Skip to Content

Limbitrol (amitriptyline / chlordiazepoxide) Disease Interactions

There are 32 disease interactions with Limbitrol (amitriptyline / chlordiazepoxide):

Major

Benzodiazepines (Includes Limbitrol) ↔ Acute Alcohol Intoxication

Severe Potential Hazard, High plausibility

Applies to: Acute Alcohol Intoxication

The use of benzodiazepines with alcohol is not recommended. Patients with acute alcohol intoxication exhibit depressed vital signs. The central nervous system depressant effects of benzodiazepines may be additive with those of alcohol, and severe respiratory depression and death may occur. Therapy with benzodiazepines should be administered cautiously in patients who might be prone to acute alcohol intake.

References

  1. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  2. "Product Information. Doral (quazepam)." Wallace Laboratories, Cranbury, NJ.
  3. "Product Information. Valium (diazepam)." Roche Laboratories, Nutley, NJ.
  4. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  5. "Product Information. Dalmane (flurazepam)." Roche Laboratories, Nutley, NJ.
  6. "Product Information. Versed (midazolam)." Roche Laboratories, Nutley, NJ.
  7. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  8. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical, Abbott Park, IL.
  9. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  10. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  11. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories, Nutley, NJ.
  12. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  13. "Product Information. Klonopin (clonazepam)." Roche Laboratories, Nutley, NJ.
View all 13 references
Major

Benzodiazepines (Includes Limbitrol) ↔ Closed-Angle Glaucoma

Severe Potential Hazard, Low plausibility

Applies to: Glaucoma/Intraocular Hypertension

The manufacturers consider the use of benzodiazepines to be contraindicated in patients with acute angle-closure glaucoma or untreated open-angle glaucoma. These agents do not possess anticholinergic activity but have very rarely been associated with increased intraocular pressure.

References

  1. "Product Information. Klonopin (clonazepam)." Roche Laboratories, Nutley, NJ.
  2. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  3. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  4. "Product Information. Doral (quazepam)." Wallace Laboratories, Cranbury, NJ.
  5. "Product Information. Dalmane (flurazepam)." Roche Laboratories, Nutley, NJ.
  6. "Product Information. Versed (midazolam)." Roche Laboratories, Nutley, NJ.
  7. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  8. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical, Abbott Park, IL.
  9. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories, Nutley, NJ.
  10. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  11. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  12. "Product Information. Valium (diazepam)." Roche Laboratories, Nutley, NJ.
  13. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  14. Fraunfelder FT, Fraunfelder FW; Randall JA "Drug-Induced Ocular Side Effects 5th" Boston, MA: Butterworth-Heinemann (2001):
View all 14 references
Major

Benzodiazepines (Includes Limbitrol) ↔ Drug Dependence

Severe Potential Hazard, High plausibility

Applies to: Drug Abuse/Dependence

Benzodiazepines have the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop, particularly after prolonged use and/or excessive dosages. However, abrupt cessation following continual use of as few as 6 weeks at therapeutic levels has occasionally precipitated withdrawal symptoms. Addiction- prone individuals, such as those with a history of alcohol or substance abuse, should be under careful surveillance when treated with benzodiazepines. It may be prudent to refrain from dispensing large quantities of medication to these patients. After prolonged use or if dependency is suspected, withdrawal of benzodiazepine therapy should be undertaken gradually using a dosage- tapering schedule. If withdrawal symptoms occur, temporary reinstitution of benzodiazepines may be necessary.

References

  1. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  2. Specht U, Boenigk HE, Wolf P "Discontinuation of clonazepam after long-term treatment." Epilepsia 30 (1989): 458-63
  3. Rickels K, Schweizer E, Csanalosi I, Case WG, Chung H "Long-term treatment of anxiety and risk of withdrawal. Prospective comparison of clorazepate and buspirone." Arch Gen Psychiatry 45 (1988): 444-50
  4. Pecknold JC "Discontinuation reactions to alprazolam in panic disorder." J Psychiatr Res 27 (1993): 155-70
  5. "Product Information. Klonopin (clonazepam)." Roche Laboratories, Nutley, NJ.
  6. Bond WS, Schwartz M "Withdrawal reactions after long-term treatment with flurazepam." Clin Pharm 3 (1984): 316-8
  7. Frattola L, Garreau M, Piolti R, Bassi S, Albizzati MG, Borghi C, Morselli PL "Comparison of the efficacy, safety and withdrawal of alpidem and alprazolam in anxious patients." Br J Psychiatry 165 (1994): 94-100
  8. Wilbur R, Kulik AV "Abstinence syndrome from therapeutic doses of oxazepam." Can J Psychiatry 28 (1983): 298-300
  9. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  10. Hersch EL, Billings RF "Acute confusional state with status petit mal as a withdrawal syndrome: and five year follow-up." Can J Psychiatry 33 (1988): 157-9
  11. Berlin RM, Conell LJ "Withdrawal symptoms after long-term treatment with therapeutic doses of flurazepam: a case report." Am J Psychiatry 140 (1983): 488-90
  12. Hayward P, Wardle J, Higgitt A, Gray J "Changes in ''withdrawal symptoms'' following discontinuation of low-dose diazepam." Psychopharmacology (Berl) 125 (1996): 392-7
  13. Jaffe R, Gibson E "Clonazepam withdrawal psychosis." J Clin Psychopharmacol 6 (1986): 193
  14. Browne JL, Hauge KJ "A review of alprazolam withdrawal." Drug Intell Clin Pharm 20 (1986): 837-41
  15. Schneider LS, Syapin PJ, Pawluczyk S "Seizures following triazolam withdrawal despite benzodiazepine treatment." J Clin Psychiatry 48 (1987): 418-9
  16. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  17. Kroboth PD, Bertz RJ, Smith RB "Acute tolerance to triazolam during continuous and step infusions: estimation of the effect offset rate constant." J Pharmacol Exp Ther 264 (1993): 1047-55
  18. Tien AY, Gujavarty KS "Seizure following withdrawal from triazolam." Am J Psychiatry 142 (1985): 1516-7
  19. Patterson WM "Triazolam withdrawal." J Clin Psychiatry 49 (1988): 369
  20. "Product Information. Doral (quazepam)." Wallace Laboratories, Cranbury, NJ.
  21. Finer MJ "Habituation to chlordiazepoxide in an alcoholic population." JAMA 213 (1970): 1342
  22. Robinson GM, Sellers EM "Diazepam withdrawal seizures." Can Med Assoc J 126 (1982): 944-5
  23. Fontaine R, Chouinard G, Annable L "Rebound anxiety in anxious patients after abrupt withdrawal of benzodiazepine treatment." Am J Psychiatry 141 (1984): 848-52
  24. Keshavan MS, Moodley P, Eales M, Joyce E, Yeragani VK "Delusional depression following benzodiazepine withdrawal." Can J Psychiatry 33 (1988): 626-7
  25. Finley PR, Nolan PE, Jr "Precipitation of benzodiazepine withdrawal following sudden discontinuation of midazolam." DICP 23 (1989): 151-2
  26. Rosebush PI, Mazurek MF "Catatonia after benzodiazepine withdrawal." J Clin Psychopharmacol 16 (1996): 315-9
  27. Heritch AJ, Capwell R, Roy-Byrne PP "A case of psychosis and delirium following withdrawal from triazolam." J Clin Psychiatry 48 (1987): 168-9
  28. Bond WS, Berwish NJ, Swift B "Severe withdrawal syndrome after substitution of a short-acting benzodiazepine for a long-acting benzodiazepine." Drug Intell Clin Pharm 19 (1985): 742-4
  29. Busto U, Sellers EM, Naranjo CA, et al "Withdrawal reaction after long-term therapeutic use of benzodiazepines." N Engl J Med 315 (1986): 854-9
  30. "Product Information. Valium (diazepam)." Roche Laboratories, Nutley, NJ.
  31. MacKinnon GL, Parker WA "Benzodiazepine withdrawal syndrome: a literature review and evaluation." Am J Drug Alcohol Abuse 9 (1982): 19-33
  32. "Product Information. Dalmane (flurazepam)." Roche Laboratories, Nutley, NJ.
  33. Hauser P, Devinsky O, De Bellis M, Theodore WH, Post RM "Benzodiazepine withdrawal delirium with catatonic features. Occurrence in patients with partial seizure disorders." Arch Neurol 46 (1989): 696-9
  34. Rigby J, Harvey M, Davies DR "Mania precipitated by benzodiazepine withdrawal." Acta Psychiatr Scand 79 (1989): 406-7
  35. Ryan GP, Boisse NR "Experimental induction of benzodiazepine tolerance and physical dependence." J Pharmacol Exp Ther 226 (1983): 100-7
  36. Roy-Byrne PP, Sullivan MD, Cowley DS, Ries RK "Adjunctive treatment of benzodiazepine discontinuation syndromes - a review." J Psychiatr Res 27 Suppl (1993): 143-53
  37. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  38. Kales A, Bixler EO, Soldatos CR, Jacoby JA, Kales JD "Lorazepam: effects on sleep and withdrawal phenomena." Pharmacology 32 (1986): 121-30
  39. Ananth J "Abstinence syndrome from therapeutic doses of oxazepam." Can J Psychiatry 28 (1983): 592
  40. Pierce MW, Shu VS, Groves LJ "Safety of estazolam. The United States clinical experience." Am J Med 88 (1990): s12-7
  41. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical, Abbott Park, IL.
  42. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories, Nutley, NJ.
  43. Greenblatt DJ, Shader RI, Abernethy DR "Current status of benzodiazepines (second of two parts): clinical use of benzoidazepines." N Engl J Med 309 (1983): 410-6
  44. Howe JG "Lorazepam withdrawal seizures." Br Med J 280 (1980): 1163-4
  45. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  46. Petursson H, Lader MH "Benzodiazepine dependence." Br J Addict 76 (1981): 133-45
  47. Lapierre YD, Labelle A "Manic-like reaction induced by lorazepam withdrawal." Can J Psychiatry 32 (1987): 697-8
  48. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 48 references
Major

