Nurses Compass
Drug Guide
Cryptenamine Acetates
Classification
Therapeutic: Antidepressant, Tricyclic
Pharmacological: Serotonin-Norepinephrine Reuptake Inhibitor
FDA Approved Indications
- Major depressive disorder
- Anxiety disorders
Mechanism of Action
Cryptenamine Acetates inhibits the reuptake of serotonin and norepinephrine, increasing their synaptic concentrations and exerting antidepressant effects.
Dosage and Administration
Adult: Typically 25-50 mg orally once daily, adjustable based on response and tolerability.
Pediatric: Not approved for use in children.
Geriatric: Start at lower doses due to increased sensitivity; monitor closely.
Renal Impairment: Adjust dosage based on severity of impairment.
Hepatic Impairment: Use with caution; dosage adjustments may be necessary.
Pharmacokinetics
Absorption: Well absorbed orally.
Distribution: Widely distributed, crosses blood-brain barrier.
Metabolism: Metabolized primarily in the liver via CYP450 enzymes.
Excretion: Excreted mainly in urine as metabolites.
Half Life: Approximately 24 hours, allowing once-daily dosing.
Contraindications
- Known hypersensitivity to cryptenamine or other tricyclic antidepressants.
- Recent myocardial infarction.
Precautions
- Suicidality risk, especially in young adults.
- Use cautiously in patients with epilepsy, urinary retention, angle-closure glaucoma, or bipolar disorder.
Adverse Reactions - Common
- Dry mouth (Common)
- Constipation (Common)
- Drowsiness (Common)
- Dizziness (Common)
Adverse Reactions - Serious
- Cardiac arrhythmias (Serious)
- Seizures (Serious)
- Endocrine disturbances, such as SIADH or hyponatremia (Serious)
Drug-Drug Interactions
- MAO inhibitors, other serotonergic drugs, CNS depressants
Drug-Food Interactions
- Alcohol, fermented foods with tyramine (may increase hypertensive crisis risk)
Drug-Herb Interactions
- St. John’s Wort, herbal supplements affecting serotonin levels
Nursing Implications
Assessment: Monitor mental status, suicidal ideation, and response to therapy.
Diagnoses:
- Risk for injury related to orthostatic hypotension or sedation.
- Ineffective coping related to side effects.
Implementation: Administer after meals to decrease gastrointestinal upset. Monitor ECG in patients with cardiac history. Regularly check blood pressure and heart rate.
Evaluation: Assess for improvement in depressive symptoms and adverse effects.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Do not discontinue abruptly to avoid withdrawal symptoms.
- Report any signs of worsening depression or suicidal thoughts.
- Limit alcohol and avoid sedatives unless approved by healthcare provider.
Special Considerations
Black Box Warnings:
- Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults.
Genetic Factors: CYP2D6 poor metabolizers may require dose adjustments.
Lab Test Interference: May cause false positives in certain urinary drug screening tests.
Overdose Management
Signs/Symptoms: Seizures, dysrhythmias, hypotension, coma, tachycardia.
Treatment: Supportive care, activated charcoal if within 1 hour of ingestion, cardiac monitoring, and management of dysrhythmias; consider IV sodium bicarbonate for cardiotoxicity.
Storage and Handling
Storage: Store at room temperature, away from moisture, heat, and light.
Stability: Stable for 24 months under proper conditions.