Please help me with this question

core0 · Jun 26, 2007

I have a question for you seasoned Beers Criteria knowledgeable nurses out there... Tofranil-pm Should this be given to a 78yo women...she has a hx of Breast CA(in the 80's, radical L mastectomy), severe osteoporosis, uses a walker/cane, very obstinant about asking for help with ADLs. She has taken it for a week now for problems with sleep and had a fall this am. As far as I can see elavil is on the list but not tofranil-pm, and I know Tyl-PM is also a bad one to give elderly.
SO, can anyone out there let me know about this med with the elderly.
Thank you so much for your time!

Well I learned something today. I had never heard of Beers Criteria. On the other hand neither did any of the five NPs I asked today (Small N all in cardiology or CT surgery). Tofranil is Imipramine which is a tricyclic antidepressant. These are not used much for depression any more but are frequently used for their side effects. One of these side effects is sedation. Tofranil is not particularly sedating at Tricyclics go but does have some sedation. More commonly Elavil is used because it is very sedating. These are very cheap meds so not an awful choice. Bottom line is that any tricyclic has some pain effect and some sedation (maybe not disipramine).

In the elderly I do not like these drugs as for the very reason that they are probably on the list. They tend to have the bad effects of sedation - leaving the patient groggy when they get out of bed at night leading to falls. I prefer meds such as Ambien which promote deep sleep but do not leave the patient as groggy.

The other thing that you have to remember is that never ever mix these with MAOI's (if you ever see one of the few patients still on these). Also it may promote urinary retention which is why you might want to avoid this in the elderly. Finally these meds may promote breast development and lactation (a point that I will forever remember after having to explain to a parent why her 10 year old son was lactating).

David Carpenter, PA-C

caldje · Jul 8, 2007

per a geriatrician- TCAs are alright.. EXCEPT for amitriptyline (which is one of Beer's). Due to anticholinergic effects. Other TCAs effect NE at different levels and are ok.