amitriptyline oral : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD 1106 Uses This medication is used to treat mental/mood problems such as depression . It may help improve mood and feelings of well-being, relieve anxiety and tension, help you sleep better, and increase your energy level. This medication belongs to a class of medications called tricyclic antidepressants. It works by affecting the balance of certain natural chemicals (neurotransmitters such as serotonin) in the brain . OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional. Side Effects See also Warning section. Drowsiness, dizziness, dry mouth , blurred vision , constipation , weight gain, or trouble urinating may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or use a saliva substitute. To prevent constipation , maintain a diet adequate in fiber, drink plenty of water, and exercise . If you become constipated while using this drug, consult your pharmacist for help in selecting a laxative . Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor right away if any of these rare but serious side effects occur: easy bruising/bleeding, persistent heartburn , shaking, mask-like facial expressions, muscle spasms , severe stomach / abdominal pain , decreased sexual ability/desire, enlarged/painful breasts . Get medical help right away if you have any very serious side effects, including: black stools, vomit that looks like coffee grounds, severe dizziness, fainting , seizures , eye pain /swelling/redness, widened pupils, vision changes (such as seeing rainbows around lights at night). This medication may rarely cause a very serious condition called neuroleptic malignant syndrome (NMS).

Get medical help right away if you have any of the following symptoms: fever, muscle stiffness, severe confusion, sweating, fast/irregular heartbeat. A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. Precautions See also Warning section. Before taking amitriptyline, tell your doctor or pharmacist if you are allergic to it, or to other tricyclic antidepressants (such as nortriptyline), or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems.

Talk to your pharmacist for more details. Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding problems, breathing problems, liver problems, recent heart attack, problems urinating (such as due to enlarged prostate), overactive thyroid (hyperthyroidism), personal or family history of glaucoma (angle-closure type), personal or family history of mental/mood conditions (such as bipolar disorder, psychosis), family history of suicide, seizures, conditions that may increase your risk of seizures (such as other brain disease, alcohol withdrawal). Amitriptyline may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away. The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation.

Before using amitriptyline, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death). Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using amitriptyline safely. This drug may make you drowsy or dizzy or cause blurred vision. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely. Avoid alcoholic beverages. Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). This medication may make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths, and sunlamps. Use a sunscreen and wear protective clothing when outdoors.

If you have diabetes, this drug may make it harder to control your blood sugar levels. Monitor your blood sugar levels regularly and tell your doctor of the results. Your doctor may need to adjust your diabetes medication, exercise program, or diet. Older adults may be more sensitive to the side effects of this drug, especially dry mouth, dizziness, drowsiness, confusion, constipation, difficulty urinating, and QT prolongation (see above). Dizziness, drowsiness, and confusion can increase the risk of falling. During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor. Since untreated mental/mood problems (such as depression, anxiety, panic disorder) can be a serious condition, do not stop using this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy. This medication passes into breast milk and the effect on a nursing infant is unknown. Consult your doctor before breast-feeding. What should I know regarding pregnancy, nursing and administering amitriptyline to children or the elderly?

Interactions Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval. Some products that may interact with this drug include: arbutamine, disulfiram, thyroid supplements, other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen, "blood thinners" such as warfarin), anticholinergic drugs (such as benztropine, belladonna alkaloids), certain drugs for high blood pressure (drugs that work in the brain such as clonidine, guanabenz, reserpine). Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction.

Avoid taking MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication. Other medications can affect the removal of amitriptyline from your body, thereby affecting how amitriptyline works. These drugs include cimetidine, terbinafine, drugs to treat irregular heart rate (such as quinidine/propafenone/flecainide), antidepressants (such as SSRIs including paroxetine/fluoxetine/fluvoxamine). This is not a complete list. Many drugs besides amitriptyline may affect the heart rhythm (QT prolongation in the EKG), including amiodarone, cisapride, dofetilide, pimozide, procainamide, quinidine, sotalol, macrolide antibiotics (such as erythromycin), among others.

Therefore, before using amitriptyline, report all medications you are currently using to your doctor or pharmacist. Tell your doctor or pharmacist if you are taking other products that cause drowsiness, including alcohol, antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and narcotic pain relievers (such as codeine). Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain decongestants or ingredients that cause drowsiness. Ask your pharmacist about using those products safely. Aspirin can increase the risk of bleeding when used with this medication. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually at dosages of 81-325 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details. Amitriptyline is very similar to nortriptyline. Do not use medications containing nortriptyline while using amitriptyline.

