Tricyclic Antidepressants (TCAs)
PREGNANCY CATEGORY C OR D (AMITRIPTYLINE, IMIPRAMINE, NORTRIPTYLINE)
Therapeutic Actions
Mechanism of action is unknown. The TCAs are structurally related to the phenothiazine antipsychotic drugs (eg, chlorpromazine), but in contrast to them, TCAs inhibit the pre-synaptic reuptake of the neurotransmitters norepinephrine and serotonin; anticholinergic at CNS and peripheral receptors; the relation of these effects to clinical efficacy is unknown.
Indications
Relief of symptoms of major depressive disorders
Treatment of OCDs
Unlabeled uses: Treatment of obstructive sleep apnea, panic disorder, eating disorders, PMS, migraine, ADHD, insomnia associated with depression, fibromyalgia, neuropathic pain, adult enuresis
Contraindications and Cautions
Contraindicated with hypersensitivity to any tricyclic drug, concomitant therapy with an MAOI, recent MI, myelography within previous 24 hr or scheduled within 48 hr, pregnancy (limb reduction abnormalities reported), or lactation.
Use cautiously with EST; preexisting CV disorders (severe coronary heart disease, progressive heart failure, angina pectoris, paroxysmal tachycardia); angle-closure glaucoma, increased IOP, urine retention, ureteral or urethral spasm; seizure disorders (lower seizure threshold); hyperthyroidism (predisposes to CVS toxicity, including cardiac arrhythmias); impaired hepatic, renal function; psychiatric patients; schizophrenic or paranoid may exhibit a worsening of psychosis; manic-depressive disorder may shift to hypomanic or manic phase; elective surgery (discontinue as long as possible before surgery).
Adverse Effects
CNS: Sedation and anticholinergic (atropine-like) effects (dry mouth, blurred vision, disturbance of accommodation for near vision, mydriasis, increased IOP), confusion (especially in elderly), disturbed concentration, hallucinations, disorientation, decreased memory, feelings of unreality, delusions, anxiety, nervousness, restlessness, agitation, panic, insomnia, nightmares, hypomania, mania, exacerbation of psychosis, drowsiness, weakness, fatigue, headache, numbness, tingling, paresthesia of extremities, incoordination, motor hyperactivity, akathisia, ataxia, tremors, peripheral neuropathy, extrapyramidal symptoms, seizures, speech blockage, dysarthria, tinnitus, altered EEG
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