From the Guidelines
Tricyclic antidepressants (TCAs) can be categorized based on their pharmacological properties, with examples including tertiary amine TCAs such as amitriptyline (50-150 mg/day) and imipramine (75-200 mg/day), and secondary amine TCAs such as nortriptyline (50-150 mg/day) and desipramine (50-200 mg/day) [ 1 ].
Key Characteristics of TCAs
- These medications are typically administered orally, with treatment durations ranging from several weeks to months, and are often used to treat major depressive disorder, chronic pain, and other conditions [ 1 ].
- Dose titration is often necessary to achieve optimal therapeutic effects while minimizing side effects [ 1 ].
- Secondary amine TCAs (e.g., desipramine and nortriptyline) may be better tolerated in patients with certain conditions due to their lower anticholinergic effects [ 1 ].
Examples of TCAs
- Tertiary amine TCAs:
- Amitriptyline (50-150 mg/day)
- Imipramine (75-200 mg/day)
- Secondary amine TCAs:
- Nortriptyline (50-150 mg/day)
- Desipramine (50-200 mg/day)
Important Considerations
- TCAs have multiple actions, including inhibition of serotonin and noradrenergic reuptake and blockade of muscarinic 1, a1 adrenergic, and histamine 1 receptors [ 1 ].
- The selection of TCA should be based on the patient’s symptom presentation [ 1 ].
From the FDA Drug Label
Tricyclic antidepressant drugs, including amitriptyline hydrochloride, particularly when given in high doses, have been reported to produce arrhythmias, sinus tachycardia, and prolongation of the conduction time. Drugs Metabolized by P450 2D6 The biochemical activity of the drug metabolizing isozyme cytochrome P450 2D6 (debrisoquin hydroxylase) is reduced in a subset of the Caucasian population (about 7% to 10% of Caucasians are so called “poor metabolizers”); reliable estimates of the prevalence of reduced P450 2D6 isozyme activity among Asian, African and other populations are not yet available Poor metabolizers have higher than expected plasma concentrations of tricyclic antidepressants (TCAs) when given usual doses.
The categories and examples of Tricyclic Antidepressants (TCAs) are not explicitly listed in the provided drug labels. However, tricyclic antidepressant drugs are mentioned, including:
- Amitriptyline 2
- Desipramine 3 These are examples of TCAs, but the labels do not provide a comprehensive list of categories and examples of TCAs.
From the Research
Categories of Tricyclic Antidepressants (TCAs)
- Secondary amine TCAs, which include nortriptyline and desipramine, are preferred among the TCAs due to their more favorable side-effect profile 4
- Tertiary amine TCAs, which include amitriptyline, imipramine, and others, are also commonly used to treat major depressive disorder
Examples of Tricyclic Antidepressants (TCAs)
- Amitriptyline 5, 6
- Desipramine 5, 4, 6
- Imipramine 5, 7, 6
- Nortriptyline 5, 4, 7, 6
- Clomipramine 7, 6
- Doxepin 6
- Maprotiline 6
- Trimipramine 6
- Other TCAs, including amineptine, amoxapine, butriptyline, cianopramine, dibenzepin, dosulepin, dothiepin, iprindole, lofepramine, melitracen, metapramine, noxiptiline, opipramol, protriptyline, tianeptine, and quinupramine 6