Benzodiazepines (Includes Limbitrol) ↔ Renal/Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease, Renal Dysfunction

Benzodiazepines are metabolized by the liver, and the metabolites are excreted in the urine. Chlordiazepoxide, clorazepate, diazepam, flurazepam and quazepam undergo oxidative N-dealkylation to active metabolites that are substantially longer-acting than the parent compound. These metabolites then undergo further biotransformation to pharmacologically inactive products before excretion by the kidney. Therapy with benzodiazepines should be administered cautiously at lower initial dosages in patients with impaired renal and/or hepatic function. Agents that are converted to weakly active, short-acting, or inactive metabolites may be preferable in hepatic impairment. Lorazepam, oxazepam and temazepam are conjugated to inactive metabolites, while alprazolam, estazolam and triazolam undergo hydroxylation to weakly active or inactive metabolites.

References

  1. Dehlin O, Kullingsjo H, Liden A, Agrell B, Moser G, Olsen I "Pharmacokinetics of alprazolam in geriatric patients with neurotic depression." Pharmacol Toxicol 68 (1991): 121-4
  2. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  3. Murray TG, Chiang ST, Koepke HH, Walker BR "Renal disease, age, and oxazepam kinetics." Clin Pharmacol Ther 30 (1981): 805-9
  4. de Silva JAF, Strojny N "Determination of flurazepam and its major biotransformation products in blood and urine by spectrophotofluorometry and spectrophotometry." J Pharm Sci 60 (1971): 1303-14
  5. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  6. Greenblatt DJ, Divoll M, Harmatz JJ "Kinetics and clinical effects of flurazepam in young and elderly noninsomniacs." Clin Pharmacol Ther 30 (1981): 475-86
  7. Kaplan SA, de Silva JAF, Jack ML, et al "Blood level profile in man following chronic oral administration of flurazepam hydrochloride." J Pharm Sci 62 (1973): 1932-5
  8. Ghabrial H, Desmond PV, Watson KJ, et al "The effects of age and chronic liver disease on the elimination of temazepam." Eur J Clin Pharmacol 30 (1986): 93-7
  9. Kraus JW, Desmond PV, Marshall JP, Johnson RF, Schenker S, Wilkinson GR "Effects of age and liver disease on disposition of lorazepam." Clin Pharmacol Ther 24 (1978): 411-9
  10. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical, Abbott Park, IL.
  11. Wilensky AJ, Levy RH, Troupin AS, Moretti-Ojemann L "Clorazepate kinetics in treated epileptics." Clin Pharmacol Ther 24 (1978): 22-30
  12. Chung M, Hilbert JM, Gural RP, Radwanski E, Symchowicz S, Zampaglione N "Multiple-dose quazepam kinetics." Clin Pharmacol Ther 35 (1984): 520-4
  13. Ochs HR, Greenblatt DJ, Kaschell HJ, Klehr U, Divoll M, Abernathy DR "Diazepam kinetics in patients with renal insufficiency or hyperthyroidism." Br J Clin Pharmacol 12 (1981): 829-32
  14. Greenblatt DJ, Divoll MK, Soong MH, Boxenbaum HG, Harmatz JS, Shader RI "Desmethyldiazepam pharmacokinetics: studies following intravenous and oral desmethyldiazepam, oral clorazepate, and intravenous diazepam." J Clin Pharmacol 28 (1988): 853-9
  15. Allen MD, Greenblatt DJ, Arnold JD "Single- and multiple-dose kinetics of estazolam, a triazolo benzodiazepine." Psychopharmacology (Berl) 66 (1979): 267-74
  16. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  17. Kroboth PD, Smith RB, Silver MR, Rault R, Sorkin MI, Puschett JB, Juhl RP "Effects of end stage renal disease and aluminium hydroxide on triazolam pharmacokinetics." Br J Clin Pharmacol 19 (1985): 839-42
  18. "Product Information. Klonopin (clonazepam)." Roche Laboratories, Nutley, NJ.
  19. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  20. Kroboth PD, Smith RB, Van Thiel DH, Juhl RP "Nighttime dosing of triazolam in patients with liver disease and normal subjects: kinetics and daytime effects." J Clin Pharmacol 27 (1987): 555-60
  21. Klotz U, Avant GR, Hoyumpa A, Schenker S, Wikinson GR "The effects of age and liver disease on the disposition and elimination of diazepam in adult man." J Clin Invest 55 (1975): 347-59
  22. Hilbert JM, Chung M, Radwanski E, Gural R, Symchowicz S, Zampaglione N "Quazepam kinetics in the elderly." Clin Pharmacol Ther 36 (1984): 566-9
  23. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  24. Schmith VD, Piraino B, Smith RB, Kroboth PD "Alprazolam in end-stage renal disease: I. Pharmacokinetics." J Clin Pharmacol 31 (1991): 571-9
  25. Sellers EM, Greenblatt DJ, Giles HG, et al "Chlordiazepoxide and oxazepam disposition in cirrhosis." Clin Pharmacol Ther 26 (1979): 240-6
  26. "Product Information. Dalmane (flurazepam)." Roche Laboratories, Nutley, NJ.
  27. Greenblatt DJ "Clinical pharmacokinetics of oxazepam and lorazepam." Clin Pharmacokinet 6 (1981): 89-105
  28. Sellers EM, Greenblatt DJ, Giles HG, et al "Chlordiazepoxide and oxazepam disposition in cirrhosis." Clin Pharmacol Ther 26 (1979): 240-6
  29. Cutler RE, Blair AD "Pharmacokinetics of diazepam in normal and uremic humans." Clin Pharmacol Ther 25 (1979): 219-20
  30. Hoyumpa AM "Disposition and elimination of minor tranquilizers in the aged and in patients with liver disease." South Med J 71 (1978): 23-8
  31. Johnson J, Padilla BG, Carter J, Holt JH, Ozawa T "Adverse effects of flurazepam in a hemodialysis patient." J Am Assoc Nephrol Nurses Tech 4 (1977): 93-5
  32. "Product Information. Doral (quazepam)." Wallace Laboratories, Cranbury, NJ.
  33. Tedesco FJ, Mills LR "Diazepam (valium) hepatitis." Dig Dis Sci 27 (1982): 470-2
  34. Morrison G, Chiang ST, Koepke HH, Walker BR "Effect of renal impairment and hemodialysis on lorazepam kinetics." Clin Pharmacol Ther 35 (1984): 646-52
  35. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  36. Roberts RK, Wilkinson GR, Branch RA, Schenker S "Effect of age and parenchymal liver disease on the disposition and elimination of chlordiazepoxide (librium)." Gastroenterology 75 (1978): 479-85
  37. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  38. Hicks R, Dysken MW, Davis JM, et al "The pharmacokinetics of psychotropic medication in the elderly: a review." J Clin Psychiatry 42 (1981): 374-85
  39. Kroboth PD, Smith RB, Rault R, Silver MR, Sorkin MI, Puschett JB, Juhl RP "Effects of end-stage renal disease and aluminum hydroxide on temazepam kinetics." Clin Pharmacol Ther 37 (1985): 453-9
  40. Busch U, Molzahn M, Bozler G, Koss FW "Pharmacokinetics of oxazepam following multiple administration in volunteers and patients with chronic renal disease." Arzneimittelforschung 31 (1981): 1507-11
  41. Verbeeck RK, Tjandramaga TB, de Schepper PJ, Verberckmoes R "Impaired elimination of lorazepam following subchronic administration in two patients with renal failure." Br J Clin Pharmacol 12 (1981): 749-50
  42. Juhl RP, Van Thiel DH, Dittert LW, Smith RB "Alprazolam pharmacokinetics in alcoholic liver disease." J Clin Pharmacol 24 (1984): 113-9
  43. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories, Nutley, NJ.
  44. Ochs HR, Rauh HW, Greenblatt DJ, Kaschell HJ "Clorazepate dipotassium and diazepam in renal insufficiency: serum concentrations and protein binding of diazepam and desmethyldiazepam." Nephron 37 (1984): 100-4
  45. "Product Information. Valium (diazepam)." Roche Laboratories, Nutley, NJ.
  46. Gustavson LE, Carrigan PJ "The clinical pharmacokinetics of single doses of estazolam." Am J Med 88 (1990): s2-5
  47. Morgan DD, Robinson JD, Mendenhall CL "Clinical pharmacokinetics of chlordiazepoxide in patients with alcoholic hepatitis." Eur J Clin Pharmacol 19 (1981): 279-85
View all 47 references
Major

