• Reference Number: HEY-677/2022
• Departments: Pain Medicine
• Last Updated: 1 March 2022

Introduction

This leaflet has been produced to give you general information about your treatment.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for further discussion. If after reading it you have any concerns or require any further explanation please discuss this with a member of the healthcare team caring for you.

Why do I need an Anti-depressant?

Tricyclics are a family of medicines which include Amitriptyline, Dothiepin (Dosulepin), Imipramine, Lofepramine and Nortriptyline.

You have been prescribed: ………………………………………………………….

Tricyclics are used to treat nerve pain. This type of pain is often not relieved by normal pain relief.  Tricyclics can be used in combination with other pain relief to manage your pain.

When pain goes on for long periods of time, it can interfere with your usual sleep pattern so that you do not wake in the morning feeling refreshed.  This in turn can make it more difficult to cope with pain, so sleep is disturbed further.  This cycle can eventually lead to a state where pain is badly controlled and sleep is poor.   A side effect of tricyclic medications is that, in some people, they can cause drowsiness and help with sleep.  This is a reason why patients with pain are treated with these medicines to try and return their sleep pattern to a normal level.

Are Tricyclics used for treating depression?

Yes, they are used for treating depression but research has shown that they are also effective in helping pain. The doses used for improving pain and sleep patterns are much smaller than those used for depression. Remember, the aim of treatment with tricyclics is:

•  To reduce pain.
•  To help establish a sleep pattern.
•  Break the cycle of pain.

How long will it be before the Tricyclics take effect?

You should notice that your pain starts to improve over one to two weeks after starting a tricyclic. It may be six weeks or longer before you begin to notice any improvement in your sleep pattern. Some people feel the benefit straightaway.

How Long will I have to take a Tricyclic?

We recommend you take this medication for at least three months. If it is helpful you may need to take it for many months, so you will need a repeat prescription from your GP. Your treatment will be reviewed in hospital by the doctors and Pain Service looking after you. If you are discharged then your GP should review your treatment. You may also have had an appointment made for you to visit a specialist pain clinic within the community.
It is important that you continue taking your regular pain relief, unless you have been advised to stop taking these by your doctor.

How should I take a Tricyclic?

•  A tricyclic should be taken in addition to your current tablets unless you are told otherwise.
•  You should take the tablet(s) as a single dose about one hour before you usually go to sleep.
•  If you feel drowsy when you first wake up, you should take the tablets sooner than one hour before you usually go to sleep.
• Sometimes the dose will need to be adjusted to find the right dose for you. This will be done by your hospital doctor, pain service or GP.

Do I need to have any tests whilst taking a Tricyclics?

No, you will not need any special checks whilst you are taking this medication.

Are there any side effects?

All medications have side effects but not everyone will experience them. Side effects will usually appear soon after you start taking the medication but they should become less troublesome by the end of the first week. The most common side effects of tricyclic medications are:

•  A dry mouth
•  Drowsiness (this is why the tablets should be taken before you go to sleep)
•  Other side effects are detailed on the medication information leaflet supplied with the tablets

Can I drink alcohol whilst taking a Tricyclic?

If the tricyclic medication makes you feel tired or gives you other side effects, then drinking alcohol may increase these side effects. Because of this, we would advise you to avoid drinking alcohol if these side effects are affecting you.

Is it safe for me to drive whilst taking a Tricyclic?

Tricyclic medication may cause drowsiness. If you feel affected by this, we advise you not to drive until the effects have worn off.
Please read the manufacturer’s instruction leaflet for further advice.

Is it safe to take other medicines whilst receiving treatment with a Tricyclic?

Before you take or buy any new medicines, including herbal remedies, tell your doctor or pharmacist that you are taking a tricyclic and ask their advice.

What should I do if I forget to take a dose?

This medication is normally taken before you go to sleep. If you forget or skip a dose, then continue as normal the next day. Do not double up if you have missed a dose.

Never give your prescribed tablets to other people as they may not be safe for them to take. Any leftover tablets should be taken to your local pharmacy for safe disposal.

Additional Information

The information in this leaflet is not intended to replace the advice given to you by your GP or the Pain Service looking after you. If you require more information or have any questions, please speak to your GP or the Pain Service who are looking after you:-

Hull University Teaching Hospitals NHS Trust
Pain Service
Outpatient Department
East Riding Community Hospital, Beverley
East Yorkshire
Tel: (01482) 478868

In the event of an emergency and outside normal working hours of the Pain Clinic  (9.00am – 4.00pm), please contact your own GP or your local Emergency Department.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.