TCAS

• block the reuptake of serotonin and norepinephrine to increase the activity of endogenous pain-modulating pathways
• best used for chronic neuropathic pain

| TCA | Anticholinergic | Drowsiness | Insomnia/ agitation | Orthostatic hypotension | QTc prolongation* | Gastrointestinal toxicity | Weight gain | Sexual dysfunction | | --- | --- | --- | --- | --- | --- | --- | --- | --- | | Amitriptyline | 4+ | 4+ | 0 | 3+ | 1 to 2+ | 1+§§ | 4+ | 3 to 4+ | | Amoxapine | 2+ | 2+ | 2+ | 2+ | ND¥¥ | 0§§ | 2+ | ND | | Clomipramine | 4+ | 4+ | 1+ | 2+ | 3+ | 1+§§ | 4+ | 4+ | | Desipramine | 1+ | 2+ | 1+ | 2+ | 1 to 2+ | 0§§ | 1+ | ND | | Doxepin | 3+ | 3+ | 0 | 2+ | 3+ | 0§§ | 4+ | 3+ | | Imipramine | 3+ | 3+ | 1+ | 4+ | 3+ | 1+§§ | 4+ | 3+ | | Maprotiline | 2+ | 3+ | 0 | 2+ | 1+ | 0§§ | 2+ | ND | | Nortriptyline | 2+ | 2+ | 0 | 1+ | 1 to 2+ | 0§§ | 1+ | ND | | Protriptyline | 2+ | 1+ | 1+ | 2+ | ND¥¥ | 1+§§ | 1+ | 3 to 4+ | | Trimipramine | 4+ | 4+ | 1+ | 3+ | ND¥¥ | 0§§ | 4+ | ND |