Indications And Dose
Depressive illness ▶BY MOUTH ▶Adult: 140–210 mg daily in divided doses ▶Elderly: May respond to lower doses
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Drug reference
Depressive illness ▶BY MOUTH ▶Adult: 140–210 mg daily in divided doses ▶Elderly: May respond to lower doses
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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.
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→Appendix 1: tricyclic antidepressants
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Accommodation disorder. agitation. agranulocytosis. arrhythmias. bone marrow disorders. cardiac conduction disorder. confusion. constipation. coordination abnormal. dizziness. drowsiness. dry mouth . eosinophilia. face oedema. galactorrhoea. glaucoma. granulocytopenia. gynaecomastia. hallucination. headache. heart failure aggravated. hepatic disorders. hyperhidrosis (on discontinuation). hyponatraemia. hypotension. increased risk of fracture. leucopenia. malaise. mood altered. mucositis. nausea. paraesthesia. paranoid delusions. photosensitivity reaction. psychosis. respiratory depression. seizure. sexual dysfunction. SIADH. skin haemorrhage. skin reactions. sleep disorder. suicidal tendencies. taste altered. testicular disorders. thrombocytopenia. tinnitus. tremor. urinary disorders. vomiting. withdrawal syndrome SIDE-EFFECTS, FURTHER INFORMATION The risk of side- effects is reduced by titrating slowly to the minimum effective dose (every 2–3 days). Consider using a lower starting dose in elderly patients. Overdose Tricyclic and related antidepressants cause dry mouth, coma of varying degree, hypotension, hypothermia, hyperreflexia, extensor plantar responses, convulsions, respiratory failure, cardiac conduction defects, and arrhythmias. Dilated pupils and urinary Nervous system retention also occur. Lofepramine is associated with the lowest risk of fatality in overdosage, in comparison with other tricyclic antidepressant drugs. For details on the management of poisoning see Tricyclic and related antidepressants under Emergency treatment of poisoning p. 1430.
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Neonatal withdrawal symptoms and respiratory depression reported if used during third trimester.
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The amount secreted into breast milk is too small to be harmful.
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Manufacturer advises caution in mild to moderate impairment; avoid in severe impairment.
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Avoid in severe impairment.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution Oral suspension CAUTIONARY AND ADVISORY LABELS 2 ▶Lofepramine (Non-proprietary) Lofepramine (as Lofepramine hydrochloride) 14 mg per 1 ml Lofepramine 70mg/5ml oral suspension sugar free sugar-free | 150 ml P £33.87 DT = £30.00 Tablet CAUTIONARY AND ADVISORY LABELS 2 ▶Lofepramine (Non-proprietary) Lofepramine (as Lofepramine hydrochloride) 70 mg Lofepramine 70mg tablets | 56 tablet P £29.00 DT = £19.57
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Withdrawal effects may occur within 5 days of stopping treatment with antidepressant drugs; they are usually mild and self-limiting, but in some cases may be severe. The risk of withdrawal symptoms is increased if the antidepressant is stopped suddenly after regular administration for 8 weeks or more. The dose should preferably be reduced gradually over about 4 weeks, or longer if withdrawal symptoms emerge (6 months in patients who have been on long-term maintenance treatment). If possible tricyclic and related antidepressants should be withdrawn slowly.
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Driving and skilled tasks Drowsiness may affect the performance of skilled tasks (e.g. driving). Effects of alcohol enhanced.
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May respond to lower doses
First-line fragment. Read the complete Indications and Dose section above.
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