If you have a friend named Tina, you definitely won’t forget your tricyclic antidepressants.

  1. T – Trimipramine (Surmontil)
  2. I – Imipramine (Tofranil)
  3. N – Nortriptyline (Pamelor)
  4. A – Amitriptyline (Elavil)

Besides noticing Tina in your life, you will also notice that these all end in -ine. Just do not forget about doxepin (Sinequan) as well!

What is this Mysterious Drug?

Tricyclic antidepressants block the reabsorption of norepinephrine and serotonin. By doing so, neurotransmitters will be more available at postsynaptic receptors. This is used to treat depression, alcohol and drug withdrawal, bi-polar disorder, and for clients who has failed to respond well to other antidepressants, such as SSRIs.

Signs & Symptoms

“When assessing a client undergoing tricyclic antidepressant therapy, which of the following should the nurse watch out for when experiencing anticholinergic effects?”

  1. Tremors
  2. Sedation
  3. Hypotension
  4. Urine retention

The answer is D! Yes, all of the above choices are ALL signs and symptoms of tricyclics, but you need to be aware of the anticholinergic effects (urinary retention, blurred vision, constipation and dry mouth).

You’re going to want to watch out for sedation, orthostatic hypotension, decreased sexual desire, dry mouth, urinary retention, and tachycardia. Just remember to associate with anticholinergic effect!

Now that you know the signs and symptoms, think about what you would teach the patient. If tricyclics can cause sedation, then teach the patient to not drive heavy machinery and to take the medication at night time. There is “tri” in tricyclic so that will help you to remember that the drug will take approximately three weeks to achieve the therapeutic level.

Drug Interactions

Ask if the patients are taking any other medication to prevent unwanted drug interactions. Ask about herbs because a lot of patients do not count herbs.

Taking tricyclics with MAOIs can cause hypertensive crisis. YOU CAN PREVENT THIS by making sure that you don’t administer tricyclics within 14 days of taking MAOIs. It is also important to know that you do NOT administer tricyclics to patients who is in the acute recovery phase of myocardial ischemia or severe coronary artery disease.

St. John’s Wort is DEFINITELY a drug that they cannot take with tricyclic. You can remember this based on “do not ride your tricyclic bike at a St. John church”. It is simply not wanted.

Nursing Implications

“When preparing to provide patient education on Amitriptyline (Elavil), which of the following substances should the nurse tell the client to avoid?”

  1. Coffee
  2. Alcohol

Tricyclic combined with alcohol will produce additive CNS depression. You want to advise patients to stop smoking and to avoid alcohol. Though this is kind of common sense because I can not imagine any nurse being proactive to tell their patients that they should smoke and drink anyway.

The patient would typically take tricyclic antidepressants for at LEAST six months. The rule of thumb about taking antidepressants is that the risk of suicide increases when clients initially begin to feel better. You NEED to monitor closely for mood changes or changes in behavior.

HT: Mosby Elsevier – Mosby’s Pharmacology Memory Note Cards