Depressive illness, particularly where sedation is required
(not recommended—increased risk of fatality in
overdose) (initiated by a specialist)
▶BY MOUTH
▶Adult: Initially 75 mg daily in divided doses,
alternatively initially 75 mg once daily, dose to be
taken at bedtime, increased if necessary to 150 mg
daily, doses to be increased gradually; up to 225 mg
daily in some circumstances (e.g. hospital use)
▶Elderly: Initially 50–75 mg daily in divided doses,
alternatively initially 50–75 mg once daily, dose to be
taken at bedtime, increased if necessary to 75–150 mg
daily, doses to be increased gradually; up to 225 mg
daily in some circumstances (e.g. hospital use)
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Acute porphyrias p. 1120.
arrhythmias. during the manic phase of bipolar disorder.
heart block. immediate recovery period after myocardial
infarction
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Cardiovascular disease. chronic constipation.
diabetes. epilepsy. history of bipolar disorder. history of
psychosis. hyperthyroidism (risk of arrhythmias).
increased intra-ocular pressure. patients with a significant
risk of suicide. phaeochromocytoma (risk of arrhythmias).
prostatic hypertrophy. susceptibility to angle-closure
glaucoma. urinary retention
CAUTIONS, FURTHER INFORMATION Treatment should be
stopped if the patient enters a manic phase.
Elderly patients are particularly susceptible to many of
the side-effects of tricyclic antidepressants; low initial
doses should be used, with close monitoring, particularly
for psychiatric and cardiac side-effects.
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Limited
quantities of tricyclic antidepressants should be prescribed
at any one time because their cardiovascular and
epileptogenic effects are dangerous in overdosage.
A maximum prescription equivalent to 2 weeks’ supply
of 75 mg daily should be considered in patients with
increased risk factors for suicide at initiation of treatment,
during any dose adjustment, and until improvement
occurs.
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