Lofepramine is a tricyclic antidepressant (TCA), developed in the early 1980s and is most recognizable in European countries via brand-names like Tymelyt®, and Gamanil® and by the generic name Lomont. The drug has never been approved or sold in the US. Like many of the TCAs, lofepramine increases the available or free amounts of the neurotransmitters, serotonin and norepinephrine, which may alleviate depression and anxiety. Not all patients can take this medication and it does have both benign and serious side effects, though some report the medication has fewer side effects than other TCAs.
This drug is indicated in the use of depression that features anxiety or panic symptoms, and it may be prescribed to treat anxiety disorders. It appears to have greater action as an anxiolytic, or antianxiety agent, than as an antidepressant. TCAs are less often prescribed than newer drugs like the selected serotonin reuptake inhibitors (SSRIs) or the serotonin-norepinephrine reuptake inhibitors (SNRIs) because they tend to have more side effects. SNRIs may especially be used in place of TCAs since they have similar effects to them with lower adverse effects. SNRIs and TCAs share other similarities and both appear to have a higher rate of causing withdrawal symptoms, which means drugs like lofepramine should be tapered upon discontinuation.
Some people should not take lofepramine. This includes children, women who are pregnant or plan to become pregnant, people with bipolar disorder, and those who have recently had a heart attack or stroke. The benefits of using lofepramine must be weighed if patients have conditions like enlarged prostate, a history of cardiac disease, seizure disorders, or glaucoma.
There are important warnings about lofepramine; it particularly may increase suicidal thinking or behavior, especially among teens and young adults. A number of medications interact with this drug, which may require a dosage change, or that may render the drug ineffective. These include antihistamines, hormonal birth control, antacids, anti-seizure drugs, anti-clotting drugs or blood thinners, and some over-the-counter medications for coughs or colds. Patients should not accept a prescription for lofepramine without first providing their doctors with a list of all prescribed and over-the-counter drugs, and any herbal, mineral or vitamin supplements they use.
Less severe side effects associated with lofepramine are nausea, headache, dizziness, and sleepiness. Blurred vision, constipation, sexual dysfunction, dry mouth, and perspiration may also occur.
People should report at once or get medical attention if they experience more severe side effects like allergic reaction, rash, jaundice, or seizure. Other serious side effects include confusion, hallucinations or altered thinking, suicidal thinking, extreme agitation, and severe restlessness. Ringing in the ears and cardiac events like rhythm disturbance and palpitations should also be reported immediately. The drug can also affect normal blood cell counts and may result in hypotension, and doctors should screen for these.
Not all people experience side effects with lofepramine, or they may have transient ones that resolve with continued use. It is hard to predict an individual's response to this drug, which is variable. Many people do find this medicine helpful and it continues to be used in a number of European countries.