Benzodiazepines (Includes Limbitrol) ↔ Respiratory Depression

Severe Potential Hazard, High plausibility

Applies to: Pulmonary Impairment, Asphyxia, Respiratory Arrest

Benzodiazepines may cause respiratory depression and apnea, usually when given in high dosages and/or by intravenous administration. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with benzodiazepines should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are particularly important, and equipment for resuscitation should be immediately available if the parenteral route is used. Benzodiazepines, especially injectable formulations, should generally be avoided in patients with sleep apnea, severe respiratory insufficiency, or hypoxia.

References

  1. Cohen S, Khan A "Respiratory distress with use of lorazepam in mania." J Clin Psychopharmacol 7 (1987): 199-200
  2. Eldridge PR, Punt JA "Risks associated with giving benzodiazepines to patients with acute neurological injuries." Br Med J 300 (1990): 1189-90
  3. Berggren L, Eriksson I, Mollenholt P, Sunzel M "Changes in respiratory pattern after repeated doses of diazepam and midazolam in healthy subjects." Acta Anaesthesiol Scand 31 (1987): 667-72
  4. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  5. Man GC, Hsu K, Sproule BJ "Effect of alprazolam on exercise and dyspnea in patients with chronic obstructive pulmonary disease." Chest 90 (1986): 832-6
  6. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  7. Skatrud JB, Badr S, Begle RL, Juan D "Ventilatory response to single, high dose estazolam in healthy humans." J Clin Pharmacol 30 (1990): 543-8
  8. Iber FL, Livak A, Kruss DM "Apnea and cardiopulmonary arrest during and after endoscopy." J Clin Gastroenterol 14 (1992): 109-13
  9. "Product Information. Klonopin (clonazepam)." Roche Laboratories, Nutley, NJ.
  10. "Product Information. Dalmane (flurazepam)." Roche Laboratories, Nutley, NJ.
  11. Yakel DL, Jr Whittaker SE, Elstad MR "Midazolam-induced angioedema and bronchoconstriction." Crit Care Med 20 (1992): 307-8
  12. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  13. "Product Information. Doral (quazepam)." Wallace Laboratories, Cranbury, NJ.
  14. Sullivan RJ, Jr "Respiratory depression requiring ventilatory support following 0.5 mg of triazolam." J Am Geriatr Soc 37 (1989): 450-2
  15. "Product Information. Valium (diazepam)." Roche Laboratories, Nutley, NJ.
  16. Pierce MW, Shu VS, Groves LJ "Safety of estazolam. The United States clinical experience." Am J Med 88 (1990): s12-7
  17. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical, Abbott Park, IL.
  18. "Product Information. Versed (midazolam)." Roche Laboratories, Nutley, NJ.
  19. Berry RB, Kouchi K, Bower J, Prosise G, Light RW "Triazolam in patients with obstructive sleep apnea." Am J Respir Crit Care Med 151 (1995): 450-4
  20. Mendelson WB, Weingartner H, Greenblatt DJ, Garnett D, Gillin JC "A clinical study of flurazepam." Sleep 5 (1982): 350-60
  21. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  22. Munoz HR, Dagnino JA, Rufs JA, Bugedo GJ "Benzodiazepine premedication causes hypoxemia during spinal anesthesia in geriatric patients." Reg Anesth 17 (1992): 139-42
  23. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  24. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories, Nutley, NJ.
  25. Taylor JW, Simon KB "Possible intramuscular midazolam-associated cardiorespiratory arrest and death." DICP 24 (1990): 695-7
  26. Murphy PJ, Erskine R, Langton JA "The effect of intravenously administered diazepam, midazolam and flumazenil on the sensitivity of upper airway reflexes." Anaesthesia 49 (1994): 105-10
  27. Model DG, Berry DJ "Effects of chlordiazepoxide in respiratory failure due to chronic bronchitis." Lancet 2 (1974): 869-70
  28. Dixon D "Respiratory depression following midazolam." Anaesthesia 40 (1985): 922
  29. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  30. Donaldson D, Gibson G "System complications with intravenous diazepam." Oral Surg Oral Med Oral Patho 49 (1980): 126-30
View all 30 references
Major

Benzodiazepines (Includes Limbitrol) ↔ Seizures

Severe Potential Hazard, Moderate plausibility

Applies to: Seizures

The use of benzodiazepines in patients with seizure disorders may increase the incidence or precipitate the onset of generalized tonic-clonic seizures (grand mal). Appropriate anticonvulsant medication might need to be initiated or the dosage increased. Abrupt cessation of benzodiazepine therapy may precipitate seizures and other withdrawal symptoms, particularly after prolonged use and/or excessive dosages. Status epilepticus may occur in patients with a history of seizures withdrawn rapidly from benzodiazepine therapy. Following chronic administration, cessation of benzodiazepine therapy should occur gradually with incrementally reduced dosages. Patients should be advised not to discontinue medication without first consulting with the physician.

