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What are indications for TCAs?
- Major depression
- Nocturnal enuresis
- Adjuvant in pain management
- Migraine prophylaxis
- urge incontinence
Precautions from TCA's??
- Prostatic hypertrophy
- Epilepsy (lowers seizure threshold)
Pregancy - safe, but reduce dose in last week of pregnany to minimise baby having withdrawal effects
Contraindications for TCAs??
Serotonin toxicity - do not use within two weeks of stopping a MAOI or within two days of stopping meclobemide
Adverse effects of TCAs?
- Sedation, dry mouth, constipation, weight gain, orthostatic hypotension, dizziness, tremor.
Dosage of Amitriptyline?
Depression - 25-75mg daily
Pain/migraine prophylaxis: 10-25mg at night
Dosage of dothiepin?
25-75mg once daily for depression
Counselling for TCAs?
Side effects - dizziness, dry mouth, constipation.
May get a flare in depression in the first few weeks. Monitor.
Take at night to reduce daytime sedation
you may feel dizzy on standing, get up slowly
May increase the effects of alcohol.