- Amitriptyline
- Tertiary amine TCA
- Serotonin and norepinephrine reuptake inhibitor
| - Chronic pain
- Neuropathic pain2
- Headache: treatment and prophylaxis
- Postherpetic neuralgia: treatment and prophylaxis
| - 25 mg QHS to maximum 100 mg/day
| Dry mouth, orthostatic hypotension, urinary retention, constipation, sedation, weight gain | - Black box warning: increased risk of suicidality in patients younger than 24 years
- Caution in the elderly, patients with CAD, after acute MI, seizure disorder, angle-closure glaucoma
- Cardiac conduction effects. Prolonged QT if combined with cisapride
- Increased drug levels with other CYP 450-2D6 inhibitors.3 Fatal in overdose
- Serotonin syndrome when combined with SSRIs or MAOIs
- Pregnancy Class C
|
- Nortriptyline
- Secondary amine TCA
- Serotonin and norepinephrine reuptake inhibitor
| - Chronic pain2
- Neuropathic pain2
- Myofascial pain2
- Burning mouth syndrome2
| - 25 mg QHS to maximum
- 150 mg/day
| Dry mouth, orthostatic hypotension, urinary retention, constipation, sedation, weight gain,4 etc. | - Black box warning: increased risk of suicidality in patients younger than 24 years
- Caution in the elderly, patients with CAD. Cardiac conduction effects including prolonged QT
- Drug interactions with other CYP 450-2D6 inhibitor drugs.3 Fatal in overdose
- Serotonin syndrome
- Pregnancy Class C
|
Duloxetine- Serotonin and norepinephrine reuptake inhibitor
- Weak inhibitor of dopamine reuptake
| - Diabetic neuropathy5
- Fibromyalgia5
- Chronic musculoskeletal pain5
| - Start at 30 mg/day
- Maximum 60 mg/day (for pain)
| Nausea, xerostomia, constipation, insomnia, somnolence, fatigue, etc. | - Black box warning: increased risk of suicidality in patients younger than 24 years
- Duloxetine is not FDA approved for use in children
- Withdrawal syndrome
- Serotonin syndrome
- Pregnancy Class C
|
Venlafaxine- Serotonin and norepinephrine reuptake inhibitor
- Weak inhibitor of dopamine reuptake
| - Neuropathic pain5
- Tension-type headache: prophylaxis5
| - 37.5 mg q day or BID
- Maximum 225 mg/day
| Somnolence, dizziness, nervousness, headache, nausea, sweating, etc. | - Black box warning: increased risk of suicidality in patients younger than 24 years
- Withdrawal syndrome
- Caution in patients with seizure history, elderly, CV risk factors,6 etc.
- Serotonin syndrome
- Pregnancy Class C
|