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Amitriptyline

Generic Name: 

Amitriptyline

Brand Names: 

Elavil, Vanatrip

Amitriptyline Description: 

Amitriptyline is a tricyclic antidepressant with sedative effects that is used in the treatment of depression.

Amitriptyline Side Effects: 

Treatment with amitriptyline may cause the following side effects:

  • Speech problems
  • Confusion
  • Hallucinations
  • Depression
  • Seizures
  • Jaundice
  • Chest pain
  • Constipation
  • Fatigue

For more information, visit our amitriptyline side effects page.

Amitriptyline Uses: 

Amitriptyline is used to treat depression. Depression is a serious mental illness that can seriously compromise a quality of life and can also lead to suicidal thoughts and tendencies. Depression is a chronic illness that involves both the mind and the body and requires long-term treatment. Symptoms of depression include:

  • Lack of interest in normal daily activities
  • Feeling sad, hopeless or worthless
  • Crying for no reason
  • Sleeping problems
  • Difficulty focusing, concentrating or making decisions
  • Weight gain or loss
  • Irritability or being easily annoyed
  • Restlessness
  • Feeling tired or weak
  • Loss of interest in sex
  • Thoughts of suicide or suicidal behavior
  • Unexplained physical problems

Amitriptyline is more likely to work for patients with endogenous depression, a biological imbalance of chemicals in the brain. This form of depression, rather than reactive depression (which is a response to an event or stress), is considered genetic.

Amitriptyline Interactions: 

The following medications are not recommended to be used in addition to amitriptyline. Your doctor may decide to prescribe other medications:

  • Bepridil
  • Cisapride
  • Clorgyline
  • Furazolidone
  • Grepafloxacin
  • Iproniazid
  • Isocarboxazid
  • Levomethadyl
  • Linezolid
  • Mesoridazine
  • Metoclopramide
  • Moclobemide
  • Nialamide
  • Pargyline
  • Phenelzine
  • Pimozide
  • Procarbazine
  • Selegiline
  • Sparfloxacin
  • Terfenadine
  • Thioridazine
  • Toloxatone
  • Tranylcypromine

Using amitriptyline with the following drugs may cause an increased risk of side effects, but using both drugs may be the best course of action depending on your particular condition. Your doctor may decide to change the dose of one or both medications:

  • Acenocoumarol
  • Arbutamine
  • Atomoxetine
  • Bethanidine
  • Carbamazepine
  • Cimetidine
  • Cinacalcet
  • Diazepam
  • Dicumarol
  • Fluvoxamine
  • Galantamine
  • Guanethidine
  • Paroxetine
  • Phenprocoumon
  • Phenytoin
  • Rifapentine
  • Ritonavir
  • S-Adenosylmethionine
  • St. John's Wort
  • Topiramate
  • Warfarin

Patients with a history or current diagnosis of any of the following conditions should consult their doctor before treatment with amitriptyline:

  • Bipolar disorder (mood disorder with alternating episodes of mania and depression)
  • Heart attack
  • Diabetes
  • Glaucoma
  • Heart disease
  • Overactive thyroid
  • Schizophrenia
  • Seizures
  • Urinary retention
  • Liver disease
Amitriptyline Dosage Information: 

Typical Dosage Recommendations

Amitriptyline is available as a tablet and as an injection. Dosing recommendations were as follows:

The initial adult dose is a 75 mg tablet per day given in divided doses. The dose should not exceed 150 mg per day. Increases are best given in the late afternoon or as nighttime doses due to the sedative effect. Alternatively, therapy may be initiated as 50 mg to 100 mg given at bedtime. These doses can be increased by 25 mg to 50 mg as necessary at bedtime.

Patients who are hospitalized may require a higher dose such as 100 mg per day for initial treatment. This can be increased to 200 mg per day if needed. Rarely, the dose may be increased to 300 mg per day.

It is recommended that teenagers and older adults take lower doses, such as 10 mg three times per day and 20 mg at bedtime. A doctor must determine use for children under the age of 12.

Maintenance dosage is typically 50 to 100 mg per day. For some patients, 40 mg may be sufficient. Maintenance doses may be given in a single dose, preferably at bedtime. Maintenance dosing may continue for 3 months or longer to reduce the possibility of relapse.

Missing a Dose

If you miss a dose of amitriptyline, take it as soon as possible. If it is time for your next dose, skip the missed dose and resume your dosing schedule. Do not double dose.

Overdosing

Death may occur from an overdose of amitriptyline. Seek emergency medical treatment following an overdose of amitriptyline.

Signs and symptoms will rapidly develop after overdose, and monitoring a patient following an overdose is necessary. Symptoms of overdose include:

  • Cardiac arrhythmias
  • Severe hypotension
  • Convulsions
  • Central nervous system depression, including coma
  • Impaired myocardial contractility
  • Confusion
  • Disturbed concentration
  • Transient visual hallucinations
  • Dilated pupils
  • Disorders of ocular motility
  • Agitation
  • Hyperactive reflexes
  • Polyradiculoneuropathy (disease of peripheral nerves)
  • Stupor
  • Drowsiness
  • Muscle rigidity
  • Vomiting
  • Hypothermia
  • Hyperpyrexia (elevated body temperature above 105.8 degrees)
Amitriptyline FDA Approval: 

April 7, 1961

Amitriptyline Recall/Black Box Warning Information: 

Risk of Suicide/Depression

Amitriptyline contains a Black Box warning regarding an increase in suicidal thoughts and behavior when used in children, teenagers, and young adults with depression. Patients who initiate treatment on antidepressants should be carefully monitored for worsening depression, suicidal tendencies or unusual changes in behavior.

Other Warnings

It is possible that an episode of depression is the initial presentation of bipolar disorder. Treatment with an antidepressant may increase the likelihood of missed or manic episodes in patients who are at risk of bipolar disorder.

Before beginning treatment with amitriptyline or other antidepressants, patients should be screened to determine if they are at risk for bipolar disorder. Screening includes a psychiatric history including a family history of suicide, bipolar disorder and depression. Amitriptyline hydrochloride, the generic name for amitriptyline, is not indicated for the treatment of bipolar depression.

 

Sources: 
  1. http://www.mayoclinic.com/health/drug-information/DR602731/DSECTION=before-using
  2. http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.DrugDetails
  3. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=11542
  4. http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682388.html
  5. http://www.mayoclinic.com/health/depression/DS00175

 

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