Antidepressants, Tricyclic (Systemic)

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.

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:

• Amphetamines or
• Appetite suppressants (diet pills) or
• Ephedrine or
• Epinephrine (e.g., Adrenalin) or
• Isoproterenol (e.g., Isuprel) or
• Medicine for asthma or other breathing problems or
• Medicine for colds, sinus problems, or hay fever or other allergies or
• Phenylephrine (e.g., Neo-Synephrine) - Using these medicines with tricyclic antidepressants may increase the risk of serious effects on the heart

• Antipsychotics (medicine for mental illness) or
• Clonidine (e.g., Catapres) - Using these medicines with tricyclic antidepressants may increase the CNS depressant effects and increase the chance of serious side effects

• Antithyroid agents (medicine for overactive thyroid) or
• Cimetidine (e.g., Tagamet) - Using these medicines with tricyclic antidepressants may increase the chance of serious side effects

• Central nervous system (CNS) depressants (medicine that causes drowsiness) - Using these medicines with tricyclic antidepressants may increase the CNS depressant effects

• Guanadrel (e.g., Hylorel) or
• Guanethidine (e.g., Ismelin) - Tricyclic antidepressants may keep these medicines from working as well

• Methyldopa (e.g., Aldomet) or
• Metoclopramide (e.g., Reglan) or
• Metyrosine (e.g., Demser) or
• Pemoline (e.g., Cylert) or
• Pimozide (e.g., Orap) or
• Promethazine (e.g., Phenergan) or
• Rauwolfia alkaloids (alseroxylon [e.g., Rauwiloid], deserpidine [e.g., Harmonyl], rauwolfia serpentina [e.g., Raudixin], reserpine [e.g., Serpasil]) or
• Trimeprazine (e.g., Temaril) - Tricyclic antidepressants may cause certain side effects to be more severe and occur more often

• Metrizamide - The risk of seizures may be increased

• Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g., Marplan], isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate]) - Taking tricyclic antidepressants while you are taking or within 2 weeks of taking MAO inhibitors may cause sudden high body temperature, extremely high blood pressure, severe convulsions, and death; however, sometimes certain of these medicines may be used together under close supervision by your doctor

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:

• Alcohol abuse (or history of) - Drinking alcohol may cause increased CNS depressant effects

• Asthma or
• Bipolar disorder (manic-depressive illness) or
• Blood disorders or
• Convulsions (seizures) or
• Difficult urination or
• Enlarged prostate or
• Glaucoma or increased eye pressure or
• Heart disease or
• High blood pressure (hypertension) or
• Schizophrenia - Tricyclic antidepressants may make the condition worse

• Kidney disease or
• Liver disease - Higher blood levels of tricyclic antidepressants may result, increasing the chance of side effects

• Overactive thyroid or
• Stomach or intestinal problems - Tricyclic antidepressants may cause an increased chance of serious side effects