Other medications can affect the removal of nortriptyline from your body, thereby affecting how nortriptyline works. Citalopram. Tricyclic Antidepressants may increase the serum concentration of Citalopram. Citalopram may increase the serum concentration of Tricyclic Antidepressants. Management: Consider alternatives to this combination when possible. Monitor for adverse effects of tricyclic antidepressants TCAs including serotonin syndrome and QT-interval prolongation, when a TCA is being used in combination with citalopram. Hepatic impairment: Use with caution in patients with hepatic impairment.
Importance of patients understanding that it may take more than 2 weeks before the full effects are apparent. Feinmann 1993; Romero-Reyes 2014. CarBAMazepine: May decrease the serum concentration of Tricyclic Antidepressants. Renal impairment: Use with caution in patients with renal impairment.
The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your not to work correctly. These are possible, but not always occur. Your doctor or can often prevent or manage interactions by changing how you use your medications or by close monitoring. Nortriptyline is not approved for use in treating bipolar depression. CNS Depressants. Specifically, sleepiness and dizziness may be enhanced.
Animal reproduction studies are inconclusive. Nortriptyline and its metabolites cross the human placenta and can be detected in cord blood Loughhead 2006. Tricyclic antidepressants may be associated with irritability, jitteriness, and convulsions rare in the neonate Yonkers 2009. Importance of informing patients of other important precautionary information. a See Cautions. The most commonly reported side effects were dizziness, headache, blurred vision, disturbance of accommodation, dry mouth, constipation, palpitation, tachycardia, and orthostatic hypotension. Distributes into milk; 100 101 102 use not recommended.
Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses or planned surgery. F. Protect from light. Many drugs besides nortriptyline may affect the heart rhythm QT prolongation in the EKG including amiodarone, cisapride, dofetilide, pimozide, procainamide, quinidine, sotalol, macrolide antibiotics such as erythromycin among others. Therefore, before using nortriptyline, report all medications you are currently using to your doctor or pharmacist. If any of these effects persist or worsen, tell your doctor or promptly.
Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. 'Multum' is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Minocycline: May enhance the CNS depressant effect of CNS Depressants. Droperidol: May enhance the CNS depressant effect of CNS Depressants. Nitroglycerin: Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Has been used for the management of anxiety in combination with anxiolytics, sedatives, or antipsychotics in patients with depression. The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. See Boxed Warning and also see Worsening of Depression and Suicidality Risk under Cautions. Narcotic analgesics also called opiates, opioid analgesics, or narcotics are a group of medicines that relieve acute and chronic severe pain by binding to opioid receptors. There are at least four opioid receptors: mu, delta, kappa and opioid receptor like-1 ORL1 receptor. These influence the opioid system which controls pain, reward and addictive behaviors. Opioid receptors are most abundant in the brain but are also found elsewhere in the body, including the digestive tract, respiratory tract and spinal cord. Distributes into milk; 100 101 102 nortriptyline concentrations in milk appear to be similar to or slightly greater than those present in maternal serum. Nortriptyline hydrochloride is a tricyclic antidepressant used to relieve the symptoms of depression. Nortriptyline hydrochloride is available in generic form. Tetrahydrocannabinol: May enhance the CNS depressant effect of CNS Depressants. Alpha2-Agonists Ophthalmic: Tricyclic Antidepressants may diminish the therapeutic effect of Alpha2-Agonists Ophthalmic. Antidepressants increased the risk compared with placebo of suicidal thinking and behavior suicidality in children, adolescents, and young adults in short-term studies of major depressive disorder MDD and other psychiatric disorders. Anyone considering the use of nortriptyline or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared with placebo in adults older than 24 years; there was a reduction in risk with antidepressants compared with placebo in adults 65 years and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Appropriately monitor patients of all ages who are started on antidepressant therapy and observe them closely for clinical worsening, suicidality, or unusual changes in behavior. Advise families and caregivers of the need for close observation and communication with the health care provider. Nortriptyline is not approved for use in pediatric patients. Iobenguane I 123: Tricyclic Antidepressants may diminish the therapeutic effect of Iobenguane I 123. permethrin
