Guidelines for Usage Of Tricyclic Antidepressants

  • Use exactly as prescribed.
  • Lower dosages are recommended for elderly, adolescent, and outpatients, as compared to hospitalized patients who will be under close supervision. Initiate dosage at a low level and increase gradually, noting carefully the clinical response and any evidence of intolerance. Once depressive symptoms are controlled, maintenance doses will be required for a longer period of time, at the lowest dose that will maintain symptom control.
  • For many of these medicines, it is not possible to prescribe a single dos­age schedule that is therapeutically effective in all patients. Consequently, the recommended dosage regimens are only a guide, which may be modified by factors such as age, chronic disease, severity of the disease, medical condition of the patient, and degree of psychotherapeutic support.
  • If a dose is missed, take it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose in order to catch up, unless advised to do so by your doctor. If more than one dose is missed, or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
  • Once symptoms are controlled, therapy may need to be continued for several months to lessen the chance of relapse.
  • Do not change the dose or discontinue therapy unless advised to do so by your doctor.
  • These drugs may take 1 to 4 weeks to improve symptoms of depression.
  • Do not use in combination with an MAOI or within 14 days of discontinuing treatment with an MAOI. After stopping this medicine, wait at least 2 weeks before starting an MAOI.
  • Using these drugs with alcohol or other central nervous system depressants (eg, pain relievers, sedatives, barbiturates) may cause added drowsiness.
  • May cause drowsiness or blurred vision. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
  • Symptoms of nausea, headache, or fatigue may develop after abruptly stopping a tricyclic antidepressant (TCA) after long-term use.
  • Notify your doctor if dry mouth, constipation, blurred vision, increased heart rate, impaired coordination, difficult urination, excessive sedation, or seizures occur.
  • Notify your doctor if you develop a fever or sore throat.
  • Notify your doctor if you experience drowsiness, dizziness, or postural hypotension. Your doctor may need to reduce the dose.
  • Be sure your doctor and pharmacist are aware of the following ­ Other medical conditions. All medications, including nonprescription medicines, that you are taking. If you have had an unusual or allergic reaction to any TCA or to maprotiline. If you are pregnant or may become pregnant. If you are breastfeeding.
  • May cause sensitivity to sunlight. Avoid prolonged exposure to the sun and UV light (eg, tanning beds). Use sunscreens and wear protective clothing until tolerance is determined.
  • Taking these drugs at bedtime may help reduce side effects (eg, day­time drowsiness). Discuss this possibility with your doctor or pharmacist.
  • Lab tests may be required to monitor therapy. Be sure to keep appointments.
  • Store at room temperature in a child-resistant container. Patients should supervise this drug carefully in the home. Amitriptyline:
  • Usual initial adult dosage for outpatients is 75 mg/day in divided doses. If necessary, this may be increased (preferably at bedtime doses) to a total of 150 mg/day. An alternative method is to begin with 50 to 100 mg at bedtime. This may be increased by 25 or 50 mg as necessary in the bedtime dose to a total of 150 mg/day. Smaller initial doses may be needed if side effects appear with higher doses.
  • Hospitalized patients may require 100 mg/day initially, which can be increased gradually to 200 mg/day. A small number of patients may need up to 300 mg/day.
  • Usual dosage for children and elderly patients is 10 mg 3 times a day with 20 mg at bedtime.
  • Usual maintenance dosage is 50 to 100 mg given as a single dose at bedtime.
  • Injection Dosage – Injection should be used for initial therapy in hospitalized patients who are unable or unwilling to take tablets. Tablets should replace the injection as soon as possible. Usual initial dosage by injection is 20 to 30 mg (2 to 3 ml) 4 times a day. Intramuscular doses may cause the effects to appear more rapidly than with tablets. Amoxapine:
  • Usual starting dosage is 50 mg 2 or 3 times daily. Dosage may be increased to 100 mg 2 or 3 times daily by the end of the first week.
  • Increases above 300 mg/day dose should only be made if 300 mg/day had been ineffective during a trial period of at least 2 weeks.
  • Usual effective dose is 200 to 300 mg/day. If no response is seen at 300 mg, dosage may be increased to 400 mg/day. Hospitalized patients who have been refractory to antidepressant therapy and who have no history of convulsive seizures may have dosage raised cautiously up to 600 mg/day in divided doses.
  • Once the effective dose is established, the daily maintenance dose, if not more than 300 mg, can be given as a single dose at bedtime. If maintenance dose is more than 300 mg per day, then divided doses should be used.

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