Tricyclic antidepressants contraindications

Serious adverse effects of epinephrine potentially occur when it is given in an excessive dose, or too rapidly, for example, as an intravenous bolus or a rapid intravenous infusion. These include ventricular dysrhythmias, angina, myocardial infarction, pulmonary edema, sudden sharp increase in blood pressure, and cerebral hemorrhage. The risk of epinephrine adverse effects is also potentially increased in patients with hypertension or ischemic heart disease, and in those using (3-blockers (due to unopposed epinephrine action on vascular Ui-adrenergic receptors), monoamine oxidase inhibitors, tricyclic antidepressants, or cocaine. Even in these patients, there is no absolute contraindication for the use of epinephrine in the treatment of anaphylaxis [1,5,6]. 

Blockers are contraindicated in patients with decompensated heart failure unless it is caused solely by tachycardia (high output). Other contraindications include sinus bradycardia, concomitant therapy with monoamine oxidase inhibitors or tricyclic antidepressants, and patients with spontaneous hypoglycemia. Side effects include nausea, vomiting, anxiety, insomnia, lightheadedness, bradycardia, and hematologic disturbances. 

Contraindications Concomitant use of MAOls, history of myelosuppression, hypersensitivity to tricyclic antidepressants... 

I Contraindications Amgle-closure glaucoma, hypersensitivityto other tricyclic antidepressants, urine retention... 

Gardner DM, Lynd LD Sumatriptan contraindications and the serotonin syndrome. Ann Pharmacother 32 33-38, 1998 Gardner DM, Shulman KI, Walker SE, et al The making of a user friendly MAOI diet. J Clin Psychiatry 57 99-104, 1996 Glassman AH, Bigger JT Cardiovascular effects of therapeutic doses of tricyclic antidepressants a review. Arch Gen Psychiatry 38 815-820,1981... 

Assessment of physical, as well as psychiatric status, is also critically important. The presence of intercurrent medical disorders, as well as any medication used to manage them, increases the likelihood of an adverse outcome with an otherwise appropriate medication. With a recent history of myocardial infarction, certain tricyclic antidepressants (TCAs) or low-potency antipsychotics might be contraindicated due to potential adverse effects on cardiac function. Another example is the avoidance of carbamazepine in a bipolar patient with a persistently low white blood cell count. Finally, b-blockers are typically contraindicated in a patient with asthma. 

Loss of accommodation and blurred vision are common inconveniences that can usually be tolerated, in the knowledge that they lessen with the duration of treatment. Exacerbation of narrow-angle glaucoma in the elderly can occur, but is not an absolute contraindication to treatment with a tricyclic antidepressant, since the anticholinergic effects can be balanced by judicious use of pilocarpine (73,74). 

Cardiovascular disease is not a contraindication to lithium, but the risks may be greater, in view of factors such as fluid and electrolyte imbalance and the use of concomitant medications. Close clinical and laboratory monitoring is necessary, and an alternative mood stabilizer may be preferred. While long-term tricyclic antidepressant therapy may be more cardiotoxic than lithium, the newer antidepressants (SSRIs and others) seem to be safe. 

Patients taking certain systemic medications are also more sensitive to the pressor effects of phenylephrine. In individuals taking atropine, the pressor effect of phenylephrine is augmented, and tachycardia can occur. Tricyclic antidepressants and monoamine oxidase (MAO) inhibitors also potentiate the cardiovascular effects of topical phenylephrine. The concomitant use of phenylephrine is contraindicated with these agents, even up to 21 days after cessation of MAO inhibitor therapy. Similarly, patients taking reserpine, guanethidine, or methyldopa are at increased risk for adverse pressor effects from topical phenylephrine because of denervation hypersensitivity accompanying the chemical sympathectomy. 

The drug is contraindicated in patients taking MAO inhibitors, tricyclic antidepressants, reserpine, guanethidine, or methyldopa. 

Although oral corticosteroids have had an established use in herpes zoster treatment, their value has become controversial.They are clearly contraindicated in HIV and while the virus is still present in immunocompetent patients. Some authors report increased quality of life and decreased acute pain with oral steroid use in the elderly, but this value is offset by potential risk. Significant relief may be obtained with early antiviral therapy so that oral steroids are an unnecessary risk. Oral steroids are of no value in preventing PHN as was previously believed. The duration of PHN, however, is significantly shortened by early and aggressive use of oral antiviral agents in the acute phase of herpes zoster. Tricyclic antidepressants may also be useful when prescribed at the time of acute... 

Clonidine, tricyclic antidepressants md antipsychotic agents (e.g. risperidone, sulpiride) may have a role in ADHD where methylphenidate and dexamfetamine are contraindicated or have failed to produce benefit. 

Adverse effects include constipation, dry mouth and insonmia which occur in > 10% of users. Less commonly, nausea, tachycardia, palpitations, raised blood pressure, anxiety, sweating and altered taste may occur. Blood pressure should be monitored closely throughout its use (twice weekly in the first 3 months). Contraindications include severe h3q>er-tension, peripheral occlusive arterial or coronary heart disease, cardiac arrhythmia, prostatic hypertrophy and those with severe hepatic or renal impairment. It should not be used to treat obesity of endocrine origin or those with a history of major eating disorder or psychiatric disease. Concomitant use with tricyclic antidepressants should be avoided (CNS toxicity). 

Similar caution should be exercised with biogenic amine uptake blockers such as tricyclic antidepressants. Amphetamine is contraindicated in advanced arteriosclerosis symptomatic cardiovascular disease moderate to severe hypertension hyperthyroidism hypersensitivity or idiosyncrasy to the sympathomimetic amines glaucoma agitated states history of drug abuse and during or within 14 days following administration of monoamine oxidase (MAO) inhibitors. 

Trimipramine is contraindicated in patients with known hypersensitivity to tricyclic antidepressants, trazodone, and related compounds in the acute recovery phase of myocardial infarction (MI), because the drug depresses cardiac function and causes dysrhythmia in patients in coma or severe respiratory depression (additive CNS and respiratory depression) and during or within 14 days of therapy with monoamine oxidase inhibitors. 

Xylometazoline is contraindicated in patients with narrow-angle glaucoma, because the drug may increase intraocular pressure, and in patients receiving tricyclic antidepressants, because of the potential for adverse cardiovascular effects. 

Remember that levodopa is a precursor of norepinephrine and epinephrine as well as dopamine and that norepinephrine and epinephrine are metabolized primarily by monoamine oxidase type A. In the presence of nonselective inhibitors of monoamine oxidases, levodopa may cause a hypertensive crisis. Though not contraindicated in Parkinson s disease, tricyclic antidepressants may interfere with the effectiveness of levodopa. The answer is (D). 

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