HYDROcodone: CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Food and Drug Administration. Medication guide: about using antidepressants in children or teenagers. Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Methylene Blue: May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? Take this medication by mouth, usually 1 to 4 times daily or as directed by your doctor. Do not stop taking any medications without consulting your healthcare provider. Dronabinol: May enhance the CNS depressant effect of CNS Depressants. Cannabis: May enhance the CNS depressant effect of CNS Depressants. Check with your doctor before you drink alcohol or use medicines that may cause drowsiness eg, sleep aids, muscle relaxers while you are using Aventyl; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness. Use Aventyl as directed by your doctor. Check the label on the medicine for exact dosing instructions. May enhance effects of alcohol. a Use with caution in patients with a history of excessive alcohol consumption. a See Interactions. Allow at least 2 weeks to elapse between discontinuance of therapy with an MAO inhibitor and initiation of nortriptyline and vice versa. a Also allow at least 5 weeks to elapse when switching from fluoxetine. If you miss a dose of Aventyl, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once. If you take 1 dose daily at bedtime, do not take the missed dose the next morning. Roche Products Inc. Endep prescribing information. opux.info propecia
It may help improve mood and feelings of well-being, relieve anxiety and tension, and increase your energy level. This medication belongs to a class of medications called tricyclic antidepressants. It works by affecting the balance of certain natural chemicals neurotransmitters in the brain. This medication may not work right away. You may see some benefit within a week. However, it may take up to 4 weeks before you feel the full effect. During pregnancy, this medication should be used only when clearly needed. Tricyclic Antidepressants. Sertraline may increase the serum concentration of Tricyclic Antidepressants. Management: Consider alternatives to this combination when possible. Monitor for adverse effects of tricyclic antidepressants TCAs including serotonin syndrome and QT-interval prolongation, when a TCA is being used in combination with sertraline. Abiraterone Acetate: May increase the serum concentration of CYP2D6 Substrates. Management: Avoid concurrent use of abiraterone with CYP2D6 substrates that have a narrow therapeutic index whenever possible. Nortriptyline was continued for approximately 12 weeks in clinical studies. The ACOG recommends that therapy for depression during pregnancy be individualized; treatment should incorporate the clinical expertise of the mental health clinician, obstetrician, primary health care provider, and pediatrician ACOG 2008. According to the American Psychiatric Association APA the risks of medication treatment should be weighed against other treatment options and untreated depression. For women who discontinue antidepressant medications during pregnancy and who may be at high risk for postpartum depression, the medications can be restarted following delivery APA 2010. Treatment algorithms have been developed by the ACOG and the APA for the management of depression in women prior to conception and during pregnancy Yonkers 2009. Take this by with a full glass of water unless otherwise directed by your doctor. Since dosing recommendations may vary, carefully follow your doctor's directions for taking this medication. This medication may be taken with food or milk if upset occurs. Methotrimeprazine: CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established. Do not share this medication with others. Performance of activities requiring mental alertness and physical coordination may be impaired. Hematologic effects: TCAs may rarely cause bone marrow suppression; monitor for any signs of infection and obtain CBC if symptoms eg, fever, sore throat evident. CNS depression: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks that require mental alertness eg, operating machinery or driving. The degree of sedation is low-moderate relative to other antidepressants Bauer 2013.
Keep all away from children and pets. For these reasons, FAERS case reports cannot be used to calculate incidence or estimates of risk for a particular product or compare risks between products. Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Antipsychotic Agents. Specifically, serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotic Agents may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Seizure disorder: Use with caution in patients with a history of seizures. Other, less serious side effects may be more likely to occur. Lab tests, including blood cell counts, may be performed while you use Aventyl. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments. APA 2010; Bauer 2002; Haddad 2001; NCCMH 2010; Schatzberg 2006; Shelton 2001; Warner 2006. Symptoms of a mazindol overdose include restlessness, tremor, rapid breathing, confusion, hallucinations, panic, aggressiveness, nausea, vomiting, diarrhea, an irregular heartbeat, and seizures. What should I avoid while taking mazindol? Ask your pharmacist about using those products safely. Piribedil: CNS Depressants may enhance the CNS depressant effect of Piribedil. Dizziness; drowsiness; dry mouth; excitement; headache; impotence; nausea; nightmares; pupil dilation; sensitivity to sunlight; sweating; tiredness; upset stomach; vomiting; weakness; weight loss or gain. MAO Inhibitors: May enhance the serotonergic effect of Tricyclic Antidepressants. This may cause serotonin syndrome. While methylene blue and linezolid are expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to monographs specific to those agents for details. Exceptions: Linezolid; Methylene Blue; Tedizolid. Avoid doing things that may cause you to overheat, such as hard work or in hot weather, or using hot tubs. When the weather is hot, drink a lot of fluids and dress lightly. If you overheat, quickly look for a place to cool down and rest. Discuss specific use of drug and side effects with patient as it relates to treatment. HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? buy finasteride online 24 hours
