Triptizol comes in a tablet form.
The recommended dose is 100-300 milligrams (mg) for most adults, and 25 mg for elderly patients. The initial dose is typically between 50-100 mg.
This medicine can be taken with or without food.
Q: What will happen if I am taken off Triptizol without being weaned off?
A: You should not stop using Elavil (Triptizol) without first talking to your doctor. The medical literature suggests tapering (gradually reducing) the dose of medication, especially if you have been taking it for a while. Stopping this medication suddenly could cause you to have withdrawal symptoms such as nausea, headache, insomnia, fatigue, and sweating. It is best to taper the dose of medication over a period of at least a few weeks to prevent withdrawal. It may take up to four weeks for Triptizol to start working. The most common side effects of Triptizol are nausea, vomiting, constipation, diarrhea, loss of appetite, dry mouth, dizziness, drowsiness, trouble concentrating, nightmares, blurred vision, headache, ringing in your ears, decreased sex drive, impotence, or difficulty having an orgasm. This is not a complete list of side effects; and more severe side effects are possible. Triptizol can interact with other medications. Burton Dunaway, PharmD
Triptizol is a tricyclic compound that has been approved for treatment of major affective disorders (e.g., depression) since the 1950s. 51 The antidepressant actions of Triptizol generally are associated with blockade of the uptake of serotonin and norepinephrine in the CNS; however, Triptizol possesses a multiplicity of other distinct pharmacological activities, e.g., antagonist actions at histamine, muscarinic, α1-adrenergic, and serotonin receptors at namomolar concentrations and at a number of ion channels (e.g., sodium, calcium, and potassium) at micromolar concentrations. 52,53 Triptizol also has micromolar affinity for blocking the uptake of the antinociceptive and anti-inflammatory purine adenosine. 52 In addition, Triptizol has peripheral anti-inflammatory/analgesic actions in several in vivo models that are associated with acute, local delivery of low concentrations of Triptizol. Many of these pharmacological activities are likely to contribute to its analgesic and anti-inflammatory actions.
Generic Name: Triptizol (a mee TRIP ti leen)Brand Names: Vanatrip, Elavil, Endep
Medically reviewed by Sanjai Sinha, MD Last updated on Dec 15, 2018.
Many people living with chronic pain are daunted by the prospect of long term or even permanent drug therapy. What are these drugs, are they safe and how do they work? Concerns such as these can stop people persevering with medicines that may offer a real, life-enhancing solution to their condition. Dr Mick Serpell explains how Triptizol works and gives reassurance about the side effects that you might experience, especially in the early stages
The FDA requires Triptizol to carry a black-box warning because of the risk of suicide.
In short-term studies, a small number of children, teen-agers and young adults (up to 24 years old) who took antidepressants such as Triptizol became suicidal shortly after starting treatment.
You may have suicidal thoughts while taking an antidepressant, especially if you are younger than 24 years old.
Your family members or other caregivers should watch for changes in your mood or other symptoms.
You, a family member, or caregiver should tell your doctor right away if you experience any of the following symptoms while taking Triptizol (especially during the first weeks of treatment or any time you change your dose):
- Thoughts of harming or killing yourself
- Worsening depression
- Extreme worry or other new feelings of anxiousness
- Panic attacks
- Difficulty falling asleep or staying asleep
- Aggressive behavior
- Unusual restlessness
- Unusual mood or behavior changes
- Unusual excitement or hyperactivity
- Agitation, hostility, or aggressiveness
- Unusually impulsive behavior
Children under age 18 should not take Triptizol, but in rare cases, a doctor may decide the benefits outweigh the risks.
Before having any type of surgery, you should tell your surgeon that you are taking Triptizol.
You may also need to make a plan with the doctor who prescribed the drug to carefully taper off before surgery.
You should not stop taking Triptizol suddenly, as you could experience withdrawal symptoms.
It may take a few weeks before you feel the full effects of this medication.
Use this drug as directed, stay in touch with your doctor during your treatment for depression, and tell your doctor if Triptizol isn't helping after four weeks.
