Contraindicated with hypersensitivity to any tricyclic drug, concomitant therapy with an MAOI, within 2 wk of MAOI use, recent MI, myelography within previous 24 hr or scheduled within 48 hr, pregnancy (limb reduction abnormalities), lactation.

Use cautiously with EST (increased hazard with TCAs); pre-existing CV disorders (possibly increased risk of serious CVS toxicity); angle-closure glaucoma, increased IOP; urinary retention, ureteral or urethral spasm (anticholinergic effects may exacerbate these conditions); seizure disorders; hyperthyroidism (predisposes to CVS toxicity, including cardiac arrhythmias); impaired hepatic, renal function; psychiatric patients (schizophrenic or paranoid patients may exhibit a worsening of psychosis); bipolar disorder (may shift to hypomanic or manic phase); elective surgery (discontinued as long as possible before surgery).