Drug reference
Depressive illness (particularly where sedation required) ▶BY MOUTH ▶Adult: 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 150–300 mg daily ▶Elderly: Initially 10–25 mg 3 times a day, maintenance 75–150 mg daily
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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. anticholinergic syndrome. arrhythmias. bone fracture. bone marrow depression. constipation. drowsiness. dry mouth. hyperglycaemia. hyperhidrosis. hypotension. jaundice cholestatic. mood altered. paranoid delusions. peripheral neuropathy. rash. respiratory depression. seizure. sexual dysfunction. suicidal tendencies. tremor. urinary hesitation. 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 retention also occur. For details on the management of poisoning see Tricyclic and related antidepressants under Emergency treatment of poisoning p. 1430.
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Use only if potential benefit outweighs risk.
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The amount secreted into breast milk is too small to be harmful.
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Manufacturer advises 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 Tablet CAUTIONARY AND ADVISORY LABELS 2 ▶Trimipramine (Non-proprietary) Trimipramine (as Trimipramine maleate) 10 mg Trimipramine 10mg tablets | 28 tablet P £197.18 DT = £179.18 Trimipramine (as Trimipramine maleate) 25 mg Trimipramine 25mg tablets | 28 tablet P £205.44 DT = £200.50 Capsule CAUTIONARY AND ADVISORY LABELS 2 ▶Trimipramine (Non-proprietary) Trimipramine (as Trimipramine maleate) 50 mg Trimipramine 50mg capsules | 28 capsule P £217.50 DT = £217.50 OTHER ANTIDEPRESSANTS
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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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Initially 50–75 mg daily in divided doses,
First-line fragment. Read the complete Indications and Dose section above.
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Initially 10–25 mg 3 times a day, maintenance
First-line fragment. Read the complete Indications and Dose section above.
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