Discontinue the drug several days before elective surgery if possible. When amitriptyline is given with anticholinergic agents or sympathomimetic drugs, including epinephrine combined with local anesthetics, close supervision and careful adjustment of dosage are required. Paralytic ileus may occur in patients taking tricyclic antidepressants in combination with anticholinergic-type drugs. Since amitriptyline, in combination with anticholinergic type drugs, may give rise to paralytic ileus, particularly in elderly or hospitalized patients, appropriate measures should be taken if constipation occurs in these patients. Cimetidine is reported to reduce hepatic metabolism of certain tricyclic antidepressants.
Caution is advised if patients receive large doses of ethchlorvynol concurrently.
Transient delirium has been reported in patients who were treated with 1 g of ethchlorvynol and 75 to 150 mg of amitriptyline. Amitriptyline may enhance the response to alcohol and the effects of barbiturates and other CNS depressants. Delirium has been reported with concurrent administration of amitriptyline and disulfiram. However, pharmacological similarities among the tricyclic antidepressant drugs require that each of the reactions be considered when amitriptyline is administered. Skin rash, urticaria, photosensitization, edema of the face and tongue, itching.