This medication may also be used to help quit smoking. Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. OCD, or non-OCD anxiety disorders suggests that the benefits of antidepressant therapy in treating these conditions may outweigh the risks of suicidal behavior or suicidal ideation. k No suicides occurred in these pediatric trials. Ipratropium Oral Inhalation: May enhance the anticholinergic effect of Anticholinergic Agents. Please refer to the for information on shortages of one or more of these preparations. cheapest albendazole online uk
Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Tricyclic Antidepressants. Methylphenidate may increase the serum concentration of Tricyclic Antidepressants. MAO inhibitor recommendations: Refer to adult dosing. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Tell your doctor if your condition persists or worsens such as your feelings of sadness get worse, or you have thoughts of suicide. Tricyclic Antidepressants. Management: Seek alternatives to this combination when possible. Monitor patients receiving metoclopramide with tricyclic antidepressants for signs of extrapyramidal symptoms, neuroleptic malignant syndrome, and serotonin syndrome. Tricyclic Antidepressants. FluvoxaMINE may increase the serum concentration of Tricyclic Antidepressants. Management: Consider alternatives to this combination when possible. Monitor for adverse effects of tricyclic antidepressants TCAs including serotonin syndrome and QT-interval prolongation, when a TCA is being used in combination with fluvoxamine. Discontinuation of therapy: Upon discontinuation of antidepressant therapy, gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for the detection of re-emerging symptoms. Evidence supporting ideal taper rates is limited. APA and NICE guidelines suggest tapering therapy over at least several weeks with consideration to the half-life of the antidepressant; antidepressants with a shorter half-life may need to be tapered more conservatively. In addition for long-term treated patients, WFSBP guidelines recommend tapering over 4 to 6 months. Among the drugs of choice for the symptomatic treatment of postherpetic neuralgia. Do not become overheated in hot weather or while you are being active; heatstroke may occur. Take the missed dose as soon as you remember. However, if it is almost time for your next dose or if it is already evening, skip the missed dose and take only your next regularly scheduled dose. A dose taken too late in the day will cause insomnia. Do not take a double dose of this medication. What happens if I overdose? Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Liquid and chewable forms of this product may contain sugar, alcohol, or aspartame. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Always consult your doctor or healthcare specialist for medical advice. Dimethindene Topical: May enhance the CNS depressant effect of CNS Depressants.
Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Nortriptyline is not approved for use in pediatric patients. a See Pediatric Use under Cautions. Has been used for the management of acute depressive episodes in combination with an antipsychotic in patients with schizophrenia. Tell your doctor if your depression worsens or you have suicidal thoughts while taking nortriptyline hydrochloride. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy. The dosage is based on your medical condition and response to treatment. To reduce your risk of side effects such as dry mouth, dizziness your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully. Glycopyrrolate Oral Inhalation: Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate Oral Inhalation. Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid using drugs with substantial anticholinergic effects in patients receiving secretin whenever possible. If such agents must be used in combination, monitor closely for a diminished response to secretin. Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. This drug may make you drowsy or dizzy or cause blurred vision. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely. Limit alcoholic beverages. To relieve dry mouth, suck on sugarless hard candy or ice chips, chew sugarless gum, drink water, or use a saliva substitute. Hospitalized patients under close supervision may generally be given higher dosages than outpatients. QuiNIDine: Tricyclic Antidepressants may enhance the QTc-prolonging effect of QuiNIDine. QuiNIDine may increase the serum concentration of Tricyclic Antidepressants. Sulfonylureas: Cyclic Antidepressants may enhance the hypoglycemic effect of Sulfonylureas. Inhibits the activity of histamine, 5-hydroxytryptamine, and acetylcholine. It increases the pressor effect of norepinephrine but blocks the pressor response of phenethylamine. However, additional receptor effects have been found including desensitization of adenyl cyclase, down regulation of beta-adrenergic receptors, and down regulation of serotonin receptors. cheap bonviva glasgow
Take mazindol exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you. This information should not be used to decide whether or not to take Aventyl or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about Aventyl. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to Aventyl. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using Aventyl. Peginterferon Alfa-2b: May decrease the serum concentration of CYP2D6 Substrates. Peginterferon Alfa-2b may increase the serum concentration of CYP2D6 Substrates. Never take more of this medication than is prescribed for you. Too much mazindol could be very dangerous to your health. Bridge JA, Iyengar S, Salary CB. