Tricyclic antidepressants hematologic

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. 

Tricyclic antidepressants resemble the phenothiazine antipsychotics such as chlorpromazine in structure and function. Like the phenothiazine derivatives (e.g., chlorpromazine), tricyclic antidepressants (e.g., amitriptyline) may reduce the seizure threshold and precipitate seizures in epileptic patients, cause cholestatic jaundice, movement disorders, and hematologic side effects. Unlike the phenothiazine derivatives, the tricyclic antidepressants may increase motor activity, have a very slow onset and long duration of action, a relatively narrow margin of safety, and a strong anticholinergic effect. In fact, dry mouth is the most common side effect, and other anticholinergic effects such as tachycardia, loss of accommodation, constipation, urinary retention, and paralytic ileus have been reported following amitriptyline. 

They resemble the phenothiazide derivatives such as chlorpromazine in structure and function. Like the phe-nothiazine derivatives (e.g., chlorpromazine), tricyclic antidepressants (e.g., imipramine) may reduce the seizure threshold and precipitate seizures in epileptic patients, and may cause cholestatic jaundice, movement disorders, and hematologic side effects. 

CBZ should be used with caution in patients with a history of congestive heart failure or cardiac arrhythmias (because it may aggravate them) and with a history of hematologic reactions to other drugs or hypersensitivity to tricyclic antidepressants. Blood levels should be monitored in patients with renal or hepatic impairment. 

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