Tricyclic antidepressants with other substances

Table 3 Interactions of tricyclic antidepressants with other substances...

Medications play an important part in the treatment of ADD. Stimulants are the mainstay of the treatment of ADD methylphenidate (Ritalin), dextroamphetamine (Dexedrine), and pemoline (Cylert). These differ in their half-lives, with Ritalin having the shortest and Cylert the longest. A warning has recently been issued about Cylert because of reports of sometimes fatal liver toxicity. Thus, it is recommended that it be used only if methylphenidate and dextroamphetamine are ineffective. There is individual variability in resporise, so that a person who does not respond to one may respond well to another. Other medications can also be effective in the treatment of ADD and may be useful, especially in residual ADD, where substance abuse may be an issue. These include tricyclic antidepressants (especially desipramine and imi-pramine) SSRIs, bupropion, venlafaxine, and clonidine. There are reports of antipsy-chotics and lithium being helpful in selected cases, as well. 

Usually in intoxication cases there is enough of the original poison in a free form in the sample to be detectable (cf 4). In the few cases where this is not so it is necessary to include a hydrolysis procedure for its release and detection. This may be done rapidly if the purpose is preferentially qualitative. We found this situation in a case of intoxication from several substances one of which was suspected to be diazepam. This was detectable only after hydrolysis with 6 N HCl for 5 mins. As hydrolysis may destroy other compounds of interest, e.g. tricyclic antidepressants, it should be used only in a second run, after a first one without hydrolysis. Similarly derivatization of the sample is usually unnecessary but may be called for if the preliminary findings are considered incomplete or require confirmation. 

Erectile dysfunction (ED), the inability to achieve or maintain a penile erection sufficient to permit satisfactory sexual intercourse, is estimated to affect over 100 million men worldwide, with a prevalence of 39% in those of 40 years. Its numerous causes include cardiovascular disease, diabetes mellitus and other endocrine disorders, alcohol and substance abuse, and psychological factors (14%). While the evidence is not conclusive, drug therapy is thought to underlie 25% of cases, notably from antidepressants (SSRI and tricyclic), phenothiazines, cypro-terone acetate, fibrates, levodopa, histamine H -receptor blockers, phenytoin, carbamazepine, allopurinol, indomethacin, and possibly adrenoceptor blockers and thiazide diuretics. 

---