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA. MAOIs, SSRIs. Symptoms may include agitation; confusion; hallucinations; coma; fever; fast or irregular heartbeat; tremor; excessive sweating; and nausea, vomiting, or diarrhea. Contact your doctor at once if you have any of these symptoms. Discontinuation syndrome: Abrupt discontinuation or interruption of antidepressant therapy has been associated with a discontinuation syndrome. Symptoms arising may vary with antidepressant however commonly include nausea, vomiting, diarrhea, headaches, lightheadedness, dizziness, diminished appetite, sweating, chills, tremors, paresthesias, fatigue, somnolence, and sleep disturbances eg, vivid dreams, insomnia. Less common symptoms include electric shock-like sensations, cardiac arrhythmias more common with tricyclic antidepressants myalgias, parkinsonism, arthralgias, and balance difficulties. Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. Swallow extended-release capsules whole. Do not crush or chew extended-release capsules or tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split extended-release tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing. Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Amphetamines: Tricyclic Antidepressants may enhance the stimulatory effect of Amphetamines. Tricyclic Antidepressants may also potentiate the cardiovascular effects of Amphetamines. Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take see Drug Interactions section. average cost topiramate without insurance
Dizziness, drowsiness, and confusion can increase the risk of falling. Associated with more frequent anticholinergic, sedative, or cardiovascular effects and weight gain than SSRIs. Perhexiline: CYP2D6 Substrates may increase the serum concentration of Perhexiline. Perhexiline may increase the serum concentration of CYP2D6 Substrates. Vitamin K Antagonists eg, warfarin: Tricyclic Antidepressants may enhance the anticoagulant effect of Vitamin K Antagonists. Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Tricyclic Antidepressants. PARoxetine may increase the serum concentration of Tricyclic Antidepressants. Management: Consider alternatives to this combination when possible. Monitor for adverse effects of tricyclic antidepressants TCAs including serotonin syndrome and QT-interval prolongation, when a TCA is being used in combination with paroxetine. Altretamine: May enhance the orthostatic hypotensive effect of Tricyclic Antidepressants. AbobotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of AbobotulinumtoxinA. OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional. Terbinafine Systemic: May increase the serum concentration of Nortriptyline. Nortriptyline is a used to treat depression. Store at room temperature away from light and moisture. not store in the bathroom. Risk of manifestations of psychosis in patients with schizophrenia. Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. CYP2D6 Inhibitors Moderate: May decrease the metabolism of CYP2D6 Substrates.
Serotonin Modulators. The development of serotonin syndrome may occur. Exceptions: Nicergoline; Tedizolid. Aventyl comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get Aventyl refilled. Brixen-Rasmussen L, Halgrener J, Jorgensen A. Amitriptyline and nortriptyline excretion in human breast milk. Psychopharmacology. Escitalopram. Escitalopram may increase the serum concentration of Tricyclic Antidepressants. Management: Consider alternatives to this combination when possible. Monitor for adverse effects of tricyclic antidepressants TCAs including serotonin syndrome and QT-interval prolongation, when a TCA is being used in combination with escitalopram. Metaxalone: May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Iohexol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iohexol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants. aggrenox
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Asunaprevir: May increase the serum concentration of CYP2D6 Substrates. This may not be a complete list of all interactions that may occur. Ask your health care provider if Aventyl may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine. Has been used for the short-term management of acute depressive episodes in bipolar disorder.
Nortriptyline is not FDA approved for use in children. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs. Tricyclic Antidepressants. FLUoxetine may increase the serum concentration of Tricyclic Antidepressants. Management: Consider alternatives to this combination when possible. Monitor for adverse effects of tricyclic antidepressants TCAs including serotonin syndrome and QT-interval prolongation, when a TCA is being used in combination with fluoxetine. Prescriptions should be written for the smallest quantity consistent with good patient care. The patient's family or caregiver should be alerted to monitor patients for the emergence of suicidality and associated behaviors such as anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia, hypomania, and mania; patients should be instructed to notify their healthcare provider if any of these symptoms or worsening depression or psychosis occur.
Nortriptyline may cause a condition that affects the heart rhythm QT prolongation. Carefully consider these findings when assessing potential benefits and risks of nortriptyline in a child or adolescent for any clinical use. h i j k See Worsening of Depression and Suicidality Risk under Cautions. If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip themissed dose and resume your usual dosing schedule.
Some ingredients is this product may pass into milk. Discuss the risks and benefits with your doctor before -feeding. This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and lactation. Take each dose with a full glass of water. Lithium: May enhance the neurotoxic effect of Tricyclic Antidepressants. Management: This combination should be undertaken with great caution.