Health Guide
Drug Guide

Antidepressant, tricyclic (Oral route, parenteral route)

Brand Names:

Dosage Forms:

Uses of This Medicine:

Tricyclic antidepressants are used to relieve mental depression.

One form of this medicine (imipramine) is also used to treat enuresis (bedwetting) in children. Another form (clomipramine) is used to treat obsessive-compulsive disorders. Tricyclic antidepressants may be used for other conditions as determined by your doctor.

These medicines are available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, tricyclic antidepressants are used in certain patients with the following medical conditions:

Before Using This Medicine:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children

Children are especially sensitive to the effects of this medicine. This may increase the chance of side effects during treatment. However, side effects in children taking this medicine for bedwetting usually disappear upon continued use. The most common of these are nervousness, sleeping problems, tiredness, and mild stomach upset. If these side effects continue or are bothersome, check with your doctor.

Antidepressants must be used with caution in children with depression. Studies have shown occurrences of children thinking about suicide or attempting suicide in clinical trials for this medicine. More study is needed to be sure antidepressants are safe and effective in children

Older adults

Drowsiness, dizziness, confusion, vision problems, dryness of mouth, constipation, and problems in urinating are more likely to occur in elderly patients, who are usually more sensitive than younger adults to the effects of tricyclic antidepressants.

Pregnancy

Studies have not been done in pregnant women. However, there have been reports of newborns suffering from muscle spasms and heart, breathing, and urinary problems when their mothers had taken tricyclic antidepressants immediately before delivery. Also, studies in animals have shown that some tricyclic antidepressants may cause unwanted effects in the fetus.

Breast-feeding

Tricyclic antidepressants pass into the breast milk. Doxepin has been reported to cause drowsiness in the nursing baby.

Other medicines

Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.

Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Other interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other medical problems

The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:

Proper Use of This Medicine:

To lessen stomach upset, take this medicine with food, even for a daily bedtime dose, unless your doctor has told you to take it on an empty stomach.

Take this medicine only as directed by your doctor , to benefit your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

Sometimes this medicine must be taken for several weeks before you begin to feel better. Your doctor should check your progress at regular visits.

To use doxepin oral solution:

Dosing

The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

Missed dose

Call your doctor or pharmacist for instructions.

If you miss a dose of this medicine and your dosing schedule is:

If you have any questions about this, check with your doctor.

Storage

Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not keep outdated medicine or medicine no longer needed.

Keep the liquid form of this medicine from freezing.

Precautions While Using This Medicine:

It is very important that your doctor check your progress at regular visits to allow dosage adjustments and to help reduce side effects.

This medicine will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your medical doctor or dentist before taking any of the above while you are taking this medicine .

Antidepressants may cause some people to be agitated, irritable or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you or your caregiver notice any of these adverse effects, tell your doctor right away.

This medicine may cause some people to become drowsy. If this occurs, do not drive, use machines, or do anything else that could be dangerous if you are not alert.

Dizziness, lightheadedness, or fainting may occur, especially when you get up from a lying or sitting position. Getting up slowly may help. If this problem continues or gets worse, check with your doctor.

This medicine may cause dryness of the mouth. For temporary relief, use sugarless gum or candy, melt bits of ice in your mouth, or use a saliva substitute. However, if your mouth continues to feel dry for more than 2 weeks, check with your medical doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.

Tricyclic antidepressants may cause your skin to be more sensitive to sunlight than it is normally. Exposure to sunlight, even for brief periods of time, may cause a skin rash, itching, redness or other discoloration of the skin, or a severe sunburn. When you begin taking this medicine:

If you have a severe reaction from the sun, check with your doctor.

Before you have any medical tests, tell the medical doctor in charge that you are taking this medicine. The results of the metyrapone test may be affected by this medicine.

Before having any kind of surgery, dental treatment, or emergency treatment, tell the medical doctor or dentist in charge that you are using this medicine. Taking tricyclic antidepressants together with medicines used during surgery or dental or emergency treatments may increase the risk of side effects.

For diabetic patients:

Do not stop taking this medicine without first checking with your doctor. Your doctor may want you to reduce gradually the amount you are using before stopping completely. This may help prevent a possible worsening of your condition and reduce the possibility of withdrawal symptoms such as headache, nausea, and/or an overall feeling of discomfort.

The effects of this medicine may last for 3 to 7 days after you have stopped taking it. Therefore, all the precautions stated here must be observed during this time.

For patients taking protriptyline:

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Stop taking this medicine and get emergency help immediately if any of the following effects occur:

Reported for amoxapine only
(Rare)
Convulsions (seizures)
difficult or fast breathing
fever with increased sweating
high or low (irregular) blood pressure
loss of bladder control
muscle stiffness (severe)
pale skin
unusual tiredness or weakness

Check with your doctor as soon as possible if any of the following side effects occur:

Less common
Blurred vision
confusion or delirium
constipation (especially in the elderly)
decreased sexual ability (more common with amoxapine and clomipramine)
difficulty in speaking or swallowing
eye pain
fainting
fast or irregular heartbeat (pounding, racing, skipping)
hallucinations
loss of balance control
mask-like face
nervousness or restlessness
problems in urinating
shakiness or trembling
shuffling walk
slowed movements
stiffness of arms and legs
Less common
(Reported for amoxapine only (in addition to the above))
Lip smacking or puckering
puffing of cheeks
rapid or worm-like movements of tongue
uncontrolled chewing movements
uncontrolled movements of hands, arms, or legs
Rare
Anxiety
breast enlargement in both males and females
hair loss
inappropriate secretion of milk in females
increased sensitivity to sunlight
irritability
muscle twitching
red or brownish spots on skin
ringing, buzzing, or other unexplained sounds in the ears
seizures (more common with clomipramine)
skin rash and itching
sore throat and fever
swelling of face and tongue
swelling of testicles (more common with amoxapine)
trouble with teeth or gums (more common with clomipramine)
weakness
yellow eyes or skin
Symptoms of acute overdose
Confusion
convulsions (seizures)
disturbed concentration
drowsiness (severe)
enlarged pupils
fast, slow, or irregular heartbeat
fever
hallucinations (seeing, hearing, or feeling things that are not there)
restlessness and agitation
shortness of breath or troubled breathing
unusual tiredness or weakness (severe)
vomiting

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
Dizziness
drowsiness
dryness of mouth
headache
increased appetite (may include craving for sweets)
nausea
tiredness or weakness (mild)
unpleasant taste
weight gain
Less common
Diarrhea
heartburn
increased sweating
trouble in sleeping (more common with protriptyline, especially when taken late in the day)
vomiting

After you stop using this medicine, it may still produce some side effects that need attention. During this period of time, check with your doctor immediately if you notice the following side effects:

Headache
irritability
nausea, vomiting, or diarrhea
restlessness
trouble in sleeping, with vivid dreams
unusual excitement
Reported for amoxapine only
(in addition to the above)
Lip smacking or puckering
puffing of cheeks
rapid or worm-like movements of the tongue
uncontrolled chewing movements
uncontrolled movements of arms or legs

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.


Last Updated: 6/12/2013

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