The tricyclics amitriptyline and desipramine
, while effective, are less well tolerated, according to the guidelines.
The TCAs amitriptyline (with both serotonergic and noradrenergic effects) and desipramine
(with predominantly noradrenergic effects) have shown efficacy in the treatment of diabetic neuropathy. Clomipramine, a TCA with potent serotonergic properties, has shown clinical response in the treatment of diabetic neuropathy. The selective serotonin reuptake inhibitors (SSRIs) have also been shown to elicit pain relief in patients with diabetic neuropathy in some,[13,14] but not all studies.
and nortriptyline also have been identified as high-risk agents.
Clomipramine at 141-150 mg per day has been shown to be superior to placebo and to desipramine
This study compared doxepin and desipramine
to examine whether a more sedating antidepressant (doxepin) might prove more useful for chronic low back pain.
C's pharmacogenomic-based interpretive report Use as directed Use with caution Use with caution and more frequent monitoring Antidepressants: Antidepressants: Amitriptyline, None Duloxetine, (a), (b) bupropion, (a) mirtazapine citalopram, (c) clomipramine, (a), (b) desipramine
, (a), (b) escitalopram, (c) fluoxetine, (a) fluvoxamine, (c) imipramine, (a), (b) nortriptyline, (a), (b) sertraline, (c) paroxetine, (c) trazodone, (a) venlafaxine (a) Antipsychotics: Antipsychotics: Aripiprazole, Clozapine, (a) haloperidol, (a) olanzapine, perphenazine, (a) risperidone quetiapine, (a) ziprasidone What could be causing Mrs.
Romans favors desipramine
, because it has the least anticholinergic side effects, or doxepin, if sedation is desirable.
For adjuvant therapy, you can use anti-convulsants (gabapentin and valproic acid) and tricyclic antidepressants (amitriptyline, nortriptyline, imipramine, and desipramine
The TCAs identified in the 1985 NAMCS included amitriptyline, amoxapine, desipramine
, doxepin, imipramine, nortriptyline, protryptiline, trimipramine, and a combination of amitriptyline and perphenazine.
Selected psychotropics that affect P-glycoprotein Substrates Amitriptyline Paroxetine Carbamazepine Quetiapine Chlorpromazine Risperidone Citalopram Sertraline Doxepin Topiramate Nortriptyline Venlafaxine Olanzapine Inhibitors Amitriptyline Imipramine Carbamazepine Nefazodone Chforpromazine Paroxetine Desipramine
Sertraline Disulfiram Thioridazine Fluoxetine Trifluoperazine Fluvoxamine Trimipramine Haloperidol Inducers(a) Amitriptyline Phenothiazines Nefazodone Trazodone (a.) Data supporting induction is limited Source: Reference 8 Gary M.
Bauer prefers the secondary amines nortriptyline or desipramine
, or doxepin or imipramine for patients who need help sleeping.
Denver Bureau Suicide Completers Testing Positive for Antidepressant Tricyclics 21% Amitriptyline 26 Nortriptyline 20 Doxepin 10 Clomipramine 2 Desipramine
2 Imipramine 1 Protriptyline 1 Atypicals 44% Venlafaxine 41 Buproprion 36 Mirtazapine 27 Trazodone 23 Nefazodone 1 SSRIs 35% Citalopram 44 Sertraline 25 Fluoxetine 16 Paroxetine 12 Fluvoxamine 5 n=292 Source: Ms.