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 may occur), lactation.

Use cautiously with EST; pre-existing CV disorders (eg, severe CAD, progressive HF, angina pectoris, paroxysmal tachycardia); angle-closure glaucoma, increased IOP; urinary retention, ureteral or urethral spasm (anticholinergic effects of TCAs may exacerbate these conditions); seizure disorders (TCAs lower the seizure threshold); hyperthyroidism (predisposes to CVS toxicity, including cardiac arrhythmias); impaired hepatic, renal function; psychiatric patients (schizophrenic or paranoid patients may exhibit a worsening of psychosis); patients with bipolar disorder (may shift to hypomanic or manic phase); elective surgery (TCAs should be discontinued as long as possible before surgery).