The dose of epinephrine has to be minimized when patients are taking which of the following drugs?

a. phenylephrine (Neo-Synephrine)
b. amitriptyline (Elavil)
c. acetaminophen (Tylenol)
d. ibuprofen (Advil)

b. Tricyclic antidepressants (e.g., amitriptyline, desipramine, nortirptyline, and imipramine) act by blocking the reuptake of catecholamines and thus may increase the hypertensive effects of EPI. Nonselective b1 and b2 agonists may also cause a hypertensive crisis. Thus, the amount of epinephrine should be limited to 0.04 mg (2 cartridges of 1:100,000) in patients taking these drugs.