Amitriptyline


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult: PO Depression Initial: 25 mg bid, gradually increase by 25 mg every other day up to 150 mg daily in divided doses. Alternatively, initiate therapy with 50-100 mg at bedtime, may be increased by 25-50 mg as necessary to a total dose of 150mg/day. For hospitalized patients: Initial: 100 mg/day, may be increased to 200 mg/day as necessary, up to 300mg/day. Duration of treatment: 2-4 weeks, up to 6 months after recovery to prevent relapse. Neuropathic pain; Prophylaxis of migraine Initial: 10-25 mg preferably in the evening. May gradually increase to 10-25 mg every 3-7 days as tolerated. Recommended doses: 25-75 mg/day preferably in the evening.
Administration
May be taken with or without food.
Contraindications
Recent MI, arrythmia (e.g. heart block), coronary artery insufficiency. Concomitant use within 14 days of MAOIs use and cisapride. Severe hepatic impairment. Children <6 years.
Special Precautions
Patient with CV disease (e.g. previous MI, stroke, tachycardia, or conduction abnormalities), head trauma, brain damage, alcoholism, history of seizures, diabetes mellitus, bipolar disorder, narrow angle glaucoma, urinary retention, prostatic hypertrophy, paranoid symptomology, pylorus stenosis, paralytic ileus, hyperthyroidism. Behavioural changes and increased risk of suicidal thinking. Concomitant electroconvulsive therapy and elective surgery. CYP2D6 ultrarapid, intermediate and poor metabolisers. CYP2C19 ultrarapid, rapid and poor metabolisers. Elderly and children. Renal and mild to moderate hepatic impairment. Pregnancy and lactation. Patient Counselling This drug may cause dizziness, drowsiness, and visual disturbances, if affected, do not drive or operate machinery. Avoid abrupt withdrawal. Monitoring Parameters Obtain blood glucose, heart rate, blood pressure, weight, BMI, ECG, electrolyte levels (as indicated). Assess mental status, suicidal ideation, anxiety, social functioning, mania, panic attacks or other unusual changes in behaviour. Monitor TCA plasma levels when co-administered with a CYP2D6 inhibitor drug.
Adverse Reactions
Significant: Serotonin syndrome e.g. CNS depression, bone fractures, bone marrow suppression, mild pupillary dilation, orthostatic hypotension, QT interval prolongation, suicidal tendency. Blood and lymphatic system disorders: Agranulocytosis, leukopenia, thrombocytopenia, purpura, eosinophilia. Cardiac disorders: MI, heart block, arrythmias, tachycardia, palpitation. Ear and labyrinth disorders: Tinnitus. Eye disorders: Mydriasis, blurred vision, increased intraocular pressure, accommodation disorder. Gastrointestinal disorders: Dry mouth, constipation, nausea, epigastric distress, vomiting, anorexia, stomatitis, peculiar taste, diarrhoea, parotid swelling, black tongue. General disorders and administration site conditions: Fever, hyperthermia, ataxia. Investigations: Increase or decrease of blood sugar, weight gain or loss. Metabolism and nutrition disorders: Oedema, decreased appetite. Nervous system disorders: Headache, seizures, incoordination, tremors, peripheral neuropathy, numbness, paraesthesia, extrapyramidal symptoms (e.g. speech difficulties), involuntary movements, tardive dyskinesia, disturbed concentration, excitement, insomnia, stroke, restlessness, drowsiness, agitation, dysgeusia. Psychiatric disorders: Confusional states, hallucinations, disorientation, delusions, nightmares, dysarthria, anxiety, delirium, hypomania, mania. Renal and urinary disorders: Urinary retention, frequency. Reproductive system and breast disorders: Testicular swelling, gynecomastia, breast enlargement, galactorrhea, libido decreased, impotence. Skin and subcutaneous tissue disorders: Rash, urticaria, photosensitivity, alopecia. Vascular disorders: Syncope, hypertension, hypotension.
Drug Interactions
May potentiate CV effects of sympathomimetic agents (e.g. adrenaline, ephedrine, isoprenaline, noradrenaline, phenylephrine, phenylpropanolamine). May enhance sedative effects of barbiturates and other CNS depressants. May reduce antihypertensive effects of adrenergic neuron blockers (e.g. guanethidine, betanidine, reserpine, clonidine, methyldopa). May increase ventricular arrythmias with antiarrhythmics (e.g. quinidine, amiodarone), antihistamines (e.g. astemizole, terfenadine), halofantrine, sotalol. Diuretics (e.g. furosemide) may increase risk of hypokalaemia. May increase serum concentrations with antifungals (e.ag. fluconazole, terbinafine). Risk of delirium with disulfiram. Increased rate of metabolism with barbiturates. Increased plasma concentration with cimetidine, methylphenidate, antipsychotics, and Ca-channel blockers. Decreased rate of metabolism with CYP2D6 inhibitors.
ATC Classification
N06AA09 - amitriptyline ; Belongs to the class of non-selective monoamine reuptake inhibitors. Used in the management of depression.
Disclaimer: This information is independently developed by CIMS based on amitriptyline from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to CIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, CIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2021 CIMS. All rights reserved. Powered by CIMSAsia.com
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