References

  1. Browne JL, Hauge KJ "A review of alprazolam withdrawal." Drug Intell Clin Pharm 20 (1986): 837-41
  2. Schneider LS, Syapin PJ, Pawluczyk S "Seizures following triazolam withdrawal despite benzodiazepine treatment." J Clin Psychiatry 48 (1987): 418-9
  3. Berlin RM, Conell LJ "Withdrawal symptoms after long-term treatment with therapeutic doses of flurazepam: a case report." Am J Psychiatry 140 (1983): 488-90
  4. Tien AY, Gujavarty KS "Seizure following withdrawal from triazolam." Am J Psychiatry 142 (1985): 1516-7
  5. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  6. Finley PR, Nolan PE, Jr "Precipitation of benzodiazepine withdrawal following sudden discontinuation of midazolam." DICP 23 (1989): 151-2
  7. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  8. Kales A, Bixler EO, Soldatos CR, Jacoby JA, Kales JD "Lorazepam: effects on sleep and withdrawal phenomena." Pharmacology 32 (1986): 121-30
  9. "Product Information. Doral (quazepam)." Wallace Laboratories, Cranbury, NJ.
  10. MacKinnon GL, Parker WA "Benzodiazepine withdrawal syndrome: a literature review and evaluation." Am J Drug Alcohol Abuse 9 (1982): 19-33
  11. "Product Information. Valium (diazepam)." Roche Laboratories, Nutley, NJ.
  12. Hauser P, Devinsky O, De Bellis M, Theodore WH, Post RM "Benzodiazepine withdrawal delirium with catatonic features. Occurrence in patients with partial seizure disorders." Arch Neurol 46 (1989): 696-9
  13. Ryan GP, Boisse NR "Experimental induction of benzodiazepine tolerance and physical dependence." J Pharmacol Exp Ther 226 (1983): 100-7
  14. Busto U, Sellers EM, Naranjo CA, et al "Withdrawal reaction after long-term therapeutic use of benzodiazepines." N Engl J Med 315 (1986): 854-9
  15. "Product Information. Dalmane (flurazepam)." Roche Laboratories, Nutley, NJ.
  16. "Product Information. Versed (midazolam)." Roche Laboratories, Nutley, NJ.
  17. Ananth J "Abstinence syndrome from therapeutic doses of oxazepam." Can J Psychiatry 28 (1983): 592
  18. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical, Abbott Park, IL.
  19. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories, Nutley, NJ.
  20. Petursson H, Lader MH "Benzodiazepine dependence." Br J Addict 76 (1981): 133-45
  21. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  22. Howe JG "Lorazepam withdrawal seizures." Br Med J 280 (1980): 1163-4
  23. Roy-Byrne PP, Sullivan MD, Cowley DS, Ries RK "Adjunctive treatment of benzodiazepine discontinuation syndromes - a review." J Psychiatr Res 27 Suppl (1993): 143-53
  24. Bond WS, Schwartz M "Withdrawal reactions after long-term treatment with flurazepam." Clin Pharm 3 (1984): 316-8
  25. Ghadirian AM, Gauthier S, Wong T "Convulsions in patients abruptly withdrawn from clonazepam while receiving neuroleptic medication ." Am J Psychiatry 144 (1987): 686
  26. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  27. Alvarez N, Hartford E, Doubt C "Epileptic seizures induced by clonazepam." Clin Electroencephalogr 12 (1981): 57-65
  28. Frattola L, Garreau M, Piolti R, Bassi S, Albizzati MG, Borghi C, Morselli PL "Comparison of the efficacy, safety and withdrawal of alpidem and alprazolam in anxious patients." Br J Psychiatry 165 (1994): 94-100
  29. Specht U, Boenigk HE, Wolf P "Discontinuation of clonazepam after long-term treatment." Epilepsia 30 (1989): 458-63
  30. Robinson GM, Sellers EM "Diazepam withdrawal seizures." Can Med Assoc J 126 (1982): 944-5
  31. Patterson WM "Triazolam withdrawal." J Clin Psychiatry 49 (1988): 369
  32. Wilbur R, Kulik AV "Abstinence syndrome from therapeutic doses of oxazepam." Can J Psychiatry 28 (1983): 298-300
  33. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  34. Hersch EL, Billings RF "Acute confusional state with status petit mal as a withdrawal syndrome: and five year follow-up." Can J Psychiatry 33 (1988): 157-9
  35. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  36. "Product Information. Klonopin (clonazepam)." Roche Laboratories, Nutley, NJ.
View all 36 references
Major

Benzodiazepines (Iv/Im) (Includes Limbitrol) ↔ Prolonged Hypotension

Severe Potential Hazard, High plausibility

Applies to: Altered Consciousness, Shock

Benzodiazepines should not be administered by injection to patients in shock or coma. The hypnotic and hypotensive effects of these agents may be prolonged and intensified in such patients.

References

  1. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories, Nutley, NJ.
  2. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  3. "Product Information. Valium (diazepam)." Roche Laboratories, Nutley, NJ.
  4. "Product Information. Versed (midazolam)." Roche Laboratories, Nutley, NJ.
View all 4 references
Major

Tcas (Includes Limbitrol) ↔ Anticholinergic Effects

Severe Potential Hazard, High plausibility

Applies to: Glaucoma/Intraocular Hypertension, Urinary Retention, Gastrointestinal Obstruction

Tricyclic and tetracyclic antidepressants (TCAs) have anticholinergic activity, to which elderly patients are particularly sensitive. Tertiary amines such as amitriptyline and trimipramine tend to exhibit greater anticholinergic effects than other agents in the class. Therapy with TCAs should be administered cautiously in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. In patients with angle-closure glaucoma, even average doses can precipitate an attack. Glaucoma should be treated and under control prior to initiation of therapy with TCAs, and intraocular pressure monitored during therapy.

References

  1. Gershon S "Comparative side effect profiles of trazodone and imipramine: special reference to the geriatric population." Psychopathology 17 (1984): 39-50
  2. Settle EC "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry 59 Suppl 16 (1998): 25-30
  3. Remick RA, Keller FD, Buchanan RA, Gibson RE, Fleming JA "A comparison of the efficacy and safety of alprazolam and desipramine in depressed outpatients." Can J Psychiatry 33 (1988): 590-4
  4. Feighner JP, Cohn JB, Fabre LF, Jr Fieve RR, Mendels J, Shrivastava RK, Dunbar GC "A study comparing paroxetine placebo and imipramine in depressed patients." J Affect Disord 28 (1993): 71-9
  5. Claghorn JL, Feighner JP "A double-blind comparison of paroxetine with imipramine in the long-term treatment of depression." J Clin Psychopharmacol 13 (1993): S23-7
  6. Pedersen JH, Sorensen JL "Therapeutic effect and side effects in patients with endogenous depression treated with oral nortriptyline once a day." Neuropsychobiology 6 (1980): 42-7
  7. Hermesh H, Aizenberg D, Weizman A, Lapidot M, Munitz H "Clomipramine-induced urinary dysfunction in an obsessive-compulsive adolescent." Drug Intell Clin Pharm 21 (1987): 877-9
  8. Rosen J, Pollock BG, Altieri LP, Jonas EA "Treatment of nortriptyline's side effects in elderly patients: a double-blind study of bethanechol." Am J Psychiatry 150 (1993): 1249-51
  9. Nelson JC, Jatlow PI, Bock J, Quinlan DM, Bowes MB "Major adverse reactions during desipramine treatment." Arch Gen Psychiatry 39 (1982): 1055-61
  10. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  11. Guy W, McEvoy JM, Ban TA, Wilson WH, Pate K "A double-blind clinical trial of mianserin versus amitriptyline: differentiation by adverse symptomatology." Pharmacotherapy 3 (1983): 45-51
  12. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  13. Ayd FJ, Jr "Long-term treatment of chronic depression: 15-year experience with doxepin HCl." J Clin Psychiatry 45 (1984): 39-46
  14. Rudorfer MV, Young RC "Anticholinergic effects and plasma desipramine levels." Clin Pharmacol Ther 28 (1980): 703-6
  15. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  16. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  17. Ananth J, Assalian P, Links PS "Intolerable side effects of clomipramine." J Clin Psychopharmacol 2 (1982): 215-6
  18. Warnes H, Lehmann HE, Ban TA "Adynamic ileus during psychoactive medication: a report of three fatal and five severe cases." Can Med Assoc J 96 (1967): 1112-3
  19. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  20. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  21. Remick RA, Campos PE, Misri S, Miles JE, Van Wyck, Fleet J "A comparison of the safety and efficacy of buproprion HCL and amitriptyline HCL in depressed outpatients." Prog Neuropsychopharmacol Biol Psychiatry 6 (1982): 523-7
  22. Pigott TA, Pato MT, Bernstein SE, Grover GN, Hill JL, Tolliver TJ, Murphy DL "Controlled comparisons of clomipramine and fluoxetine in the treatment of obsessive-compulsive disorder. Behavioral and biological results." Arch Gen Psychiatry 47 (1990): 926-32
  23. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  24. Jenike MA, Baer L, Greist JH "Clomipramine versus fluoxetine in obsessive-compulsive disorder: a retrospective comparison of side effects and efficacy." J Clin Psychopharmacol 10 (1990): 122-4
  25. Judd FK, Moore K, Norman TR, Burrows GD, Gupta RK, Parker G "A multicentre double blind trial of fluoxetine versus amitriptyline in the treatment of depressive illness." Aust N Z J Psychiatry 27 (1993): 49-55
  26. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  27. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  28. Guillibert E, Pelicier Y, Archambault JC, Chabannes JP, Clerc G, Desvilles M, Guibert M, Pagot R, Poisat JL, Thobie Y "A double-blind, multicentre study of paroxetine versus clomipramine in depressed elderly patients." Acta Psychiatr Scand Suppl 350 (1989): 132-4
  29. Georgotas A, McCue RE, Hapworth W, et al "Comparative efficacy and safety of MAOIs versus TCAs in treating depression in the elderly." Biol Psychiatry 21 (1986): 1155-66
  30. Ritch R, Krupin T, Henry C, Kurata F "Oral imipramine and acute angle closure glaucoma." Arch Ophthalmol 112 (1994): 67-8
  31. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  32. Bryant SG, Fisher S, Kluge RM "Long-term versus short-term amitriptyline side effects as measured by a postmarketing surveillance system." J Clin Psychopharmacol 7 (1987): 78-82
  33. "Product Information. Asendin (amoxapine)" Lederle Laboratories, Wayne, NJ.
View all 33 references
Major

Tcas (Includes Limbitrol) ↔ Cardiovascular Disease

Severe Potential Hazard, High plausibility

Applies to: Cardiovascular Disease, Hyperthyroidism, Cerebrovascular Insufficiency, History - Cerebrovascular Disease, History - Myocardial Infarction, Hypotension, Dehydration

Tricyclic and tetracyclic antidepressants (TCAs) may cause orthostatic hypotension, reflex tachycardia, syncope, and dizziness, particularly during initiation of therapy or rapid escalation of dosage. Imipramine appears to have the greatest propensity to induce these effects, while secondary amines such as nortriptyline may do so less frequently. Tolerance to the hypotensive effects often develops after a few doses to a few weeks. Rarely, collapse and sudden death have occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include tachycardia, arrhythmias, heart block, hypertension, thrombosis, thrombophlebitis, myocardial infarction, strokes, congestive heart failure, and ECG abnormalities such as PR and QT interval prolongation. Therapy with TCAs should be avoided during the acute recovery phase following myocardial infarction, and should be administered only with extreme caution in patients with hyperthyroidism, a history of cardiovascular or cerebrovascular disease, or a predisposition to hypotension. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. Many of the newer antidepressants, including bupropion and the selective serotonin reuptake inhibitors (SSRIs), are considerably less or minimally cardiotoxic and may be appropriate alternatives.