Does amitriptyline interact with other medications? Overdose If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: extreme drowsiness, hallucinations, fast/irregular heartbeat, fainting, slow/shallow breathing, seizures. Notes Do not share this medication with others. Laboratory and/or medical tests (such as EKG, liver tests, amitriptyline blood level) may be performed from time to time to monitor your progress or check for side effects. Keep all medical appointments. Consult your doctor for more details. Missed Dose If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up. Storage Store at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture.

Do not store in the bathroom. Keep all medicines away from children and pets. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product. Information last revised August 2016. Copyright(c) 2016 First Databank, Inc. Images Amitriptyline (Elavil) Uses, Dosage, Side Effects - Drugs.com Amitriptyline Generic Name: amitriptyline (a mee TRIP ti leen) Brand Names: Vanatrip, Elavil, Endep Overview Pricing & Coupons What is amitriptyline? Amitriptyline is a tricyclic antidepressant. Amitriptyline affects chemicals in the brain that may be unbalanced in people with depression. Amitriptyline is used to treat symptoms of depression . Amitriptyline may also be used for purposes not listed in this medication guide. Important information You should not use this medicine if you have recently had a heart attack.

Do not use amitriptyline if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine. Before taking amitriptyline, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft). Slideshow Depression, Risk of Suicide, and Treatment Options You may have thoughts about suicide when you first start taking an antidepressant such as amitriptyline, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. Before taking this medicine You should not use this medicine if you are allergic to amitriptyline, or: if you have recently had a heart attack. Do not use amitriptyline if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others. To make sure amitriptyline is safe for you, tell your doctor if you have: bipolar disorder (manic-depression) or schizophrenia; a history of mental illness or psychosis; liver disease; a history of heart attack, stroke, or seizures; diabetes (amitriptyline may raise or lower blood sugar); glaucoma; or problems with urination.

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms. It is not known whether amitriptyline will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Amitriptyline can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using amitriptyline. Amitriptyline is not approved for use by anyone younger than 12 years old. How should I take amitriptyline? Take amitriptyline exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended. It may take up to 4 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve. If you need surgery, tell the surgeon ahead of time that you are using amitriptyline. You may need to stop using the medicine for a short time. Do not stop using amitriptyline suddenly, or you could have unpleasant withdrawal symptoms.

Ask your doctor how to safely stop using amitriptyline. Store at room temperature away from moisture, heat, and light. Amitriptyline dosing information Usual Adult Dose for Depression: Outpatients: Usual dose: 75 mg orally per day in divided doses; this may be increased to a total of 150 mg per day if needed Alternate dose: 40 to 100 mg orally as a single dose at bedtime; this may be increased by 25 or 50 mg as needed at bedtime to a total of 150 mg per day Maximum dose: 150 mg orally per day Inpatients: Initial dose: 100 mg orally per day Maintenance dose: 40 to 100 mg orally as a single dose at bedtime Maximum dose: 300 mg orally per day Elavil (Amitriptyline) Drug Overview and Uses for Patients and Caregivers at RxList (A-mi-TRIP-ti-leen) COMMON BRAND NAME(S): Elavil WARNING: Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders.

These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. Therefore, it is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition. Tell the doctor immediately if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed. USES: This medication is used to treat mental/mood problems such as depression. It may help improve mood and feelings of well-being, relieve anxiety and tension, help you sleep better, and increase your energy level. This medication belongs to a class of medications called tricyclic antidepressants.

It works by affecting the balance of certain natural chemicals (neurotransmitters such as serotonin) in the brain. OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional. This medication may also be used to treat nerve pain (such as peripheral neuropathy, postherpetic neuralgia), eating disorder (bulimia), other mental/mood problems (such as anxiety, panic disorder), or to prevent migraine headaches. HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking amitriptyline and each time you get a refill. If you have any questions, consult your doctor or pharmacist. Take this medication by mouth, usually 1 to 4 times daily or as directed by your doctor. If you take it only once a day, take it at bedtime to help reduce daytime sleepiness. The dosage is based on your medical condition and response to treatment.

To reduce your risk of side effects (such as drowsiness, dry mouth, dizziness), your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully. Take this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time(s) each day. Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase. It is important to continue taking this medication even if you feel well. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Also, you may experience symptoms such as mood swings, headache, tiredness, and sleep change. To prevent these symptoms while you are stopping treatment with this drug, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details. Report any new or worsening symptoms immediately. This medication may not work right away. You may see some benefit within a week. However, it may take up to 4 weeks before you feel the full effect.

