D. Lofepramine – Explanation
Lofepramine – the safest TCA in overdosage
Tricyclic antidepressants
Tricyclic antidepressants (TCAs) are used less commonly now for depression due to their side-
effects and toxicity in overdose. They are however used widely in the treatment of neuropathic pain,
where smaller doses are typically required.
Common side-effects
• drowsiness
• dry mouth
• blurred vision
• constipation
• urinary retention
Choice of tricyclic
• low-dose amitriptyline is commonly used in the management of neuropathic pain and the
prophylaxis of headache (both tension and migraine)
• lofepramine has a lower incidence of toxicity in overdose
• amitriptyline and dosulepin (dothiepin) are considered the most dangerous in overdose
| More sedative | Less sedative |
| Amitriptyline Clomipramine Dosulepin Trazodone |
Imipramine Lofepramine Nortriptyline |
*trazodone is technically a ‘tricyclic-related antidepressant’
