Amitriptyline

Amitriptyline is a dibenzocycloheptadiene tricyclic antidepressant (TCA). It increases synaptic concentration of serotonin and/or norepinephrine in the CNS by blocking the neuronal reuptake of norepinephrine and serotonin.

This medicine is widely prescribed in patients with migraine headache, depression, neuropathic pain, post-herpetic neuralgia, and nocturnal enuresis.

This product is available in tablet form and you can get this drug only with your doctor’s prescription.

If you are about to start Amitriptyline, the risk and benefit ratio of taking this drug should be considered. This is a decision that your doctor will make with your active participation. There are some important factors such as drug interaction, metabolic impairment, hypersensitivity reaction, pregnancy, lactation etc. which may alter the drug action.

Sometimes, presence of other health disorders affects the beneficial effects of this medicine and may even cause serious complications. Make sure you mention to your doctor if you have any other medical problems like bipolar illness, CVS disease, renal or liver impairment, epilepsy, thyroid dysfunction, DM etc. The use of amitriptyline is contraindicated in known hypersensitivity.

Certain drugs should not be used concurrently with such medications. It is always recommended to consult with your doctor if you are in need of some drugs for another health problem.

You should know about the following drug interactions to get rid of further complications:

• Increased risk of serotonin syndrome with SSRIs, TCAs, triptans, fentanyl, lithium, and tramadol.
• May reduce plasma levels with barbiturates, rifampicin, and other anticonvulsants.
• May increase plasma levels with methylphenidate, cimetidine, antipsychotics, and calcium channel blockers.
• May precipitate cardiac arrhythmias with thyroid hormones.
• May reduce antihypertensive effects of debrisoquine, guanethidine and clonidine.
• May increase pressor effect of epinephrine, and norepinephrine.
• May increase the risk of ventricular arrhythmias with antiarrhythmics (e.g. amiodarone or quinidine), antihistamines astemizole, terfenadine, some antipsychotics (pimozide, sertindole, and thioridazine), sotalol, cisapride, and halofantrine.

Medicines should be used following the directions given by a doctor. The dose of Amitriptyline will vary according to patient’s condition or requirements.

You should follow the doctor's directions and advice. The amount of medicine that you take should not exceed the maximum therapeutic dose. Also, the frequency of your daily drug administration and the duration of drug therapy depend on the particular medical problem for which you are taking the medicine.

• Depression: at initial stage, an adult should take 50-75 mg/day orally; up to 150 mg/day if needed. Maximum therapeutic dose is 300 mg/day in severe cases. Children and adolescent should be treated with 25-50 mg/day as a single dose (at bedtime) or in divided doses. Elderly patients are usually prescribed to take 25-50 mg/day as a single dose or divided doses.
• Neuropathic pain: initially, 10-25 mg/day is given at night, up to 75 mg/day if needed.
• Migraine prophylaxis: initial dose should be 10 mg/day and maintenance dose may vary ranging from 50 to 75 mg per day at night.
• Nocturnal enuresis : children of 6-10 years should be treated with 10-20 mg/day. In case of 11-16 years of children, the therapeutic dose is 25-50 mg/day. All doses should be given at bedtime. Maximum duration of treatment should not exceed 3 months.

Always try to take your medicine in time. If you miss any dose of this medicine, you should take it as soon as possible. But if it is time for your next dose, then you should skip the missed dose and go back to your regular treatment schedule.

You should store the medicine in a closed container at room temperature away from heat, moisture, and direct light. All kinds of medicines should be kept out of the reach of children. Outdated medicine must be disposed in an appropriate way.

Regular visits are recommended to make sure this medicine is working properly while you are receiving Amitriptyline therapy. The use of amitriptyline in patients with bipolar illness, CVS disease, renal or liver impairment, epilepsy, thyroid dysfunction, and diabetes may be responsible for serious complications. Some important measures should be taken if you feel any discomfort following this drug therapy.

Monitoring is recommended for signs of clinical worsening, suicidality, or behavioural changes while the patient is receiving amitriptyline therapy. Recent use of MAO inhibitors (within the last 14 days), acute recovery phase post-myocardial infarction (MI), and concurrent usage with cisapride are not suitable for amitriptyline therapy.

You should avoid abrupt withdrawal of therapy to get rid of some unwanted complications like urinary retention, prostatic hyperplasia; chronic constipation, angle-closure glaucoma, and phaeochromocytoma.

Amitriptyline may affect the ability to drive or operate machinery. That’s why it should be used cautiously. In addition, it may increase the risks associated with electro-convulsive therapy.

There are some unwanted side-effects associated with Amitriptyline that usually do not need medical attention. These side-effects usually go away during the treatment episode as your body adjusts to the medicine.

Your healthcare professional may advise you about the ways to prevent or reduce those unwanted side-effects.

Sometimes, you may need to consult with the doctor if you feel any of the following serious toxic effects:

• Postural hypotension
• Tachycardia
• Cardiac arrhythmias
• Conduction disturbances
• Dry mouth
• Weight gain
• Sour or metallic taste
• Stomatitis
• Constipation
• Blurring of vision
• Urinary retention
• Fatigue
• Dizziness
• Weakness
• Tremors
• Headache
• Sexual disturbances
• Peripheral neuropathy
• Urticarial
• Angioedema
• Sweating
• Confusion
• Delirium