Depressive illness

Adult: Initially up to 75 mg daily in divided doses, then increased to 150–200 mg daily, up to 150mg may be given as a single dose at bedtime, dose to be increased gradually

Elderly: Initially 10 mg daily, increased to 30–50 mg daily, dose to be increased gradually

Depressive illness in hospital patients

Adult: Initially up to 75 mg daily in divided doses, dose to be increased gradually, increased to up to 300 mg daily in divided doses

Nocturnal enuresis

Child 6–7 years: 25 mg once daily, to be taken at bed time, initial period of treatment (including gradual withdrawal) 3 months- full physical examination before further course

Child 8–10 years: 25–50 mg once daily, to be taken at bedtime, initial period of treatment (including gradual withdrawal) 3 months- full physical examination before further course

Child 11–17 years: 50–75 mg once daily, to be taken at bedtime, initial period of treatment (including gradual withdrawal) 3 months- full physical examination before further course

• Immediate recovery period after myocardial infarction
• Acute porphyria’s arrhythmia
• During the manic phase of bipolar disorder
• Heart block

Cardiovascular disease, chronic constipation, diabetes, epilepsy, history of bipolar disorder, history of psychosis, hyperthyroidism (risk of arrhythmias),increased intra-ocular pressure, patients with a significant risk of suicide, phaeochromocytoma (risk of arrhythmias), prostatic hypertrophy (in adults), susceptibility to angle closure glaucoma, urinary retention

Cautions, Further Information

Treatment should be stopped if the patient enters a manic phase, elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants, low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.

Common or very common Anxiety, appetite decreased, arrhythmias, asthenia, cardiac conduction disorders, confusion, delirium, depression, dizziness, drowsiness, epilepsy, hallucination, headache, hepatic disorders, hypotension, mood altered, nausea, palpitations, paraesthesia, sexual dysfunction, skin reactions, sleep disorder, tremor, vomiting, weight changes.

Uncommon Psychosis

Rare or very rare Aggression, agranulocytosis, alopecia, bone marrow depression, enlarged mammary gland, eosinophilia, fever, galactorrhoea, gastrointestinal disorders, glaucoma, heart failure, leukopenia, movement disorders, mydriasis, oedema, oral disorders, peripheral vasospastic reaction, photosensitivity reaction, respiratory disorders, siadh, speech disorder, thrombocytopenia.

Frequency not known Anticholinergic syndrome, cardiovascular effects, drug fever, hyponatraemia, increased risk of fracture, neurological effects, paranoid delusions exacerbated psychiatric disorder, suicidal behaviours, tinnitus, urinary disorder, withdrawal syndrome.

Side-Effects, Further Information

The risk of side effects is reduced by titrating slowly to the minimum effective dose (every 2–3 days), consider using a lower starting dose in elderly patients, overdose tricyclic and related antidepressants cause dry mouth, coma of varying degree, hypotension, hypothermia, hyperreflexia, extensor plantar responses, convulsions, respiratory failure, cardiac conduction defects, and arrhythmias, dilated pupils and urinary retention also occurs.

Store in a cool and dry place

10×14 Tablets