PEBC: What You Need to Know: Tricyclic Antidepressants

Indications: Depression (not first line), anxiety (not first line), nerve pain, migraine prophylaxis


Examples: Amitriptyline, clomipramine, doxepin, imipramine, desimpraine, nortriptyline


Dosing: most agents can be dosed once daily at bedtime due to drowsiness (may also help with sleep)


Adverse Effects: (Many! Mostly anticholinergeic, hence, not first line)

-drowsiness

-increased heart rate (toxic in overdose due to arrhythmias)

-dizziness (orthostatic hypotension)

-weight gain

-dry mouth

-constipation

-sexual dysfunction


Drug Interactions:

-serotonin syndrome with other serotonin agents such as SSRIs, SNRIs, triptans, MAO inhibitors etc.

-anticholinergic toxicity with other agents such as opioids

-many are metabolized through CYP2D6, so caution with inhibitors such as paroxetine, terbinafine, fluoxetine

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