References

  1. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  2. Gross JS, Zwerin G "Left bundle branch block developing in a patient with sub-therapeutic nortriptyline levels: a case report." J Am Geriatr Soc 39 (1991): 1006-7
  3. Appelbaum PS, Kapoor W "Imipramine-induced vasospasm: a case report." Am J Psychiatry 140 (1983): 913-5
  4. Carpenter P, Gobel FL, Hulsing DJ "Desipramine cardiac toxicity." Minn Med 65 (1982): 231-4
  5. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  6. Ramanathan KB, Davidson C "Cardiac arrhythmia and imipramine therapy." Br Med J 1 (1975): 661-2
  7. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  8. Bluhm RE, Wilkinson GR, Shelton R, Branch RA "Genetically determined drug-metabolizing activity and desipramine- associated cardiotoxicity: a case report." Clin Pharmacol Ther 53 (1993): 89-95
  9. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  10. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  11. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  12. Rudorfer MV, Young RC "Desipramine: cardiovascular effects and plasma levels." Am J Psychiatry 137 (1980): 984-6
  13. Dunn FG "Malignant hypertension associated with use of amitriptyline hydrochloride." South Med J 75 (1982): 1124-5
  14. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  15. Christensen P, Thomsen HY, Pedersen OL, et al "Cardiovascular effects of amitriptyline in the treatment of elderly depressed patients." Psychopharmacology (Berl) 87 (1985): 212-5
  16. Robinson DS, Nies A, Corcella J, Cooper TB, Spencer C, Kefover R "Cardiovascular effects of phenelzine and amitriptyline in depressed outpatients." J Clin Psychiatry 43 (1982): 8-15
  17. Kantor SJ, Glassman AH, Bigger JT, Jr Perel JM, Giardina EV "The cardiac effects of therapeutic plasma concentrations of imipramine." Am J Psychiatry 135 (1978): 534-8
  18. Burrows GD, Vohra J, Hunt D, Sloman JG, Scoggins BA, Davies B "Cardiac effects of different tricyclic antidepressant drugs." Br J Psychiatry 129 (1976): 335-41
  19. Feighner JP, Cohn JB, Fabre LF, Jr Fieve RR, Mendels J, Shrivastava RK, Dunbar GC "A study comparing paroxetine placebo and imipramine in depressed patients." J Affect Disord 28 (1993): 71-9
  20. Roose SP, Dalack GW, Glassman AH, Woodring S, Walsh BT, Giardina EG "Is doxepin a safer tricyclic for the heart?" J Clin Psychiatry 52 (1991): 338-41
  21. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  22. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  23. Pedersen JH, Sorensen JL "Therapeutic effect and side effects in patients with endogenous depression treated with oral nortriptyline once a day." Neuropsychobiology 6 (1980): 42-7
  24. Roose SP, Glassman AH, Siris SG, Walsh BT, Bruno RL, Wright LB "Comparison of imipramine- and nortriptyline-induced orthostatic hypotension: a meaningful difference." J Clin Psychopharmacol 1 (1981): 316-9
  25. Settle EC "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry 59 Suppl 16 (1998): 25-30
  26. Georgotas A, McCue RE, Hapworth W, et al "Comparative efficacy and safety of MAOIs versus TCAs in treating depression in the elderly." Biol Psychiatry 21 (1986): 1155-66
  27. Strasberg B, Coelho A, Welch W, Swiryn S, Bauernfeind R, Rosen K "Doxepin induced torsade de pointes." Pacing Clin Electrophysiol 5 (1982): 873-7
  28. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  29. "Product Information. Asendin (amoxapine)" Lederle Laboratories, Wayne, NJ.
  30. Van Sweden B "Rebound antidepressant cardiac arrhythmia." Biol Psychiatry 24 (1988): 363-4
  31. Linnoila M, Jobson KO, Gilliam JH, Paine RL "Effects of doxepin on blood pressure and heart rate in patients with primary major affective disorder ." J Clin Psychopharmacol 2 (1982): 433-4
  32. Laird LK, Lydiard RB, Morton WA, Steele TE, Kellner C, Thompson NM, Ballenger JC "Cardiovascular effects of imipramine, fluvoxamine, and placebo in depressed outpatients." J Clin Psychiatry 54 (1993): 224-8
  33. Young RC, Alexopoulos GS, Shamoian CA, Dhar AK, Kutt H "Heart failure associated with high plasma 10-hydroxynortriptyline levels." Am J Psychiatry 141 (1984): 432-3
  34. Luchins DJ "Review of clinical and animal studies comparing the cardiovascular effects of doxepin and other tricyclic antidepressants." Am J Psychiatry 140 (1983): 1006-9
  35. Nelson JC, Jatlow PI, Bock J, Quinlan DM, Bowes MB "Major adverse reactions during desipramine treatment." Arch Gen Psychiatry 39 (1982): 1055-61
  36. Veith RC, Bloom V, Bielski R, Friedel RO "ECG effects of comparable plasma concentrations of desipramine and amitriptyline." J Clin Psychopharmacol 2 (1982): 394-8
  37. Faravelli C, Brat A, Marchetti G, Franchi F, Padeletti L, Michelucci A, Pastorino A "Cardiac effects of clomipramine treatment. ECG and left ventricular systolic time intervals." Neuropsychobiology 9 (1983): 113-8
  38. Roos JC "Cardiac effects of antidepressant drugs. A comparison of the tricyclic antidepressants and fluvoxamine." Br J Clin Pharmacol 15 Suppl 3 (1983): s439-45
View all 38 references
Major

Tcas (Includes Limbitrol) ↔ Pheochromocytoma

Severe Potential Hazard, Moderate plausibility

Applies to: Pheochromocytoma

Tricyclic and tetracyclic antidepressants (TCAs) may potentiate the effects of circulating catecholamines. Enhanced sympathetic activity can provoke hypertensive crises in patients with pheochromocytoma or other tumors of the adrenal medulla, such as some neuroblastomas. Therapy with TCAs should be administered cautiously in patients with these tumors.

References

  1. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  2. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  3. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  5. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  6. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  7. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  8. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  9. "Product Information. Remeron (mirtazapine)." Organon, West Orange, NJ.
  10. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  11. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  12. "Product Information. Asendin (amoxapine)" Lederle Laboratories, Wayne, NJ.
View all 12 references
Major

Tricyclic Antidepressants (Includes Limbitrol) ↔ Acute Myocardial Infarction Recovery

Severe Potential Hazard, Moderate plausibility

Applies to: Myocardial Infarction

The use of most tricyclic antidepressants is contraindicated in patients that are going through the acute recovery period after a myocardial infarction.

Major

Tricyclic Antidepressants (Includes Limbitrol) ↔ Cardiovascular Disease

Severe Potential Hazard, Moderate plausibility

Applies to: Cardiovascular Disease

Tricyclic antidepressants should be used with extreme caution in patients with evidence of cardiovascular disease because of the possibility of fluctuations in the blood pressure, arrhythmias, conduction defects, tachycardia, myocardial infarction and stroke. This also applies to patients who have family history of sudden death, cardiac dysrhythmias, or conduction disturbances. In some cases a gradual dose titration is recommended.

