Because of its lack of anticholinergic side effects,<unk>  is especially useful in situations in which antimuscarinic effects are particularly problematic (e.g., in patients with benign prostatic hyperplasia, closed-angle glaucoma, or severe constipation).<unk> 's propensity to cause sedation is a dual-edged sword. For many patients, the relief from agitation, anxiety, and insomnia can be rapid; for other patients, including those individuals with considerable psychomotor retardation and feelings of low energy, therapeutic doses of<unk>  may not be tolerable because of sedation.<unk>  elicits orthostatic hypotension in some people, probably as a consequence of α1-adrenergic receptor blockade. The unmasking of bipolar disorder may occur with<unk>  and other antidepressants. Precautions for<unk>  include known hypersensitivity to<unk>  and under 18 years and combined with other antidepressant medications, it may increase the possibility of suicidal thoughts or actions. While<unk>  is not a true member of the SSRI class of antidepressants, it does still share many properties of the SSRIs, especially the possibility of discontinuation syndrome if the medication is stopped too quickly. Care must, therefore, be taken when coming off the medication, usually by a gradual process of tapering down the dose over a period of time. Suicide Antidepressants may increase the risk of suicidal thoughts and behaviors in children and young adults. Close monitoring for emergence of suicidal thoughts and behaviors is thus recommended. Sedation Since<unk>  may impair the mental and/or physical abilities required for performance of potentially hazardous tasks, such as operating an automobile or machinery, the patient should be cautioned not to engage in such activities while impaired. Compared to the reversible MAOI antidepressant drug moclobemide, more impairment of vigilance occurs with<unk> .<unk>  has been found to impair driving ability. Cardiac Case reports have noted cardiac arrhythmias emerging in relation to<unk>  treatment, both in patients with pre-existing mitral valve prolapse and in patients with negative personal and family histories of cardiac disease. QT prolongation has been reported with<unk>  therapy. Arrhythmia identified include isolated PVCs, ventricular couplets, and in two patients short episodes (three to four beats) of ventricular tachycardia. Several post-marketing reports have been made of arrhythmia in<unk> -treated patients who have pre-existing cardiac disease and in some patients who did not have pre-existing cardiac disease. Until the results of prospective studies are available, patients with pre-existing cardiac disease should be closely monitored, particularly for cardiac arrhythmias.<unk>  is not recommended for use during the initial recovery phase of myocardial infarction. Concomitant administration of drugs that prolong the QT interval or that are inhibitors of CYP3A4 may increase the risk of cardiac arrhythmia. Priapism A relatively rare side effect associated with<unk>  is priapism, likely due to its antagonism at α-adrenergic receptors. More than 200 cases have been reported, and the manufacturer estimated that the incidence of any abnormal erectile function is about one in 6,000 male patients treated with<unk> . The risk for this side effect appears to be greatest during the first month of treatment at low dosages (i.e. <150mg/day). Early recognition of any abnormal erectile function is important, including prolonged or inappropriate erections, and should prompt discontinuation of<unk>  treatment. Spontaneous orgasms have also been reported with<unk>  in men. Clinical reports have described<unk> -associated psychosexual side effects in women as well, including increased libido, priapism of the clitoris, and spontaneous orgasms. Others Rare cases of liver toxicity have been observed, possibly due to the formation of reactive metabolites. Elevated prolactin concentrations have been observed in people taking<unk> . They appear to be increased by around 1.5- to 2-fold. Studies on<unk>  and cognitive function are mixed, with some finding improvement, others finding no change, and some finding impairment.<unk>  does not seem to worsen periodic limb movements during sleep.<unk>  is associated with increased risk of falls in older adults. It has also been associated with increased risk of hip fractures in older adults. Pregnancy and lactation Sufficient data in humans are lacking. Use should be justified by the severity of the condition to be treated.
Trazodone
Hydrocodone
Vilazodone
Oxycodone
Nefazodone
Norhydrocodone
Guanfacine
Amitriptyline