Drilldown: Medicines
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generic:
brand:
(multiple, generic dominant) (1) ·
Elavil (US brand discontinued; generic widely available), Endep, Tryptizol (1) ·
Pamelor (US brand discontinued; generic widely available), Aventyl (1) ·
Remeron (US brand discontinued; generic widely available), Remeron SolTab (ODT) (1) ·
Sinequan (oral antidepressant, US brand discontinued), Silenor (low-dose for insomnia), Prudoxin / Zonalon (topical cream) (1)
classes:
Analgesic (1) ·
Opioid (1) ·
Prodrug (1) ·
secondary amine)]] (1) ·
[[:Category:Antidepressants|Antidepressant]] (4) ·
[[:Category:Antihistamines|Antihistamine (potent H1)]] (1) ·
[[:Category:Migraine prophylactics|Migraine prophylactic]] (2) ·
[[:Category:Neuropathic pain medicines|Neuropathic pain medicine]] (2) ·
[[:Category:Sleep aids|Sleep aid (off-label)]] (1) ·
[[:Category:Sleep aids|Sleep aid (Silenor low-dose)]] (1) ·
[[:Category:Tetracyclic antidepressants|Tetracyclic antidepressant]] (1) ·
[[:Category:Tricyclic antidepressants|Tricyclic antidepressant (TCA (1) ·
[[:Category:Tricyclic antidepressants|Tricyclic antidepressant (TCA)]] (2)
mechanism:
None (3) ·
Prodrug; converted to [[Morphine|morphine]] by [[Enzyme:CYP2D6|CYP2D6]] for analgesic action. (1) ·
'"`UNIQ--vote-00000019-QINU`"' Therapeutic plasma-level monitoring is standard practice for TCAs given the narrow therapeutic index and the established plasma-level-efficacy correlation. CYP2D6 substrate; CPIC PGx guidance applies for dose individualization'"`UNIQ--ref-0000001A-QINU`"'. (1)
uses:
Mild to moderate pain; cough suppression (low-dose). (1) ·
'"`UNIQ--vote-0000001B-QINU`"', '"`UNIQ--vote-0000001C-QINU`"', '"`UNIQ--vote-0000001D-QINU`"', '"`UNIQ--vote-0000001E-QINU`"', '"`UNIQ--vote-0000001F-QINU`"' (2) ·
'"`UNIQ--vote-0000001D-QINU`"', '"`UNIQ--vote-0000001E-QINU`"', '"`UNIQ--vote-0000001F-QINU`"', '"`UNIQ--vote-00000020-QINU`"', '"`UNIQ--vote-00000021-QINU`"', '"`UNIQ--vote-00000022-QINU`"' (1) ·
'"`UNIQ--vote-0000001F-QINU`"', '"`UNIQ--vote-00000020-QINU`"', '"`UNIQ--vote-00000021-QINU`"', '"`UNIQ--vote-00000022-QINU`"', '"`UNIQ--vote-00000023-QINU`"', '"`UNIQ--vote-00000024-QINU`"', '"`UNIQ--vote-00000025-QINU`"' (1)
starting dose:
15 mg PO at bedtime, titrate to 30-45 mg/day after 1-2 weeks. '''Counterintuitive dose paradox''': lower doses (7.5-15 mg) are more sedating than higher doses because H1 antihistamine effect dominates at low dose (1) ·
Adult: 15–60 mg every 4 hours as needed. (1) ·
Depression (rarely used now): 25-75 mg PO at bedtime, titrate to 150 mg/day. Neuropathic pain / migraine prophylaxis: 10-25 mg at bedtime, titrate by 10-25 mg weekly to 50-100 mg/day. Elderly: 10 mg at bedtime (Beers-list cautions apply) (1) ·
Depression: 25 mg PO TID-QID or 75 mg at bedtime, titrate to 75-150 mg/day. Neuropathic pain: 10-25 mg at bedtime, titrate to 50-100 mg/day. Elderly: 10 mg at bedtime (Beers-list cautions, though less than amitriptyline) (1) ·
Depression: 25-75 mg/day to start, titrate to 75-150 mg/day at bedtime. Insomnia (Silenor): 3 mg PO 30 minutes before bedtime, max 6 mg. Topical (Prudoxin): apply to affected area every 3-4 hours (1)
preparations:
Capsules 10, 25, 50, 75 mg; oral solution 10 mg/5 mL (1) ·
Capsules 10, 25, 50, 75, 100, 150 mg; oral concentrate 10 mg/mL; Silenor tablets 3, 6 mg; topical cream 5% (Prudoxin, Zonalon) (1) ·
Tablet (15, 30, 60 mg); oral solution; combination products (with [[Acetaminophen|acetaminophen]] or ibuprofen). (1) ·
Tablets 10, 25, 50, 75, 100, 150 mg (1) ·
Tablets 7.5, 15, 30, 45 mg; orally disintegrating tablets (SolTab) 15, 30, 45 mg (1)
fda max:
150 mg/day; therapeutic plasma-level monitoring recommended (target 50-150 ng/mL window) (1) ·
300 mg/day (depression, hospitalized); 150 mg/day outpatient; 6 mg/day for insomnia (1) ·
300 mg/day (historical hospitalized inpatient depression); 150 mg/day outpatient typical ceiling (1) ·
360 mg/day (1) ·
45 mg/day (1)
onset:
duration: (Click arrow to add another value)
halflife:
18-44 hours'"`UNIQ--ref-00000020-QINU`"' (1) ·
2.5–3 hours (1) ·
20-40 hours'"`UNIQ--ref-00000023-QINU`"' (1) ·
Amitriptyline 10-50 hours (highly variable); nortriptyline active metabolite 18-44 hours'"`UNIQ--ref-00000026-QINU`"' (1) ·
~15 hours (parent); nordoxepin active metabolite ~30 hours'"`UNIQ--ref-00000020-QINU`"' (1)
bioavailability:
pregnancy:
Avoid; risk of neonatal opioid withdrawal with chronic use; UM-mother breastfeeding contraindicated. (1) ·
Limited human data; some observational signals reassuring relative to other antidepressants.<sup class="pcp-cn" title="This claim needs a citation.">[[[Pharmacopedia:Citation needed|citation needed]]]</sup> (1) ·
Older agent with substantial use experience; observational signals not clearly causal.<sup class="pcp-cn" title="This claim needs a citation.">[[[Pharmacopedia:Citation needed|citation needed]]]</sup> (1) ·
TCA class signal; limited human data specific to doxepin.<sup class="pcp-cn" title="This claim needs a citation.">[[[Pharmacopedia:Citation needed|citation needed]]]</sup> (1) ·
TCA class signal; limited human data specific to nortriptyline.<sup class="pcp-cn" title="This claim needs a citation.">[[[Pharmacopedia:Citation needed|citation needed]]]</sup> (1)
legal:
US Schedule II (single-entity); Schedule III–V (combination products by content). (1) ·
[[USLegal:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults'"`UNIQ--ref-00000022-QINU`"' (2) ·
[[USLegal:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults'"`UNIQ--ref-00000025-QINU`"' (1) ·
[[USLegal:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults'"`UNIQ--ref-00000028-QINU`"' (1)
Showing below up to 5 results in range #1 to #5.