Tricyclic antidepressants (Formulary)

Dispense limited quantities of tricyclic antidepressants at any one time because their cardiovascular effects are dangerous in overdosage.

CLOMIPRAMINE

MHRA advice: Methylthioninium chloride (methylene blue): update on central nervous system (CNS) toxicity (December 2014) (www.gov.uk)

Note:

Clomipramine is predominantly serotonergic and is preferred when there are significant symptoms of anxiety.

Capsules 10mg, 25mg, 50mg

Depression: initially 10mg daily, increased gradually as necessary to 30 to 150mg daily in divided doses or as a single dose at bedtime; maximum 250mg daily.
Older people, initially 10mg daily increased carefully over approximately 10 days to 30 to 75mg daily.
Neuropathic pain: Analgesics
Migraine prophylaxis: Analgesics

Note:

Amitriptyline is not recommended for use in depression due to increased risk of fatality in overdose.

Tablets 10mg, 25mg, 50mg (Restricted: specialist recommendation only)

Depressive illness: initially 30 to 75mg daily in divided doses, alternatively initially 30 to 75mg once daily, dose to be taken at bedtime, increased gradually if necessary to 150 to 200mg.
Neuropathic pain: Analgesics
Migraine prophylaxis: Analgesics

Oral solution 25mg/5mL, 50mg/5mL (Restricted: specialist recommendation only)

Depressive illness: initially 30 to 75mg daily in divided doses, alternatively initially 30 to 75mg once daily, dose to be taken at bedtime, increased gradually if necessary to 150 to 200mg.
Neuropathic pain: Analgesics
Migraine prophylaxis: Analgesics