His first line for treating constant neuropathic pain is a
tricyclic antidepressant or venlafaxine, followed by an anticonvulsant drug or bupropion.
In a study reported in May at the annual meeting of the American Psychiatric Association, Geller found that nortriptyline, one of a class of antidepressants known as
tricyclics, is no more effective than an inactive placebo pill in treating depressed children.
Forty patients were on a
tricyclic antidepressant; the others were roughly evenly divided between mirtazapine, reboxetine, venlafaxine, quetiapine, and SSRIs.
Klemperer usually starts a
tricyclic at 10 mg nightly, increasing by 5-25 mg/week to a maximum of 150 mg nightly.
Since
tricyclic medications do not show a benefit over desmopressin, they should be considered second-line agents due to cardiotoxic side effects and life-threatening overdose outcomes.
Selective serotonin reuptake inhibitors are probably high on most physicians' list of possible treatments because unlike
tricyclics they don't cause weight gain and other troubling effects such as cardiac arrhythmia, and, unlike monoamine oxidase inhibitors, they aren't lethal in overdose.
The specific components of the metabolic syndrome exacerbated by
tricyclic antidepressants (TCAs) were hypertension, abdominal obesity, and hypertriglyceridemia, Ari-anne K.B.
Physicians who are not comfortable prescribing
tricyclics might consider such dual agonists as venlafaxine or duloxeilne, which have receptor effects similar to those of older
tricyclics, she said.
Duloxetine, controlled-release oxycodone, pregabalin, and
tricyclic antidepressants, having the strongest evidence of efficacy, are the committee's first-tier drug treatment choices, each having more than two positive randomized, controlled trials specific for DPNP, according to the new guidelines.
Tricyclic antidepressants have an NNH of 17 for side effects severe enough that patients withdrew from the study.
In that study, somewhat higher efficacy rates were seen with duloxetine, a serotonin-noradrenaline reuptake inhibitor, and nortriptyline, a
tricyclic antidepressant, compared with pregabalin, Dr.
In that paper,
tricyclic antidepressants had a number needed to treat of 3.6, comparing favorably to 7.7 for pregabalin, 7.2 for gabapentin, and 6.4 for serotonin-noradrenaline reuptake inhibitors, mainly including duloxetine, said Dr.
The discovered novel methodology involved sequential multicomponent reactions; consisting of Knoevenagel reaction followed by Michael addition; moreover, the proposed mechanism is consistent with the stepwise methodology which also availed the same
tricyclic heterocycle compounds (1c-6c) and (1d-7d).
Flecainide toxicity manifests on the electrocardiogram similar to
tricyclic antidepressant toxicity, because both are sodium channel inhibitors.
