Tricyclic antidepressants

Some of these medications have anticholinergic properties which may worsen cognition in patients with mild memory problems and antagonize the effects of cholinesterase inhibitors. Carefully evaluate alternatives for these medications. Desipramine (Norpramin® or Pertofrane®) has the least anticholinergic side effects of any of the tricyclics.

When used for neuropathic pain, patients over the age of 65 may do better on gabapentin (Neurontin®) due to a lower risk of side effects. When used for sleep, please consider possible use of trazodone (Desyrel®) due to lower risk for anticholinergic side effects. When used for depression, consider using an alternative antidepressant class.

Examples

• Amitriptyline (Elavil®)
• Clomipramine (Anafranil®)
• Desipramine (Norpramin® or Pertofrane®)
• Doxepin (Sinequan®)
• Imipramine (Tofranil®)
• Protriptyline (Vivactil®)
• Trimipramine (Surmontil®)