Major

Tricyclic Antidepressants (Includes Limbitrol) ↔ Depression

Severe Potential Hazard, Moderate plausibility

Applies to: Depression

Adult and pediatric patients with depression may experience worsening of their symptoms and may have the emergence of suicidal thoughts and behavior. Patients should be monitored appropriately and observed closely for worsening of their symptoms, suicidality or changes in their behavior, especially during the first few months of treatment, and at times of dose changes. Families and caregivers should be advised of the need for close observation and communication with the treating physician. Discontinuing the medication should be considered if symptoms are persistently worse, or abrupt in onset. It may be prudent to refrain from dispensing large quantities of medication to these patients.

Major

Tricyclic Antidepressants (Includes Limbitrol) ↔ Seizure Disorders

Severe Potential Hazard, Moderate plausibility

Applies to: Alcoholism, CNS Disorder

Tricyclic antidepressants (TCAs), can lower the seizure threshold and trigger seizures. These drugs should be used with extreme caution in patients with a history of seizures, or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism. Daily dose restrictions might apply for specific antidepressants. Physicians are encouraged to get additional dosing recommendations on the manufacturer's prescribing information.

References

  1. Pascual J, Combarros O, Berciano J "Partial status epilepticus following single low dose of chlorimipramine in a patient on MAO-inhibitor treatment." Clin Neuropharmacol 10 (1987): 565-7
  2. Settle EC "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry 59 Suppl 16 (1998): 25-30
  3. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  4. Robinson ML "Epileptic fit after clomipramine." Br J Psychiatry 132 (1978): 525-6
  5. Flechter S, Rabey JM, Regev I, Borenstein N, Vardi J "Convulsive attacks due to antidepressant drug overdoses: case reports and discussion." Gen Hosp Psychiatry 5 (1983): 217-21
View all 5 references
Moderate

Benzodiazepines (Includes Limbitrol) ↔ Depression

Moderate Potential Hazard, Moderate plausibility

Applies to: Psychosis, Depression

Benzodiazepines depress the central nervous system and may cause or exacerbate mental depression and cause suicidal behavior and ideation. Episodes of mania and hypomania have also been reported in depressed patients treated with some of these agents. Therapy with benzodiazepines should be administered cautiously in patients with a history of depression or other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.

References

  1. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  2. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  3. "Product Information. Klonopin (clonazepam)." Roche Laboratories, Nutley, NJ.
  4. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical, Abbott Park, IL.
  5. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories, Nutley, NJ.
  6. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  7. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  8. "Product Information. Dalmane (flurazepam)." Roche Laboratories, Nutley, NJ.
  9. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  10. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  11. "Product Information. Valium (diazepam)." Roche Laboratories, Nutley, NJ.
  12. "Product Information. Doral (quazepam)." Wallace Laboratories, Cranbury, NJ.
View all 12 references
Moderate

Benzodiazepines (Includes Limbitrol) ↔ Obesity

Moderate Potential Hazard, Moderate plausibility

Applies to: Obesity

The plasma half-lives of benzodiazepines may be prolonged in obese patients, presumably due to increased distribution into fat. Marked increases in distribution (> 100%) have been reported for diazepam and midazolam, and moderate increases (25% to 100%) for alprazolam, lorazepam, and oxazepam. Therapy with benzodiazepines should be administered cautiously in obese patients, with careful monitoring of CNS status. Longer dosing intervals may be appropriate. When dosing by weight, loading doses should be based on actual body weight, while maintenance dose should be based on ideal body weight to avoid toxicity.

References

  1. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical, Abbott Park, IL.
  2. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories, Nutley, NJ.
  3. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  5. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  6. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  7. "Product Information. Klonopin (clonazepam)." Roche Laboratories, Nutley, NJ.
  8. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  9. "Product Information. Versed (midazolam)." Roche Laboratories, Nutley, NJ.
  10. "Product Information. Doral (quazepam)." Wallace Laboratories, Cranbury, NJ.
  11. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  12. "Product Information. Dalmane (flurazepam)." Roche Laboratories, Nutley, NJ.
  13. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  14. "Product Information. Valium (diazepam)." Roche Laboratories, Nutley, NJ.
View all 14 references
Moderate

Benzodiazepines (Includes Limbitrol) ↔ Paradoxical Reactions

Moderate Potential Hazard, Moderate plausibility

Applies to: Psychosis, Hyperkinetic Syndrome of Childhood

Paradoxical reactions, including excitability, irritability, aggressive behavior, agitation, nervousness, hostility, anxiety, sleep disturbances, nightmares and vivid dreams, have been reported with the use of benzodiazepines in psychiatric patients and pediatric patients with hyperactive aggressive disorders. Such patients should be monitored for signs of paradoxical stimulation during therapy with benzodiazepines. The manufacturers do not recommend the use of benzodiazepines for the treatment of psychosis.

References

  1. "Product Information. Dalmane (flurazepam)." Roche Laboratories, Nutley, NJ.
  2. "Product Information. Valium (diazepam)." Roche Laboratories, Nutley, NJ.
  3. Fiset L, Milgrom P, Beirne OR, Roy-Byrne P "Disinhibition of behaviors with midazolam: report of a case." J Oral Maxillofac Surg 50 (1992): 645-9
  4. White MC, Silverman JJ, Harbison JW "Psychosis associated with clonazepam therapy for blepharospasm." J Nerv Ment Dis 170 (1982): 117-9
  5. Marchevsky S, Isaacs G, Nitzan I "Behavioral disinhibition with clonazepam." Gen Hosp Psychiatry 10 (1988): 447
  6. Goodman WK, Charney DS "A case of alprazolam, but not lorazepam, inducing manic symptoms." J Clin Psychiatry 48 (1987): 117-8
  7. Fava M, Borofsky GF "Sexual disinhibition during treatment with a benzodiazepine: a case report." Int J Psychiatry Med 21 (1991): 99-104
  8. Cunningham TA "Letter: Adverse reaction to flurazepam." Can Med Assoc J 112 (1975): 805
  9. Binder RL "Three case reports of behavioral disinhibition with clonazepam." Gen Hosp Psychiatry 9 (1987): 151-3
  10. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical, Abbott Park, IL.
  11. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories, Nutley, NJ.
  12. Schogt B, Conn D "Paranoid symptoms associated with triazolam." Can J Psychiatry 30 (1985): 462-3
  13. Lobo BL, Miwa LJ "Midazolam disinhibition reaction." Drug Intell Clin Pharm 22 (1988): 725
  14. Weilburg JB, Sachs G, Falk WE "Triazolam-induced brief episodes of secondary mania in a depressed patient." J Clin Psychiatry 48 (1987): 492-3
  15. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  16. Karch FE "Rage reaction associated with clorazepate dipotassium." Ann Intern Med 91 (1979): 61-2
  17. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  18. Cohen LS, Rosenbaum JF "Clonazepam: new uses and potential problems." J Clin Psychiatry 48 (1987): 50-6
  19. Pollack MH "Clonazepam: a review of open clinical trials." J Clin Psychiatry 48 (1987): 12-5
  20. Rush CR, Higgins ST, Hughes JR, Bickel WK "A comparison of the acute behavioral effects of triazolam and temazepam in normal volunteers." Psychopharmacology (Berl) 112 (1993): 407-14
  21. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  22. Edwards JG, Inman WH, Pearce GL, Rawson NS "Prescription-event monitoring of 10,895 patients treated with alprazolam." Br J Psychiatry 158 (1991): 387-92
  23. Dorevitch A "Mania associated with clonazepam." DICP 25 (1991): 938-9
  24. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  25. Koczerginski D, Kennedy SH, Swinson RP "Clonazepam and lithium--a toxic combination in the treatment of mania?" Int Clin Psychopharmacol 4 (1989): 195-9
  26. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  27. Rothschild AJ "Disinhibition, amnestic reactions, and other adverse reactions secondary to triazolam: a review of the literature." J Clin Psychiatry 53 (1992): 69-79
  28. French AP "Dangerously aggressive behavior as a side effect of alprazolam." Am J Psychiatry 146 (1989): 276
  29. Wysowski DK, Barash D "Adverse behavioral reactions attributed to triazolam in the Food and Drug Administration's Spontaneous Reporting System." Arch Intern Med 151 (1991): 2003-8
  30. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  31. Bixler EO, Kales A, Brubaker BH, Kales JD "Adverse reactions to benzodiazepine hypnotics: spontaneous reporting system." Pharmacology 35 (1987): 286-300
  32. "Product Information. Klonopin (clonazepam)." Roche Laboratories, Nutley, NJ.
  33. Viscott DS "Chlordiazepoxide and hallucinations. Report of cases." Arch Gen Psychiatry 19 (1968): 370-6
  34. "Product Information. Versed (midazolam)." Roche Laboratories, Nutley, NJ.
  35. "Product Information. Doral (quazepam)." Wallace Laboratories, Cranbury, NJ.
View all 35 references
Moderate

Chlordiazepoxide (Includes Limbitrol) ↔ Porphyria

Moderate Potential Hazard, Moderate plausibility

Applies to: Porphyria

There have been isolated reports associating the use of chlordiazepoxide with exacerbation of porphyria. Therapy with chlordiazepoxide should be administered cautiously in patients with porphyria.