Tell your doctor if your condition persists or worsens (such as your feelings of sadness get worse, or you have thoughts of suicide). Elavil is a medication used to treat symptoms of depression. Elavil Elavil Amitriptyline, sold under the brand name Elavil among others, is a medication used to treat symptoms of depression. A small number of children, teenagers, and young adults (up to 24 years of age) who took antidepressants (‘mood elevators’) such as amitriptyline during clinical studies became suicidal (thinking about harming or killing oneself or planning or trying to do so). Children, teenagers, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions. However, experts are not sure about how great this risk is and how much it should be considered in deciding whether a child or teenager should take an antidepressant. Children younger than 18 years of age should not normally take amitriptyline, but in some cases, a doctor may decide that amitriptyline is the best medication to treat a child’s condition.

You should know that your mental health may change in unexpected ways when you take amitriptyline or other antidepressants even if you are an adult over age 24. You may become suicidal, especially at the beginning of your treatment and any time that your dose is increased or decreased. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor when you are unable to seek treatment on your own. Your healthcare provider will want to see you often while you are taking amitriptyline, especially at the beginning of your treatment. Be sure to keep all appointments for office visits with your doctor. The doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you begin treatment with amitriptyline. Read the information carefully and ask your doctor or pharmacist if you have any questions.

You also can obtain the Medication Guide from the FDA website: . No matter your age, before you take an antidepressant, you, your parent, or your caregiver should talk to your doctor about the risks and benefits of treating your condition with an antidepressant or with other treatments. You should also talk about the risks and benefits of not treating your condition. You should know that having depression or another mental illness greatly increases the risk that you will become suicidal. This risk is higher if you or anyone in your family has or has ever had bipolar disorder (mood that changes from depressed to abnormally excited) or mania (frenzied, abnormally excited mood) or has thought about or attempted suicide. Talk to your doctor about your condition, symptoms, and personal and family medical history. You and your doctor will decide what type of treatment is right for you. Other Sources: Elavil® … Amitriptyline is used to treat symptoms of depression. Amitriptyline is in a class of medications called tricyclic … Amitriptylinecomes as a tablet to take by mouth.

It is usually taken one to four times … – Drugs and Supplements Elavil overdose; Adepril overdose; Endep overdose; Enovil overdose; Trepiline overdose … Amitriptyline … Amitriptyline hydrochloride is a prescription medication. Brands include: Adepril Amitid Amitril Elavil Emitrip Endep Enovil Trepiline Tryptanol … – Medical Encyclopedia Amitriptyline Amitriptyline Elavil®, Endep®, Amitriptyline by Mylan, Amitriptyline by Sidmak CAUTION: Federal law prohibits dispensing without prescription. For migraine prophylaxis- Adults: Titrate to response. Doses of 10-300 mg PO per day have been used. BACKGROUND Schulman EA, Silberstein SD. Symptomatic and prophylactic treatment of migraine and tension-type headache. Neurology 1992;42(suppl 2):16ï¿½21.

[amitriptyline dosage, atenolol dosage, chlorpromazine dosage, cyproheptadine dosage, dexamethasone dosage, diflunisal dosage, diltiazem dosage, doxepin dosage, fluoxetine dosage, haloperidol dosage, ibuprofen dosage, indomethacin dosage, ketoprofen dosage, meclofenamate, mefenamic acid dosage, meperidine dosage, morphine dosage, nadolol dosage, naproxen dosage, nifedipine dosage, nimodipine dosage, nortriptyline dosage, phenelzine dosage, phenytoin dosage, piroxicam dosage, prednisone dosage, propranolol dosage, sulindac dosage, timolol dosage, verapamil dosage, ï¿½-blockers overview] DESCRIPTION Amitriptyline is an oral and parenteral tertiary amine tricyclic antidepressant. It is structurally related to the thioxanthene antipsychotics such as thiothixene.

Amitriptyline is also related to the skeletal muscle relaxant cyclobenzaprine, although amitriptyline is not believed to possess muscle-relaxant properties. Amitriptyline is metabolized to nortriptyline, an active metabolite that is also marketed separately. Clinically, amitriptyline is used to treat depression, pain of neuropathic origin, attention-deficit hyperactivity disorder, functional enuresis in children, panic disorder, and phobic disorder, and to manage some eating disorders. Amitriptyline was approved by the FDA in 1961. CLINICAL PHARMACOLOGY Mechanism of Action: The precise action of tricyclic antidepressants is not fully understood, but it is believed that the most important effect is the decreased reuptake of norepinephrine and serotonin. Amitriptyline appears to exert effects on both norepinephrine and serotonin (5-HT), although the selective-acting desipramine is a more potent inhibitor of norepinephrine transport.

