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

CLOMIPRAMINE

Important: Therapy notes


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. 

Important: Formulation and dosage details

Formulation:

Capsules 10mg, 25mg, 50mg

Dosage:

  • 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 

AMITRIPTYLINE

Important: Therapy notes


Note: 

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

Important: Formulation and dosage details

Formulation:

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

Dosage:

  • 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 

Important: Formulation and dosage details

Formulation:

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

Dosage:

  • 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 

Editorial Information

Document Id: F074