The TCAs are the very dominant class of antidepresents.The first line treatment for DPN is through Tricyclic Antidepressants (Mendell and Sahenk, 2003). TCA is a very good pain reliever hence very cheap. Nine TCAs are available in the USA, and they all have an iminodibenzyl core. TCAs tends to be well absorbed and have long half life.
It has few side effects like constipation, urinary retention and dry mouth, dizziness and blur vision but, side effects can be prohibited by starting with low dose followed with high potency. The range of dose varies from person to person. It is suggested that initial dose should start from 10–25 mg once a day and then gradually increase the quantity. In prescribing TCAs caution should be taken. A study has shown that a risk of sudden cardiac death increase if the dose of TCAs is exceeded from 100mg/day for the patient with cardiovascular disease (Ray WA, 2004).in another research by Max et al (1992) showed that 70 % patients with painful DPN when used TCAs amitriptyline and desipramine they get good relief from pain.
This is very challenging to find a specific drug for all patients, which can be effective in reducing DNP. In this advanced era where all the time new researches in medicines are taking place TCAs are still very effective in reducing pain.
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