Amitriptyline is metabolized to nortriptyline, which accounts for most of the norepinephrine-reuptake inhibition after amitriptyline administration. Nortriptyline itself also possesses antidepressant activity. Additional hydroxy metabolites apparently are active as well. The down-regulation of limbic beta-receptors that results from this synaptic neurotransmitter increase occurs ~5ï¿½7 days after therapeutic concentrations are reached. Monoamine oxidase is not inhibited by either amitriptyline or nortriptyline. Tricyclic antidepressants do not affect dopamine reuptake. Varying degrees of sedation can be produced, and the seizure threshold can be lowered. Amitriptyline possesses strong anticholinergic activity. Cardiac dysrhythmias can result from the direct quinidine-like effect on cardiac function combined with anticholinergic activity and norepinephrine potentiation. Changes in sex hormone concentrations and blood glucose can result from amitriptyline's effect on the endocrine system. Pharmacokinetics: Amitriptyline is well absorbed from the GI tract, but individual response can vary considerably.

The full antidepressant effects can take several weeks to produce, although adverse effects can occur after the first dose. Peak plasma concentrations are obtained within 2ï¿½12 hours following oral or IM administration. Tricyclic antidepressants are highly protein-bound (predominantly to alpha1-acid glycoprotein) in plasma and tissues. Because tricyclic antidepressants are long-acting, a single daily dose may be given to improve patient compliance. Half-life values range from 10ï¿½50 hours for amitriptyline and 20ï¿½100 hours for nortriptyline. Amitriptyline is metabolized in the liver to nortriptyline, which is lipophilic and crosses the blood-brain barrier. Amitriptyline and nortriptyline are distributed into the lungs, heart, brain, and liver. Nortriptyline is known to cross the placenta and is also distributed into breast milk. Both undergo enterohepatic circulation. Lipophilic metabolites, such as nortriptyline, are most likely to be reabsorbed and further metabolized.

Between 25ï¿½50% of a single dose is excreted in urine as active metabolites within 24 hours. A small amount of excretion occurs in feces. thrombocytopenia urinary retention The anticholinergic effects of tricyclic antidepressants contraindicate their use in patients with decreased GI motility. Tricyclic antidepressants can induce or exacerbate hiatal hernia, and can cause paralytic ileus or constipation. Patients who have increased intraocular pressure or angle-closure glaucoma, benign prostatic hypertrophy, GI disease, gastroesophageal reflux disease (GERD), or urinary retention should be treated with caution because of the anticholinergic activity of tricyclic antidepressants. Anticholinergic effects appear most frequently and cause the greatest morbidity in geriatric patients. The anticholinergic effects of amitriptyline may increase lens discomfort for wearers of contact lenses. Mydriasis, disturbance of accommodation, and dry eyes may contribute to blurred vision and lens intolerance. The use of lubricating drops may be necessary, or in severe cases discontinued use of contact lenses while taking amitriptyline.

Following prolonged therapy with high doses, abrupt discontinuation of the tricyclic antidepressant should be avoided because it could precipitate symptoms of cholinergic rebound such as nausea, vomiting, or diarrhea. This is particularly true for the tertiary amine tricyclic antidepressants: amitriptyline, imipramine, clomipramine, trimipramine, and doxepin. Tricyclic antidepressants should be used with caution in patients with a history of alcoholism or who may use alcohol or other sedative medications because the depressant effects on the CNS can be potentiated. Decreased mental alertness can occur. Tricyclic antidepressants can exacerbate schizophrenia or manic symptoms of bipolar disorder because of the drugs' effects on the CNS. Bipolar disorder patients who are not concomitantly treated with an anticyclic medication are likely to switch from depression to mania, and some schizophrenic patients can experience exacerbation of psychosis. Tricyclic antidepressants should be used with extreme caution in patients with a preexisting seizure disorder because these drugs can lower the seizure threshold. Tricyclic antidepressants should be used with caution in patients with Parkinson's disease.

Tricyclic antidepressants rarely can induce or worsen extrapyramidal symptoms. In addition, involuntary movements, which appear to be tardive dyskinesia, can occur. Patients with respiratory depression should be treated cautiously with tricyclic antidepressants because of additive CNS-depressant effects. Tricyclic antidepressants should be used with caution in patients (especially children and elderly) with cardiac disease because of the alterations in ECG patterns. Many adverse cardiovascular effects are associated with the use of tricyclic antidepressant drugs, and they can lead to complete cardiac collapse and sudden death. Although the risk of these events occurring is higher after acute overdose, patients with cardiovascular disease should be closely monitored and regular ECG tracings made. Tricyclic antidepressants should not be given to patients who are in the acute recovery phase following myocardial infarction; this could cause sudden death. Asthma can be aggravated by administering tricyclic antidepressants to patients with the disease. Tricyclic antidepressants are known to produce an allergic response in some patients. There appears to be cross-sensitivity, and caution should be used when changing from one tricyclic antidepressant to another. Alternative therapy should be considered.

