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Triptyline

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Indications:

Relief of depression. Endogenous depression is more likely to be alleviated than are other depressive states. Unlabeled Uses: Management of chronic pain associated with migraine, tension headache, phantom limb pain, tic douloureux, diabetic neuropathy, peripheral neuropathy, cancer or arthritis; treatment of panic and eating disorders.

Contraindications:

Hypersensitivity to any tricyclic antidepressant; use during acute recovery phase of MI; concomitant use with MAOIs, except under close medical supervision; may block the antihypertensive action of guanethidine or similarly active compounds.

Adverse reactions:

Cardiovascular: Orthostatic hypotension; hypertension; tachycardia; palpitations; arrhythmias; ECG changes. CNS: Confusion; hallucinations; disturbed concentration; decreased memory; delusions; nervousness; restlessness; agitation; panic; insomnia; nightmares; mania; exacerbation of psychosis; drowsiness; dizziness; weakness; emotional lability; numbness; tremors; extrapyramidal symptoms (eg, pseudoparkinsonism, movement disorders, akathisia); seizures. Dermatologic: Rash; pruritus; photosensitivity reaction; dry skin; acne; itching. EENT: Conjunctivitis; blurred vision; increased IOP; mydriasis; tinnitus; nasal congestion; peculiar taste in mouth. GI: Nausea; vomiting; anorexia; GI distress; diarrhea; flatulence; dry mouth; constipation. Genitourinary: Impotence; sexual dysfunction; menstrual irregularities; dysmenorrhea; nocturia; urinary frequency; UTI; vaginitis; cystitis; urinary retention and hesitancy. Hematologic: Bone marrow depression, including agranulocytosis; eosinophilia; purpura; thrombocytopenia; leukopenia. Hepatic: Jaundice. Metabolic: Elevation or depression of blood sugar levels. Respiratory: Pharyngitis; rhinitis; sinusitis; cough. Miscellaneous: Breast enlargement.

Interactions:

Barbiturates, charcoal: May cause decreased blood levels of amitriptyline. Cimetidine, fluoxetine: May cause increased blood levels of amitriptyline. Clonidine: Use with product may result in hypertensive crisis. CNS depressants: Depressant effects may be additive. MAOIs: May cause hyperpyretic crises, severe convulsions, and death when given with amitriptyline.

Warnings:

Pregnancy Category D. Lactation: Excreted in breast milk. Children: Not recommended for children younger than 12 yr of age. Special Risk Patients: Caution is needed with history of seizures; urinary retention; urethral or ureteral spasm; angle-closure glaucoma or increased IOP; cardiovascular disorders; hyperthyroidism and patients receiving thyroid medication; hepatic or renal function impairment; schizophrenia; paranoia. Changing from MAOI to amitriptyline: Waiting period of 7 to 10 days is necessary to prevent hypertensive crisis. Serotonin syndrome: Some TCAs inhibit neuronal reuptake of serotonin and can increase synaptic serotonin levels.

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