References

  1. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories, Nutley, NJ.
Moderate

Tcas (Includes Limbitrol) ↔ Bone Marrow Suppression

Moderate Potential Hazard, Low plausibility

Applies to: Bone Marrow Depression/Low Blood Counts

The use of tricyclic and tetracyclic antidepressants (TCAs) has rarely been associated with bone marrow suppression. Leukopenia, agranulocytosis, thrombocytopenia, anemia, eosinophilia, purpura, and pancytopenia have been reported with some TCAs. Patients with preexisting bone marrow suppression or blood dyscrasias receiving TCAs should be monitored closely during therapy for further decreases in blood counts.

References

  1. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  2. Hunt KA, Resnick MP "Clomipramine-induced agranulocytosis and its treatment with G-CSF." Am J Psychiatry 150 (1993): 522-3
  3. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  4. Souhami RL, Ashton CR, Lee-Potter JP "Agranulocytosis and systemic candidiasis following clomipramine therapy." Postgrad Med J 52 (1976): 472-4
  5. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  6. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  7. Magni G, Urbani A, Silvestro A, Grassetto M "Clomipramine-induced pancytopenia." J Nerv Ment Dis 175 (1987): 309-10
  8. Albertini RS, Penders TM "Agranulocytosis associated with tricyclics." J Clin Psychiatry 39 (1978): 483-5
  9. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  10. Wolf B, Conradty M, Grohmann R, Ruther E, Witzgall H, Londong V "A case of immune complex hemolytic anemia, thrombocytopenia, and acute renal failure associated with doxepin use." J Clin Psychiatry 50 (1989): 99-100
  11. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  12. Gravenor DS, Leclerc JR, Blake G "Tricyclic antidepressant agranulocytosis." Can J Psychiatry 31 (1986): 661
  13. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  14. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  15. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  16. Draper BM, Manoharan A "Neutropenia with cross-intolerance between two tricyclic antidepressant agents." Med J Aust 146 (1987): 452-3
View all 16 references
Moderate

Tcas (Includes Limbitrol) ↔ Diabetes

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus

Both elevation and lowering of blood sugar levels have been reported with the use of some tricyclic antidepressants (TCAs). Rarely, these effects have also occurred with maprotiline, a tetracyclic antidepressant. Patients with diabetes should be monitored for worsening control of blood glucose when treated with these agents, particularly during dosage escalation or whenever dosage has been altered.

References

  1. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  3. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  4. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  5. Zogno MG, Tolfo L, Draghi E "Hypoglycemia caused by maprotiline in a patient taking oral antidiabetics." Ann Pharmacother 28 (1994): 406
  6. "Product Information. Asendin (amoxapine)" Lederle Laboratories, Wayne, NJ.
  7. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  8. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  9. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  10. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  11. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
View all 11 references
Moderate

Tcas (Includes Limbitrol) ↔ Renal/Liver Disease

Moderate Potential Hazard, High plausibility

Applies to: Liver Disease, Renal Dysfunction

Tricyclic and tetracyclic antidepressants (TCAs) are known to undergo metabolism in the liver. Some of the metabolites, such as those of imipramine, clomipramine and desipramine, may be pharmacologically active. Many of the metabolites are also excreted by the kidney. There are very limited data concerning the use of TCAs in patients with renal and/or liver disease. Therapy with TCAs should be administered cautiously in patients with significantly impaired renal or hepatic function. Dosage adjustments may be necessary.

References

  1. Gram LF, Andreasen PB, Overo KF, Christiansen J "Comparison of single dose kinetics of imipramine, nortriptyline and antipyrine in man." Psychopharmacology (Berl) 50 (1976): 21-7
  2. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  3. Ziegler VE, Biggs JT, Wylie LT, Rosen SH, Hawf DJ, Coryell WH "Doxepin kinetics." Clin Pharmacol Ther 23 (1978): 573-9
  4. Sandoz M, Vandel S, Vandel B, et al "Metabolism of amitriptyline in patients with chronic renal failure." Eur J Clin Pharmacol 26 (1984): 227-32
  5. Nelson JC, Jatlow PI "Nonlinear desipramine kinetics: prevalence and importance." Clin Pharmacol Ther 41 (1987): 666-70
  6. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  7. Jorgensen A, Hansen V "Pharmacokinetics of amitriptyline infused intravenously in man." Eur J Clin Pharmacol 10 (1976): 337-41
  8. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  9. Brosen K, Gram LF "First-pass metabolism of imipramine and desipramine: impact of the sparteine oxidation phenotype." Clin Pharmacol Ther 43 (1988): 400-6
  10. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  11. Virtanen R, Scheinin M, Iisalo E "Single dose pharmacokinetics of doxepin in healthy volunteers." Acta Pharmacol Toxicol (Copenh) 47 (1980): 371-6
  12. "Product Information. Asendin (amoxapine)" Lederle Laboratories, Wayne, NJ.
  13. Alexanderson B "Pharmacokinetics of nortriptyline in man after single and multiple oral doses: the predictability of steady-state plasma concentrations from single-dose plasma-level data." Eur J Clin Pharmacol 4 (1972): 82-91
  14. Linnoila M, Insel T, Kilts C, Potter WZ, Murphy DL "Plasma steady-state concentrations of hydroxylated metabolites of clomipramine." Clin Pharmacol Ther 32 (1982): 208-11
  15. Ciraulo DA, Barnhill JG, Jaffe JH "Clinical pharmacokinetics of imipramine and desipramine in alcoholics and normal volunteers." Clin Pharmacol Ther 43 (1988): 509-18
  16. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  17. Lieberman JA, Cooper TB, Suckow RF, et al "Tricyclic antidepressant and metabolite levels in chronic renal failure." Clin Pharmacol Ther 37 (1985): 301-7
  18. Schulz P, Turner-Tamiyasu K, Smith G, Giacomini KM, Blaschke TF "Amitriptyline disposition in young and elderly normal men." Clin Pharmacol Ther 33 (1983): 360-6
  19. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  20. Midha KK, Hubbard JW, McKay G, et al "Stereoselective pharmacokinetics of doxepin isomers." Eur J Clin Pharmacol 42 (1992): 539-44
  21. Henry JF, Altamura C, Gomeni R, Hervy MP, Forette F, Morselli PL "Pharmacokinetics of amitriptyline in the elderly." Int J Clin Pharmacol Ther Toxicol 19 (1981): 1-5
  22. Gram LF, Overo KF "First-pass metabolism of nortriptyline in man." Clin Pharmacol Ther 18 (1975): 305-14
  23. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  24. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  25. Dawling S, Crome P, Braithwaite R "Pharmacokinetics of single oral doses of nortriptyline in depressed elderly hospital patients and young healthy volunteers." Clin Pharmacokinet 5 (1980): 394-401
  26. Dawlilng S, Lynn K, Rosser R, Braithwaite R "The pharmacokinetics of nortriptyline in patients with chronic renal failure." Br J Clin Pharmacol 12 (1981): 39-45
  27. Faulkner RD, Pitts WM, Lee CS, Lewis WA, Fann WE "Multiple-dose doxepin kinetics in depressed patients." Clin Pharmacol Ther 34 (1983): 509-15
View all 27 references
Moderate

Tcas (Includes Limbitrol) ↔ Schizophrenia/Bipolar Disorder

Moderate Potential Hazard, Moderate plausibility

Applies to: Schizophrenia, Bipolar Disorder, Mania

Tricyclic antidepressants (TCAs) may aggravate symptoms of psychosis in schizophrenic patients, particularly those with paranoid symptomatology. Depressed patients, usually those with bipolar disorder, may experience a switch from depression to mania or hypomania. These occurrences have also been reported rarely with the tetracyclic antidepressant, maprotiline. Therapy with these agents should be administered cautiously in patients with schizophrenia, bipolar disorder, or a history of mania.

