Yes

Antidepressant, Tricyclic (Tertiary Amine)

Treatment of moderate to severe anxiety and/or agitation and depression

C-IV

D

Depression of CNS; MAO inhibitors; acute recovery phase following myocardial infarction; angle-closure glaucoma

See individual agents

Initial: 3-4 tablets in divided doses; this may be increased to 6 tablets/day as required; some patients respond to smaller doses and can be maintained on 2 tablets

Use with caution; epinephrine, norepinephrine and levonordefrin have been shown to have an increased pressor response in combination with TCAs

Amitriptyline: The most anticholinergic and sedating of the antidepressants; pronounced effects on the cardiovascular system; long-term treatment with TCAs such as amitriptyline increases the risk of caries by reducing salivation and salivary buffer capacity. In a study by Rundergren, et al, pathological alterations were observed in the oral mucosa of 72% of 58 patients; 55% had new carious lesions after taking TCAs for a median of 51/2 years. Current research is investigating the use of the salivary stimulant pilocarpine (Salagen®) to overcome the xerostomia from amitriptyline.

Chlordiazepoxide: Over 10% of patients will experience dry mouth which disappears with cessation of drug therapy

See individual agents. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Do not breast-feed.

Tablet:

10-25: Amitriptyline hydrochloride 25 mg and chlordiazepoxide 10 mg

Boakes AJ, Laurence DR, Teoh PC, et al, "Interactions Between Sympathomimetic Amines and Antidepressant Agents in Man," Br Med J, 1973, 1(849):311-5.

Jastak JT and Yagiela JA, "Vasoconstrictors and Local Anesthesia: A Review and Rationale for Use," J Am Dent Assoc, 1983, 107(4):623-30.

Larochelle P, Hamet P, and Enjalbert M, "Responses to Tyramine and Norepinephrine After Imipramine and Trazodone," Clin Pharmacol Ther, 1979, 26(1):24-30.

Mitchell JR, "Guanethidine and Related Agents. III Antagonism by Drugs Which Inhibit the Norepinephrine Pump in Man," J Clin Invest, 1970, 49(8):1596-604.

Rundegren J, van Dijken J, Mörnstad H, et al, "Oral Conditions in Patients Receiving Long-Term Treatment With Cyclic Antidepressant Drugs," Swed Dent J, 1985, 9(2):55-64.

Svedmyr N, "The Influence of a Tricyclic Antidepressive Agent (Protriptyline) on Some of the Circulatory Effects of Noradrenaline and Adrenalin in Man," Life Sci, 1968, 7(1):77-84.