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ANTIDEPRESSANTS, TRICYCLIC (Systemic)
Some commonly used brand names are:
In the U.S.—
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, in the following dosage forms:
Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For tricyclic antidepressants, the following should be considered:
Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to any tricyclic antidepressant or to carbamazepine, maprotiline, or trazodone. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.
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.
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.
Other medicines—Although certain medicines should not be used together at all, in other cases 2 different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking a tricyclic antidepressant, it is especially important that your health care professional know if you are taking any of the following:
Other medical problems—The presence of other medical problems may affect the use of tricyclic antidepressants. 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 of tricyclic antidepressants 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 tricyclic antidepressants. If your dose is different, do not change it unless your doctor tells you to do so.
The number of capsules or tablets, or the amount of solution or syrup 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 taking tricyclic antidepressants .
Missed dose—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—To store this medicine:
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 side 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:
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
Reported for amoxapine only (in addition to the above)—less common
Lip smacking or puckering; puffing of cheeks; rapid or worm-like movements of tongue; uncontrolled chewing movements; uncontrolled movements of hands, arms, or legs
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
Other 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. However, check with your doctor if any of the following side effects continue or are bothersome:
Dizziness; drowsiness; dryness of mouth; headache; increased appetite (may include craving for sweets); nausea; tiredness or weakness (mild); unpleasant taste; weight gain
Diarrhea; heartburn; increased sweating; trouble in sleeping (more common with protriptyline, especially when taken late in the day); vomiting
Certain side effects of this medicine may occur after you have stopped taking it. Check with your doctor if you notice any of the following 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 above also may occur in some patients. If you notice any other effects, check with your doctor.
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:
Other than the above information, there is no additional information relating to proper use, precautions, or side effects for these uses.
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