References

  1. Vallada HP, Gentil V "Musical hallucinations triggered by clomipramine?" Br J Psychiatry 159 (1991): 888-9
  2. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  3. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  4. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  5. Holmes VF, Fricchione GL "Hypomania in an AIDS patient receiving amitriptyline for neuropathic pain." Neurology 39 (1989): 305
  6. Hemmingsen R, Rafaelsen OJ "Hypnagogic and hypnopompic hallucinations during amitriptyline treatment." Acta Psychiatr Scand 62 (1980): 364-8
  7. Cruz R "Clomipramine side effects." J Am Acad Child Adolesc Psychiatry 31 (1992): 1168-9
  8. "Product Information. Asendin (amoxapine)" Lederle Laboratories, Wayne, NJ.
  9. Hardoby W "Imipramine and suicidal thoughts ." Am J Psychiatry 149 (1992): 412-3
  10. Godwin CD "Case report of tricyclic-induced delirium at a therapeutic drug concentration." Am J Psychiatry 140 (1983): 1517-8
  11. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  12. van Kammen DP, van Scheyen JD, Murphy DL "Platelet monoamine oxidase activity and clomipramine-induced mania in unipolar depressed patients." Biol Psychiatry 15 (1980): 565-73
  13. Kupfer DJ, Carpenter LL, Frank E "Possible role of antidepressants in precipitating mania and hypomania in recurrent depression." Am J Psychiatry 145 (1988): 804-8
  14. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  15. Rampling D "Aggression: a paradoxical response to tricyclic antidepressants." Am J Psychiatry 135 (1978): 117-8
  16. Norman TR, Judd F, Holwill BJ, Burrows GD "Doxepin and visual hallucinations." Aust N Z J Psychiatry 16 (1982): 295-6
  17. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  18. Nelson JC, Jatlow PI, Bock J, Quinlan DM, Bowes MB "Major adverse reactions during desipramine treatment." Arch Gen Psychiatry 39 (1982): 1055-61
  19. Peet M "Induction of mania with selective serotonin re-uptake inhibitors and tricyclic antidepressants." Br J Psychiatry 164 (1994): 549-50
  20. Preskorn SH, Simpson S "Tricyclic-antidepressant-induced delirium and plasma drug concentration." Am J Psychiatry 139 (1982): 822-3
  21. Harper G "Suicidality with clomipramine." J Am Acad Child Adolesc Psychiatry 31 (1992): 369-70
  22. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  23. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  24. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 24 references
Moderate

Tcas (Includes Limbitrol) ↔ Tardive Dyskinesia

Moderate Potential Hazard, Moderate plausibility

Applies to: Tardive Dyskinesia

Tricyclic and tetracyclic antidepressants (TCAs) have anticholinergic activity, to which elderly patients are particularly sensitive. Tertiary amines such as amitriptyline and trimipramine tend to exhibit greater anticholinergic effects than other agents in the class. As with other drugs that possess anticholinergic activity, TCAs may aggravate tardive dyskinesia or induce previously suppressed symptoms. Patients with tardive dyskinesia requiring therapy with TCAs should be monitored for exacerbation of the condition.

References

  1. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  2. Lee HK "Dystonic reactions to amitriptyline and doxepin ." Am J Psychiatry 145 (1988): 649
  3. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  4. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  5. Dekret JJ, Maany I, Ramsey TA, Mendels J "A case of oral dyskinesia associated with imipramine treatment." Am J Psychiatry 134 (1977): 1297-8
  6. Schatzberg AF, Cole JO, Blumer DP "Speech blockage: a tricyclic side effect." Am J Psychiatry 135 (1978): 600-1
  7. Nelson JC, Jatlow PI, Bock J, Quinlan DM, Bowes MB "Major adverse reactions during desipramine treatment." Arch Gen Psychiatry 39 (1982): 1055-61
  8. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  9. Woogen S, Graham J, Angrist B "A tardive dyskinesia-like syndrome after amitriptyline treatment." J Clin Psychopharmacol 1 (1981): 34-6
  10. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  11. Sandyk R "Persistent akathisia associated with early dyskinesia." Postgrad Med J 60 (1984): 916
  12. Gersten SP "Tardive dyskinesia-like syndromes with clomipramine ." Am J Psychiatry 150 (1993): 165-6
  13. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  14. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  15. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  16. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  17. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  18. Finder E, Lin K-M, Ananth J "Dystonic reaction to amitriptyline." Am J Psychiatry 139 (1982): 1220
View all 18 references
Moderate

Tricyclic Antidepressants (Includes Limbitrol) ↔ Acute Alcohol Intoxication

Moderate Potential Hazard, Moderate plausibility

Applies to: Alcoholism

Tricyclic antidepressants can enhance the response to alcohol. In patients who may use alcohol excessively, it should be borne in mind that the potentiation may increase the danger inherent in any suicide attempt or overdosage.

Moderate

Tricyclic Antidepressants (Includes Limbitrol) ↔ Bipolar Disorder Screening

Moderate Potential Hazard, Moderate plausibility

Applies to: Bipolar Disorder

A major depressive episode can be the initial presentation of bipolar disorder. Patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder prior to initiating treatment with a tricyclic antidepressant. This screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that tricyclic antidepressants are not approved for use in treating bipolar depression.

Moderate

Tricyclic Antidepressants (Includes Limbitrol) ↔ Glaucoma

Moderate Potential Hazard, Moderate plausibility

Applies to: Glaucoma (Narrow Angle)

Tricyclic antidepressants as other type of antidepressants have an effect on pupil size causing dilation. This effect can potentially narrow the eye angle resulting in increased intraocular pressure and angle closure glaucoma, especially in predisposed patients. These drugs should be used with caution in patients with anatomically narrow angle or history of glaucoma. Doxepin hydrochloride capsules are contraindicated in patients with glaucoma.

Moderate

Tricyclic Antidepressants (Includes Limbitrol) ↔ Hyper/Hypoglycemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus, Hypoglycemia

There have been reports of both elevation and lowering of blood sugar levels in patients receiving tricyclic antidepressants. These drugs should be used with caution in patients with hypoglycemia, hyperglycemia or diabetes. Monitoring sugar levels is recommended.

Moderate

Tricyclic Antidepressants (Includes Limbitrol) ↔ Liver/Renal Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction, Liver Disease

In general, tricyclic antidepressants should be used with caution in patients with liver or renal disease, as these drugs are metabolized and excreted through the liver and kidneys. Dose selection, especially in the elderly patients that might have liver or renal dysfunction, should usually be limited to the smallest effective total daily dose. Some tricyclic antidepressants such as clomipramine and nortriptyline have occasionally been associated with elevations in SGOT (AST) and SGPT (ALT), and other hepatic adverse events such as jaundice. Although serious liver injury has only been reported rarely, therapy with these drugs should be administered cautiously in patients with preexisting liver disease and periodic monitoring of liver enzyme levels is recommended.

References

  1. Larrey D, Rueff B, Pessayre D, Danan G, Algard M, Geneve J, Benhamou JP "Cross hepatotoxicity between tricyclic antidepressants." Gut 27 (1986): 726-7
  2. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
Moderate

Tricyclic Antidepressants (Includes Limbitrol) ↔ Neutropenia

Moderate Potential Hazard, Moderate plausibility

Applies to: Neutropenia

The use of some tricyclic antidepressants has been associated with neutropenia (ANC < 500/mm3) and agranulocytosis (ANC < 500/mm3). Leukocyte and differential blood counts should be performed in patients that develop fever and sore throat during treatment. Therapy should be discontinued if there is evidence of pathologic neutrophil depression.

Moderate

Tricyclic Antidepressants (Includes Limbitrol) ↔ Schizophrenia

Moderate Potential Hazard, Moderate plausibility

Applies to: Schizophrenia

Some tricyclic antidepressants have shown to cause activation or exacerbation of psychosis in schizophrenic patients. A dosage reduction might be required.

Moderate

Tricyclic Antidepressants (Includes Limbitrol) ↔ Thyroid Disorders

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperthyroidism

Most tricyclic antidepressants should be administered with caution in hyperthyroid patients or those receiving thyroid medication as they may develop arrhythmias when these drugs are given.

Moderate

Tricyclic Antidepressants (Includes Limbitrol) ↔ Urinary Retention

Moderate Potential Hazard, Moderate plausibility

Applies to: Urinary Retention

Due to their anticholinergic properties, tricyclic antidepressants should be administered with caution in patients with history of urinary retention. Particularly doxepin hydrochloride capsules are contraindicated in patients with tendency to urinary retention.

Limbitrol (amitriptyline / chlordiazepoxide) drug Interactions

There are 1267 drug interactions with Limbitrol (amitriptyline / chlordiazepoxide)

Limbitrol (amitriptyline / chlordiazepoxide) alcohol/food Interactions

There are 2 alcohol/food interactions with Limbitrol (amitriptyline / chlordiazepoxide)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Hide