Tricylic Compounds include-
      Tertiary amines - Amitriptyline,Clomipramine,Doxepin,Imipramine,Trimipramine
      Secondary amines - Amoxapine, Desipiramine, Nortriptyline,Portriptyline
      Refer - Amitriptyline

Strokes,hyperpyrexia,convulsion and death can occur if taken concurrently with MAOIs.

If clomipramine is to be substituted for MAOIs, 3 weeks should elapse after discontinuing MAOI.

In combination with adrenaline and and noradrenaline it causes hypertension and arrhythmias.

Additive anticholinergic effect with phenothiazine may manifest as psychosis and/or agitation especially in elderly.

Barbiturates increase metabolism of tricyclic antidepressants hence higher dose is needed.

Conversely, cimetidine, guanethidine, haloperidol and phenothiazine block the metabolism hence lower dose may be needed.

Concentration of phenytoin may be raised to toxic levels.

Activity of warfarin potentiated. CNS effects of alcohol enhanced.

Death rare(except in patients with pre-existing significant heart block and patients on MAOI therapy).

Induction of mania in individuals with underlying maniac-depressive illness or worsening psychoses in already psychotic individuals

Delibrate overdose is frequent and often lethal (especially in combination with alcohol, decongestants and acetyl salicylic acid).

Dryness of mouth,disturbances in micturation,drowsiness, increased sweating, sexual dysfunction,

Confusion, disorientation, nightmares, Parasthesias, ataxia, tremors, Extrapyrimidal symptom, tinitus,

Dizziness, weakness, fatigue, headache,

Weight gain especially in women,

Gynaecomastia in males, and galactorrhea in females.

History of hypersensitivity to the drug and tricylic antidepressants.

Hepatic dysfunction, history of blood dysrasias, those receiving MAOIs

Lactation, Pregnancy, Mania.

Special precautions:

Cardiovascular insufficient,arterioventricular blocks(grades 1-3)arrhythmias, Narrow angle glaucoma, urinary retension

Epilepsy,severely compromised hepatic/renal function,tumors of adrenal medulla, Electroconvulsive therapy.

Hypotension, hyperthyroidism, or concomittant treatment with thyroid prepn monitoring blood count,

Hepatic and renal function. Risks of suicide

Surgical intervention,

Pregnancy, lactation. Road pusers.

Date of Approval     1992

Indications:

Obsessive compulsive disorders.

Dosage:

Initial - 25mg daily and gradually increased to 100mg/day for the next 2 weeks upto a maximum of 250mg/day.

      Refer - Amitriptyline

Refer amitriptyline

Take with food

Contraindicated for use during pregnancy and lactation

Observe caution if required to be administered