A tricyclic antidepressant
Lofepramine
A tricyclic antidepressant for depression that tends to be better tolerated and safer in overdose than older tricyclics.
What is Lofepramine?
Lofepramine is a tricyclic antidepressant used to treat depression. It works by increasing the levels of mood-related chemical messengers in the brain, and tends to cause fewer side effects and to be safer in overdose than older tricyclics. Like all antidepressants it takes a few weeks to work and should not be stopped abruptly.
Education and reference only. This is a plain-language guide to Lofepramine — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Lofepramine is one of the tricyclic antidepressants, a long-established class used for depression. It is generally regarded as one of the better-tolerated tricyclics and is comparatively safer in overdose than older members of the class such as amitriptyline or dosulepin, which is one reason it may be chosen. It still has the typical 'anticholinergic' effects of a tricyclic, such as dry mouth and constipation, and it works gradually over a few weeks.
How it works
Lofepramine increases the levels of the brain chemicals noradrenaline and serotonin by reducing their reuptake back into nerve cells. Over a few weeks this is thought to help lift mood and ease the symptoms of depression. Like other tricyclics it also blocks acetylcholine receptors, which accounts for side effects such as dry mouth, blurred vision and constipation.
What it treats
Conditions Lofepramine is used for
Practical use
How to take Lofepramine
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it regularly each day as prescribed — being consistent helps it work.
- It can be taken with or without food.
- Keep taking it even if you feel no better at first; the benefit builds over a few weeks.
- Do not stop suddenly — coming off it is done gradually to avoid withdrawal-type effects.
- If it makes you drowsy, a larger part of the day's treatment may be taken in the evening on your prescriber's advice.
- If you miss a dose, take it when you remember unless it is nearly time for the next one — do not double up.
Weighing it up
Advantages & disadvantages of Lofepramine
Advantages
- Generally better tolerated than older tricyclic antidepressants.
- Comparatively safer in overdose than older tricyclics — but an overdose is still a medical emergency and needs urgent help.
- Tends to be less sedating than some other tricyclics.
- A long-established, well-understood treatment for depression.
Disadvantages
- Still has anticholinergic effects such as dry mouth, blurred vision and constipation.
- Takes a few weeks to work, so patience is needed.
- Should not be stopped suddenly, as withdrawal-type symptoms can occur.
- Not suitable soon after a heart attack or with certain heart-rhythm problems.
Practical use
Good to know
It takes a few weeks of regular treatment before the full benefit is felt, so it is important to keep going even if you do not notice a change at first. It should not be stopped suddenly, because doing so can cause withdrawal-type symptoms; coming off it is done gradually. It has anticholinergic effects, but tends to cause less drowsiness and is safer in overdose than older tricyclics.
Who should not take it / use with caution
- People who have recently had a heart attack or who have certain heart-rhythm problems.
- People with severe liver disease or uncontrolled mania.
- Used with caution in heart disease, epilepsy, glaucoma, an enlarged prostate or urinary retention, and in older people.
- Caution in pregnancy and breastfeeding — discussed with the prescriber.
Monitoring
- Review of mood, response to treatment and any thoughts of self-harm, especially early on.
- Blood pressure and heart rate where there is a heart concern.
- Sodium levels may be checked, particularly in older people.
Side effects
- Dry mouth, constipation, blurred vision and difficulty passing urine.
- Drowsiness or, in some people, disturbed sleep.
- Dizziness on standing and a faster heartbeat.
- Sweating and weight changes.
- Possible low sodium levels, particularly in older people.
Key interactions
- Must not be combined with MAOI antidepressants; a gap is needed when switching.
- Other sedating medicines and alcohol add to drowsiness.
- Other medicines with anticholinergic effects increase dry mouth, constipation and similar effects.
- Medicines that affect heart rhythm or lower sodium can increase the risk of problems.
Available as: Tablets and an oral solution.
Answers
Lofepramine: frequently asked questions
How long does lofepramine take to work?
It usually takes a few weeks of regular use before you feel the full benefit, so keep taking it even if nothing changes at first.
Is lofepramine safer than other tricyclics?
It is generally better tolerated and is considered safer in overdose than older tricyclics, which is one reason it may be chosen.
Can I stop taking it once I feel better?
Do not stop suddenly, as this can cause withdrawal-type symptoms. Your prescriber will reduce the dose gradually when the time is right.
Will it make me drowsy?
It tends to be less sedating than some tricyclics, but it can still cause drowsiness. Avoid driving until you know how it affects you.
Can I drink alcohol with it?
Alcohol can add to drowsiness and is best avoided or limited. Ask your prescriber or pharmacist for advice.
The wider class
About Tricyclic antidepressants
Lofepramine belongs to the tricyclic antidepressants class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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