Before taking Triptizol, you should tell your doctor if you have any of the following conditions:
- Heart disease
- A history of heart attack, stroke, or seizures
- A history of drinking large amounts of alcohol
- Bipolar disorder (manic depression), schizophrenia, or any other mental illness
- Overactive thyroid
- An enlarged prostate
- Urination problems
One in four people will get significant pain relief with Triptizol. This is regarded as an excellent result for chronic pain conditions. It is started at a low dose (10 or 25 mg a day) and gradually increased in 10 or 25 mg increments each week up towards 75 mg if side effects are tolerable. Your doctor may advise you to go higher than this dose. The tablets are small and difficult to cut in half, and will often produce numbness of the tongue due to a local anaesthetic effect, but it is available as a syrup. It is better to use the syrup if small increases of dose are required during the titration (dose build-up) phase.
Not for everyone
Your doctor will not prescribe this drug for you if you have had an allergic reaction to Triptizol or related drugs; a recent heart attack; or recent administration of drugs that can interact with Triptizol.
Triptizol is the prototype of all antidepressants (see Figure 114-1 ). Its efficacy as an analgesic has been studied extensively and there is significant clinical experience in this setting. 7, 8 Blocking both norepinephrine as well as serotonin, Triptizol is an efficacious analgesic, but with significant side effects including sedation, orthostasis, as well as most of the troublesome anticholinergic side effects. It should be used cautiously in patients with cardiac conduction defects owing to its propensity to cause tachycardia and should not be used in patients with narrow-angle glaucoma and significant prostatism. In spite of its side-effect profile, Triptizol remains a reasonable starting point for implementation of tricyclic antidepressant therapy owing to its proven efficacy, low cost, availability of liquid and parenteral formulations, ability to treat sleep disturbance, dosing flexibility, and universal availability—even for those patients on Medicaid or in managed care plans with restrictive formularies. Because of its sedative properties, Triptizol should be given as a bedtime dose starting at 10 to 25 mg. The drug can be titrated upward as side effects allow in 10- to 25-mg doses with care being taken to identify the increases in side effects as the dose is raised. In particular, orthostatic hypotension can be insidious in onset as the dosage of the drug is raised and may lead to falls at night when the patient gets up to use the bathroom. If analgesia is not achieved by the time the dose is raised to 150 mg, the patient should be switched to a different antidepressant compound, preferably from another class of drugs, and/or another adjuvant analgesic could be added, such as gabapentin if appropriate. If the patient has partial relief of pain, this drug can be carefully titrated upward to a single bedtime dose of 300 mg.
When should I take it?
Triptizol is long acting, so only needs to be taken once a day. As one of the most common side effects is drowsiness, it is best to take it one to two hours before bedtime. This effect can be particularly useful if you suffer lack of sleep from your pain. Sometimes there is a ‘morning after’ type of hangover feeling, but this usually wears off with time. Occasionally Triptizol can cause insomnia; if this happens it is better to take it in the morning.
Opio >Preclinical evidence has suggested that there is some type of interaction of TCAs with central opioid receptors that may contribute to the mechanisms of TCA-induced analgesia 40,41,47,48 despite the low affinity of TCAs for the opioid receptors 47–49 because TCA antinociceptive effects are partially reversed by naloxone. 40,41,47,48
Downstream signaling resulting from antidepressants binding to receptors may have similarities with that of downstream signaling resulting from opioids binding to receptors. Gherlardini and coworkers 77 administered mice intracerebroventricular antisense oligonucleot >Triptizol (15 mg/kg subcutaneously) and clomipramine (25 mg/kg subcutaneously). 77 Ghelardini and coworkers 77 stated that their results indicated that Triptizol and clomipramine induce their analgesic effect by activating all three subtypes of the Gi-proteins.
Benbouzid and colleagues 78 suggested that δ opioid receptors are critical for TCA antinociceptive actions in the preclinical treatment of neuropathic allodynia. Benbouzid and colleagues 78 used a murine model of neuropathic pain induced by sciatic nerve constriction via implantation of a cuff (a 2-mm section of split PE-20 polyethylene tubing) to produce neuropathic-induced mechanical allodynia. After 2 weeks of treatment, nortriptyline reversed the neuropathic-induced allodynia in wild-type mice; however, nortriptyline treatment was ineffective in a Delta opioid receptor (DOR)-deficient line of DOR knockout mutant mice even after 5 weeks of treatment. 78 Also, acute injections of naltrindole (a specific DOR antagonist) at doses of 1 or 5 mg/kg, respectively, partially or totally suppressed the antinociceptive benefit of 21 days of nortriptyline treatment in neuropathic mice. 78 Benbouzid and colleagues 78 hypothesized that chronic TCA treatment may increase DOR expression level, alter their membrane localization, boost their functionality/activity, or perhaps lead to oligomerization between DOR and adrenergic receptors.