophthalmic, Phenylephrine, nasal or ophthalmic, Xylometazoline, nasal, Pimozide, Probucol, Sympathomimetics, Thyroid hormones

Antidepressant-

Oral, 25 mg (base) three or four times a day, the dosage being adjusted as needed and tolerated.

Nicotine dependence-

Oral, 25 to 100 mg per day.

Usual adult prescribing limits

Up to 150 mg (base) a day.

Antidepressant-

Children 6 to 12 years of age: Oral, 10 to 20 mg (base), or 1 to 3 mg per kg of body weight, a day in divided doses.

Adolescents: Oral, 25 to 50 mg, or 1 to 3 mg per kg of body weight, a day in divided doses, the dosage being adjusted as needed and tolerated.

Those indicating need for medical attention

Incidence less frequent:

Anticholinergic effects, fast, slow, or irregular heartbeat, fine-muscle tremors, especially in arms, hands, head, and tongue, hypotension, nervousness or restlessness, Parkinsonian syndrome, sexual function impairment

Incidence rare:

Agranulocytosis or other blood dyscrasias, allergic reaction, alopecia, anxiety, breast enlargement in both males and females, cholestatic jaundice, galactorrhea, seizures, syndrome of inappropriate secretion of antidiuretic hormone [SIADH], Testicular swelling, tinnitus, trouble with teeth or gums

Those indicating need for medical attention only if they continue or are bothersome

Incidence more frequent:

Drowsiness, dryness of mouth, headache, increased appetite, nausea, orthostatic hypotension, tiredness or weakness, mild, unpleasant taste, weight gain

Incidence less frequent

Diarrhea, excessive sweating, heartburn, trouble in sleeping, vomiting

Those indicating possible withdrawal and the need for medical attention if they occur after medication is discontinued

Occurring upon abrupt withdrawal, due to cholinergic rebound

For all tricyclic antidepressants

Headache, nausea, vomiting, or diarrhea; trouble in sleeping, with vivid dreams; unusual excitement

Occurring with gradual withdrawal after long-term treatment

For all tricyclic antidepressants

Irritability; restlessness; trouble in sleeping, with vivid dreams

Store below 30 °C (86 °F).

Protect from light and moisture.

Boxes of 100 Nortriptyline (as HCl) F.C. Tablets 10 & 25 mg