4.3.1 Tricyclic and related antidepressant drugs

Due to the risk of toxicity in overdose and the potential for suicide attempts or self-harm, consider limiting the quantity prescribed on each prescription. Lofepramine is associated with fewer anticholinergic side effects, is less sedating and is considered to be safer in overdose. Amitriptyline, imipramine and clomipramine should be avoided where there is a suicide risk.

Amitriptyline
  • Tablets 10mg, 25mg, 50mg (£1.09 = 10mg at night)
  • Oral solution 25mg in 5ml (£18.00 = 150ml)

Indications

Dose

  • Neuropathic pain, initially 10mg daily at night, gradually increased if necessary to 75mg daily; higher doses under specialist supervision
Clomipramine
  • Capsule 10mg, 25mg, 50mg (£1.62 = 25mg daily)

Indications

Imipramine
  • Tablets 10mg, 25mg (£1.01 = 25mg x 28)

Indications

Lofepramine
  • Tablets 70mg (£12.23 = 140mg daily)
  • Oral suspension 70mg in 5ml (£25.22 = 150ml)

Indications

Dose

  • 140–210mg daily in divided doses; elderly may respond to lower doses
Nortriptyline
  • Tablet 10mg, 25mg (£8.82 = 10mg daily)

Indications

  • No longer recommended for the treatment depression, but may be continued for established patients
Dosulepin

Not recommended for use due to significant safety concerns. It is more toxic than other tricyclic antidepressants due to its pro-convulsive and cardiac arrhythmic effects and it is very dangerous in overdose. Click here for more information. Prescribers should not initiate dosulepin for any new patient. If, in exceptional circumstances, there is a clinical need for dosulepin to be prescribed, this should be undertaken in a cooperation arrangement with a multi-disciplinary team and/or other healthcare professional. Click the following link for a patient information leaflet to support deprescribing.

Trimipramine

Not recommended for use due to significantly higher costs; more cost-effective tricyclic antidepressants are available. Click here for more information. Prescribers should not initiate trimipramine for any new patient. Click the following link for a patient information leaflet to support deprescribing.

Tricyclic-related antidepressants

Trazodone
  • Capsules 50mg, 100mg (£24.43 = 150mg daily)
  • Tablets 150mg (£11.80 = 150mg daily)
  • LiquidSF 50mg in 5ml (£151.49 = 120ml)

Indications

  • Depressive illness, particularly where sedation is required

Dose

  • Depression, initially 150mg (elderly 100mg) daily in divided doses after food or as a single dose at bedtime; may be increased to 300mg daily; hospital patients up to maximum 600mg daily in divided doses

 

Home > Formulary > Chapters > 4. Central Nervous System > 4.3 Antidepressant drugs > 4.3.1 Tricyclic and related antidepressant drugs

 

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