Clinical Review

Vulvovaginal disorders: 4 challenging conditions

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Names of standard agents usedAmitriptyline (Elavil)
Nortriptyline (Aventyl, Pamelor)
Desipramine (Norpramin)
Imipramine (Tofranil)
Standard dosingStart with 10 mg; increase by 10 mg weekly to 100–150 mg
Side effectsSedation, often transient
Constipation, must be actively managed
Dry mouth
Palpitations, tachycardia
Sun sensitivity
CautionsObtain EKG over 50 years or with cardiac history
Contraindicated in glaucoma
Levels must be monitored if combined with SSRI
SuccessSlow change over 6–12 months in sensitivity to touch; ability to use tampon. Minimal pain with dilator use, penetration
FailureOver 3 months at max dose without any improvement

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