Drilldown: Medicines
Use the filters below to narrow your results.
generic:
brand:
Armour Thyroid, NP Thyroid, Nature-Throid, WP Thyroid (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) ·
Synthroid, Levoxyl, Tirosint, Unithroid, Euthyrox (1)
classes:
secondary amine)]] (1) ·
[[:Category:Antidepressants|Antidepressant]] (4) ·
[[:Category:Antihistamines|Antihistamine (potent H1)]] (1) ·
[[:Category:Hormone_replacement|Hormone replacement]] (2) ·
[[: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:Thyroid_hormones|Thyroid hormone]] (2) ·
[[:Category:Tricyclic antidepressants|Tricyclic antidepressant (TCA (1) ·
[[:Category:Tricyclic antidepressants|Tricyclic antidepressant (TCA)]] (2)
mechanism:
None (3) ·
Synthetic T4 (thyroxine); peripherally deiodinated to T3 (triiodothyronine), the active hormone. '"`UNIQ--vote-00000031-QINU`"' Narrow therapeutic index; brand-to-generic switches can shift TSH and require re-titration'"`UNIQ--ref-00000032-QINU`"'. (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) ·
'"`UNIQ--vote-00000032-QINU`"' Brand-to-brand and lot-to-lot variability in T3:T4 ratio is greater than with synthetic levothyroxine, which is why endocrine guidelines prefer the synthetic'"`UNIQ--ref-00000033-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-00000033-QINU`"', '"`UNIQ--vote-00000034-QINU`"', '"`UNIQ--vote-00000035-QINU`"' (1) ·
'"`UNIQ--vote-00000034-QINU`"', '"`UNIQ--vote-00000035-QINU`"' (1)
starting dose:
1.6 mcg/kg/d in young healthy adults; 25-50 mcg/d in elderly or cardiac disease, titrated by TSH at 6-8 weeks (1) ·
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) ·
30 mg PO daily (1/2 grain); titrate by TSH at 6-8 weeks; 60 mg desiccated thyroid is approximately equivalent to 88-100 mcg levothyroxine (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:
15, 30, 60, 90, 120, 180, 240, 300 mg tablets (1/4 to 5 grains; 1 grain = 60 mg) (1) ·
25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, 300 mcg tablets; oral capsule and IV/IM also available (1) ·
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) ·
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) ·
No fixed maximum; titrated to TSH target (2)
routes:
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) ·
TSH normalization 4-8 weeks (1) ·
TSH normalization 4-8 weeks; symptomatic improvement weeks to months (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) ·
T4 ~7 days; T3 ~1 day'"`UNIQ--ref-00000036-QINU`"' (1) ·
~15 hours (parent); nordoxepin active metabolite ~30 hours'"`UNIQ--ref-00000020-QINU`"' (1) ·
~7 days (euthyroid); longer in hypothyroidism (~9-10 days), shorter in hyperthyroidism'"`UNIQ--ref-00000036-QINU`"' (1)
bioavailability:
40-80% (oral); reduced by food, calcium, iron, PPIs, fiber; take fasting with water'"`UNIQ--ref-00000037-QINU`"' (1) ·
Variable; reduced by food, calcium, iron, PPIs'"`UNIQ--ref-00000037-QINU`"' (1) ·
~30% (oral)'"`UNIQ--ref-00000021-QINU`"' (1) ·
~50% (oral)'"`UNIQ--ref-00000021-QINU`"' (1) ·
~50% (oral)'"`UNIQ--ref-00000027-QINU`"' (1) ·
~50% (oral; substantial first-pass)'"`UNIQ--ref-00000024-QINU`"' (1)
pregnancy:
First-line in pregnancy; dose typically increased 25-30% due to estrogen-driven rise in TBG and fetal demand. Lactation safe at physiologic doses.<sup class="pcp-cn" title="This claim needs a citation.">[[[Pharmacopedia:Citation needed|citation needed]]]</sup> (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) ·
Synthetic levothyroxine is the standard-of-care in pregnancy; desiccated thyroid use in pregnancy is not well studied<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:Prescription only|Rx-only]] in US (2) ·
[[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 6 results in range #1 to #6.