TY - CHAP M1 - Book, Section TI - Chapter 160. Antidepressants and Anticonvulsants Used in Pain Management A1 - Voiculescu, Lucia Daiana A1 - Ranasinghe, Chaturani A2 - Atchabahian, Arthur A2 - Gupta, Ruchir Y1 - 2013 N1 - T2 - The Anesthesia Guide AB - Table Graphic Jump Location|Download (.pdf)|PrintAntidepressants Used for Pain ManagementDrug/principal mechanism of actionPain indicationsCommon dosing1Common side effectsSpecial considerationsAmitriptylineTertiary amine TCASerotonin and norepinephrine reuptake inhibitorChronic painNeuropathic pain2Headache: treatment and prophylaxisPostherpetic neuralgia: treatment and prophylaxis25 mg QHS to maximum 100 mg/dayDry mouth, orthostatic hypotension, urinary retention, constipation, sedation, weight gainBlack box warning: increased risk of suicidality in patients younger than 24 yearsCaution in the elderly, patients with CAD, after acute MI, seizure disorder, angle-closure glaucomaCardiac conduction effects. Prolonged QT if combined with cisaprideIncreased drug levels with other CYP 450-2D6 inhibitors.3 Fatal in overdoseSerotonin syndrome when combined with SSRIs or MAOIsPregnancy Class CNortriptylineSecondary amine TCASerotonin and norepinephrine reuptake inhibitorChronic pain2Neuropathic pain2Myofascial pain2Burning mouth syndrome225 mg QHS to maximum150 mg/dayDry mouth, orthostatic hypotension, urinary retention, constipation, sedation, weight gain,4 etc.Black box warning: increased risk of suicidality in patients younger than 24 yearsCaution in the elderly, patients with CAD. Cardiac conduction effects including prolonged QTDrug interactions with other CYP 450-2D6 inhibitor drugs.3 Fatal in overdoseSerotonin syndromePregnancy Class CDuloxetineSerotonin and norepinephrine reuptake inhibitorWeak inhibitor of dopamine reuptakeDiabetic neuropathy5Fibromyalgia5Chronic musculoskeletal pain5Start at 30 mg/dayMaximum 60 mg/day (for pain)Nausea, xerostomia, constipation, insomnia, somnolence, fatigue, etc.Black box warning: increased risk of suicidality in patients younger than 24 yearsDuloxetine is not FDA approved for use in childrenWithdrawal syndromeSerotonin syndromePregnancy Class CVenlafaxineSerotonin and norepinephrine reuptake inhibitorWeak inhibitor of dopamine reuptakeNeuropathic pain5Tension-type headache: prophylaxis537.5 mg q day or BIDMaximum 225 mg/daySomnolence, dizziness, nervousness, headache, nausea, sweating, etc.Black box warning: increased risk of suicidality in patients younger than 24 yearsWithdrawal syndromeCaution in patients with seizure history, elderly, CV risk factors,6 etc.Serotonin syndromePregnancy Class CNote: SSRIs and other SNRIs not found to be effective for neuropathic pain; therefore, not included in this table.1Starting at low doses and slow titration were found to reduce most adverse effects and common side effects of antidepressants used in pain management.2Off-label usage.3Drugs such as methadone, protease inhibitors, cimetidine, cocaine, fluoxetine, paroxetine, sertraline, bupropion can cause increased levels of TCAs.4Secondary amine tricyclics have fewer reported adverse effects, such as anticholinergic side effects, compared with tertiary amine tricyclic antidepressants.5FDA approved.6Less commonly, cardiac conduction abnormalities and hypertension have been reported. SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/03/29 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=57263104 ER -