What are the most common tricyclic antidepressants (TCAs)?

From the Guidelines

The most common tricyclic antidepressants (TCAs) used in clinical practice are nortriptyline and desipramine, which are secondary-amine TCAs, due to their better tolerability and efficacy in treating neuropathic pain. According to the study by 1, these medications are recommended as first-line treatments for neuropathic pain, with nortriptyline and desipramine being specifically mentioned as options. The study suggests that these medications should be started at low doses and titrated slowly to minimize side effects, with careful monitoring in patients with cardiac conditions due to potential QT interval prolongation.

Some key points to consider when prescribing TCAs include:

• Starting with low doses, such as 10-25mg at bedtime, and gradually increasing as needed and tolerated
• Carefully monitoring patients with cardiac conditions, such as ischemic cardiac disease or ventricular conduction abnormalities, and limiting dosages to less than 100mg/d when possible
• Obtaining a screening electrocardiogram for patients older than 40 years
• Being aware of potential side effects, such as dry mouth, constipation, urinary retention, and sedation, and taking steps to minimize them
• Using caution in elderly patients and those with glaucoma or prostatic hypertrophy

It's also important to note that, according to the study by 1, tricyclic antidepressants can be effective second-line treatments for irritable bowel syndrome (IBS), with amitriptyline being specifically mentioned as an option. However, this is not directly related to the question of the most common tricyclic antidepressants used in clinical practice.

In terms of the most recent and highest quality evidence, the study by 1 provides the most relevant and up-to-date information on the use of TCAs in clinical practice, and should be prioritized when making treatment decisions.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Common Tricyclic Antidepressants

• The most common tricyclic antidepressants include:
  • Amitriptyline 2, 3, 4, 5
  • Nortriptyline 2, 3, 5
  • Imipramine 2, 5
  • Desipramine 3, 5
  • Clomipramine 2, 5
  • Doxepin 2, 3
  • Protriptyline 2
  • Butriptyline 2
  • Imipramine N-oxide 2
  • Desmethylimipramine 2

Therapeutic Use

• These tricyclic antidepressants are used to treat major depressive disorder 4, chronic orofacial pain 3, and other conditions.
• The therapeutic range for plasma concentrations of these drugs has been suggested, but more definitive studies are needed to determine the necessary plasma levels for achieving clinical response 2.

Side Effects

• Common side effects of tricyclic antidepressants include dry mouth, sedation, constipation, and orthostasis 3.
• Amitriptyline has been associated with anticholinergic side effects, tachycardia, dizziness, nervousness, sedation, tremor, dyspepsia, sexual dysfunction, and weight gain 4.