Indications: depressive illness, particularly where sedation is required; nocturnal enuresis in children; neuropathic pain); migraine prophylaxis

Caution: sedation may affect patient's responses. Avoid abrupt cessation of therapy, epilepsy; pregnancy and breast-feeding, hepatic impairment, thyroid disease, anesthesia, diabetes; alcohol intake, psychosis; susceptibility to angle-closure glaucoma; history of urinary retention; concurrent electroconvulsive therapy; porphyria.

Contra-indications: recent myocardial infarction, heart block, mania; severe liver disease.

Side Effects: antimuscarinic effects- dry mouth, sedation, blurred vision (disturbance of accommodation, increased intra-ocular pressure), constipation, nausea, difficulty with micturition; cardiovascular side effects (such as ECG changes, arrhythmias, postural hypotension, tachycardia, syncope, particularly with high doses); sweating, tremor, rashes and hypersensitivity reactions (including urticaria, photosensitivity), behavioural disturbances (particularly children), hypomania or mania, confusion or delirium (particularly elderly), headache, interference with sexual function, blood sugar changes; increased appetite and weight gain (occasionally weight loss); endocrine side effects such as testicular enlargement, gynaecomastia, galactorrhoea; also convulsions, movement disorders and dyskinesias, dysarthria, paraesthesia, taste disturbances, tinnitus, fever, agranulocytosis, leucopenia, eosinophilia, purpura, thrombocytopenia, hyponatraemia, abnormal liver function tests (jaundice).

Dose: by mouth, initially 50-75 mg (elderly and adolescents 30- 75 mg) daily in divided doses, or as a single dose at bedtime, increased gradually as necessary to a max. of 150-200 mg.

Maintenance dose, 50-100 mg daily.

Nocturnal enuresis, child 7-10 years, 10-20 mg; 11-16 years, 25-50 mg half an hour before bedtime for up to 3 months (including gradual withdrawal).