The TCAs are contraindicated in patients with known hypersensitivity to the drugs. Doxepin is contraindicated in patients with glaucoma or in those with a tendency for urinary retention. The TCAs are not given within 14 days of the MAOIs, in patients with a recent myocardial infarction, or during pregnancy or lactation. These drugs are Pregnancy Category C drugs (except imipramine, which is Pregnancy Category B), and the safety of their use during pregnancy has not been established. TCAs are contraindicated in patients scheduled to have a myelogram (x-ray of the spinal cord and associated nerves) during the next 48 hours or within 24 hours of having a myelogram.
As with all antidepressants, the TCAs are used cautiously in patients with hepatic or renal impairment. The tricyclics are used cautiously in patients with heart disease, angina, paroxysmal tachycardia, increased intraocular pressure, prostatic hypertrophy, or a history of seizures.
If the tricyclics are administered with the MAOIs, the patient is at risk for hypertensive episodes, severe convulsions, and hyperpyretic episodes. Use of the MAOIs must be discontinued at least 2 weeks before treatment with the tricyclics begins. The tricyclics may prevent the therapeutic effect of many antihypertensives. When the tricyclics are administered with dicumarol, the risk for bleeding increases.
Home Care Checklist
If your patients are taking MAOIs, they need to avoid foods containing tyramine. Otherwise they may experience a life-threatening reaction, hypertensive crisis. Be sure to instruct your patients to avoid the following foods:
Aged cheese Blue
Beef or chicken livers
Fermented meats Bologna Pepperoni Salami Dried fish
Undistilled alcoholic beverages Imported beer Ale
Red wine, especially Chianti Coffee Tea
Colas containing caffeine
Fruits and vegetables Avocado Fava beans Figs Raisins Bananas
Arrhythmias and hypertension have been reported when the TCAs are administered with the adrenergic drugs. There is a risk of severe hypertension when the TCAs are administered with clonidine.
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