BMA Concise Guide to Medicine & Drugs

Lofepramine

Brand names Feprapax, Lomont

Used in the following combined preparations None

QUICK REFERENCE

Drug group Tricyclic antidepressant drug

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Lofepramine belongs to the tricyclic antidepressant group of drugs. It is used primarily in the long-term treatment of depression. The drug serves to elevate the mood, improve appetite, increase physical activity, and restore interest in everyday pursuits.

Less sedating than some of the other tricyclic antidepressants, lofepramine is particularly useful when depression is accompanied by lethargy.

The main advantage of lofepramine over other similar drugs is that it seems to have a weaker anticholinergic action and therefore has milder side effects. In overdose, lofepramine is thought to be less harmful than other tricyclic antidepressant drugs.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, liquid.

Frequency and timing of doses 2–3 x daily.

Adult dosage range 140–210mg daily.

Onset of effect Sedation can occur within hours; full antidepressant effect may not be felt for 2–6 weeks.

Duration of action Antidepressant effect may last for 6 weeks; Common adverse effects, the first 1–2 weeks.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children. Protect from light.

Missed dose Take as soon as you remember. If your next dose is due within 3 hours, take a single dose now and skip the next.

Stopping the drug An abrupt stop can cause withdrawal symptoms and a recurrence of the original problem. Consult your doctor, who may supervise a gradual reduction in dosage over at least 4 weeks.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. But if you notice any unusual symptoms, or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

The adverse effects of lofepramine are mainly due to its mild anticholinergic action and its blocking action on the transmission of signals through the heart. Sweating, flushing, and drowsiness are common; more rarely, constipation and dryness of the mouth may occur. If any of these are severe or if you experience blurred vision or difficulty in passing urine, discuss with your doctor. If dizziness, fainting, or palpitations occur. stop taking the drug and seek immediate medical attention.

INTERACTIONS

Sedatives All drugs that have sedative effects may intensify those of lofepramine.

Anti-arrhythmic drugs and sotalol These drugs may increase the risk of abnormal heart rhythms.

Warfarin Lofepramine may, rarely, increase the effects of warfarin.

Monoamine oxidase inhibitors (MAOIs) Serious interactions are possible. These drugs are only prescribed together under close specialist medical supervision.

Selective serotonin reuptake inhibitors (SSRIs) Some SSRIs can increase the amount of lofepramine in the body, leading to more marked adverse effects.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have heart problems.

· You have had epileptic seizures.

· You have long-term liver or kidney problems.

· You have glaucoma.

· You have an overactive thyroid gland.

· You have prostate trouble.

· You have porphyria.

· You are taking other medicines.

Pregnancy Safety in pregnancy not established. Discuss with your doctor.

Breast-feeding The drug passes into the breast milk and may affect the baby. Discuss with your doctor.

Infants and children Not recommended.

Over 60 Reduced dose may be necessary as elderly patients are more sensitive to adverse reactions.

Driving and hazardous work Avoid such activities until you have learned how lofepramine affects you because the drug may cause blurred vision and reduced alertness.

Alcohol Avoid. Alcohol may increase the sedative effects of this drug.

Surgery and general anaesthetics Lofepramine may need to be stopped. Discuss with your doctor or dentist before you have any surgery.

PROLONGED USE

No problems expected.