Drilldown: Medicines
Medicines > routes:
Oral 
& duration :
24 hours (HS dosing) or
4-8 hours typical; longer at high doses; residual cognitive and perceptual effects up to 48 hours
& duration :
24 hours (HS dosing) or
4-8 hours typical; longer at high doses; residual cognitive and perceptual effects up to 48 hours Use the filters below to narrow your results.
generic:
brand:
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) ·
Sernyl (human, withdrawn 1965); Sernylan (veterinary, withdrawn 1978) (1) ·
Sinequan (oral antidepressant, US brand discontinued), Silenor (low-dose for insomnia), Prudoxin / Zonalon (topical cream) (1)
classes:
secondary amine)]] (1) ·
[[:Category:Anesthetics|Anesthetic (historical)]] (1) ·
[[:Category:Antidepressants|Antidepressant]] (4) ·
[[:Category:Antihistamines|Antihistamine (potent H1)]] (1) ·
[[:Category:Arylcyclohexylamines|Arylcyclohexylamine]] (1) ·
[[:Category:Dissociatives|Dissociative]] (1) ·
[[:Category:Migraine prophylactics|Migraine prophylactic]] (2) ·
[[:Category:Neuropathic pain medicines|Neuropathic pain medicine]] (2) ·
[[:Category:NMDA_receptor_antagonists|NMDA receptor antagonist]] (1) ·
[[:Category:Sigma-1_receptor_agonists|Sigma-1 receptor agonist]] (1) ·
[[: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 (4) ·
'"`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:
'"`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) ·
'"`UNIQ--vote-00000063-QINU`"', '"`UNIQ--vote-00000064-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) ·
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) ·
No current medical indication. Historical anesthetic dose 0.25 mg/kg IV (Sernyl). (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) ·
Historical: Sernyl 25 mg tablets, 10 mg/mL injection (human); Sernylan 100 mg/mL injection (veterinary). Illicit: white crystalline powder, oily liquid, "dipped" cigarettes ("wet"), tablets. (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) ·
45 mg/day (1) ·
N/A (no current medical indication) (1)
routes: (Click arrow to add another value)
onset:
Pain and migraine prophylaxis effect 1-4 weeks; antidepressant effect 4-6 weeks (1) ·
Sleep effect from first dose; analgesic and migraine-prophylaxis effect 1-4 weeks; antidepressant effect 4-6 weeks (1) ·
Sleep effect from first dose; antidepressant effect over 1-4 weeks (2) ·
Smoked 2-5 min; insufflated 5-15 min; oral 30-60 min; IV / IM ~5-15 min (1)
duration: (Click arrow to add another value)
halflife:
18-44 hours'"`UNIQ--ref-00000020-QINU`"' (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) ·
Highly variable, 7-46 hours (mean ~21 h); lipophilic deposition in fat with delayed re-release contributes to wide range'"`UNIQ--ref-00000065-QINU`"' (1) ·
~15 hours (parent); nordoxepin active metabolite ~30 hours'"`UNIQ--ref-00000020-QINU`"' (1)
bioavailability:
pregnancy:
None (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:
[[USLegal:DEA Schedule II|Schedule II]] controlled substance in US (rescheduled from Schedule III in 1978). No accepted medical use. UN Convention on Psychotropic Substances Schedule II internationally.'"`UNIQ--ref-00000067-QINU`"' (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.