The ability to drive, handle dangerous machinery, or do other tasks requiring complex psychomotor skills may be impaired by amitriptyline, and to a lesser extent by doxepin, particularly during the first few days of treatment. This impairment is increased by alcohol. Amoxapine, clomipramine, desipramine, imipramine, and nortriptyline appear to interact with alcohol only minimally. Specific information about other tricyclic antidepressants appears to be lacking. There is also evidence that alcoholics may need larger doses of desipramine and imipramine to control depres- sion.
Although an interaction has not been clearly demonstrated with all the tricyclic antidepressants some caution is warranted as they all have some sedative effects. The degree of impairment will depend on the individual patient. However, warn all patients of the potential effects, and counsel against driving or undertaking other skilled tasks. In addition some prescribers may feel it appropriate to offer further precautionary advice, because during the first 1 to 2 weeks of treatment many tricyclics (without alcohol) may temporarily impair the skills related to driving. Also be aware that alcoholic patients (without liver disease) may need higher doses of imipramine (possibly doubled) and desipramine to control depression, and if long-term abstinence is achieved the dosages may then eventually need to be reduced. Information about other tricyclics seems to be lacking.
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