Tricyclic antidepressants can also display cross-sensitivity to carbamazepine, maprotiline, or trazodone. Tricyclic antidepressant therapy should be discontinued several days before elective surgery because of the risk of hypertensive episodes. On rare occasions, agranulocytosis, thrombocytopenia, eosinophilia, leukopenia, or purpura have been reported with tricyclic antidepressants. Any patient with symptoms of blood dyscrasia (sore throat, fever, bruising, etc.) should have immediate laboratory studies performed and suitable therapy initiated. Use tricyclic antidepressants cautiously in patients with preexisting hematological disease. Intramuscular injections should be administered cautiously to patients receiving amitriptyline. IM injections may cause bleeding, bruising, or hematomas due to thrombocytopenia secondary to amitriptyline therapy. Tricyclic antidepressants should be used with caution in patients with hepatic disease. These agents have caused hepatitis and jaundice, which are reversible on discontinuation of the drug. Hepatic failure and death have occurred when tricyclic antidepressants were continued.

Liver-function tests should be performed and the drug discontinued if there is persistent elevation of enzymes. Metabolism of tricyclic antidepressants may be altered in patients with hepatic impairment. Patients may be more prone to sunburn during therapy with a tricyclic antidepressant. Suitable precautions should be taken such as wearing long-sleeved clothing and a hat, and routinely applying a sunblock with an SPF >=15. Tricyclic antidepressants should be used with caution in patients who have hyperthyroidism or are receiving thyroid drugs. Concomitant use with thyroid drugs can produce cardiac arrhythmias. Hypothyroidism that is untreated will prevent adequate response to antidepressant therapy. Thyroid agents also can accelerate the onset of the response to tricyclic antidepressants. Tricyclic antidepressants affect blood glucose concentrations because of their effect on the endocrine system, so they should be used with caution in patients with diabetes mellitus. Tricyclic antidepressants are not recommended for use during pregnancy, unless the possible benefits outweigh the risks. Amitriptyline is classified as FDA category C. Patients should be told about the risks to the neonate: possible fetal abnormality, delayed development, or withdrawal symptoms.

Because these drugs are excreted into breast milk, the benefits and risks of breast-feeding should be carefully weighed if tricyclic antidepressants are needed in the mother. All antidepressants should be used with caution in depressed patients because of the possibility of suicidal ideation. Close monitoring of the patient is essential during the initial stages of therapy and amitriptyline prescribed in the smallest quantity consistent with good management. Intrathecal administration of metrizamide to a patient taking amitriptyline can increase the risk of developing seizures. Tricyclic antidepressant therapy should be discontinued 48 hours before, and not restarted until 24 hours after, myelography. (Amitriptyline tablets) What do amitriptyline tablets do? AMITRIPTYLINE (Elavilï¿½, Endepï¿½) is an antidepressant. Amitriptyline can lift your spirits by treating your depression, especially if it is associated with sleep disturbance. Improvement of sleep patterns can be the first benefit of treatment. Your doctor may prescribe amitriptyline for other conditions, such as relief from nerve pain. Generic amitriptyline tablets are available.

What should my health care professional know before I take amitriptyline? They need to know if you have any of these conditions: an alcohol problem an unusual or allergic reaction to amitriptyline, other medicines, foods, dyes, or preservatives pregnant or trying to get pregnant breast-feeding How should I take this medicine? Take amitriptyline tablets by mouth. Follow the directions on the prescription label. Swallow the tablets with a drink of water. You can take the tablets with or without food. Take your doses at regular intervals. Do not take your medicine more often than directed. Do not stop taking except on your doctor's advice. Special precautions for use in children: This medicine is not for general use in children under 12 years old, but may be prescribed in special circumstances by the doctor. Adolescents, 12 to 18 years old, and elderly patients over 65 years old may have a stronger reaction to this medicine and need smaller doses. What if I miss a dose? If you miss a dose normally taken at bedtime to avoid daytime drowsiness, it may be better to miss that dose.

If you take more than one dose a day and miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Follow your doctor's advice on missed doses. Do not take double or extra doses. What other medicines can interact with amitriptyline? Amitriptyline can interact with many other medicines. An interaction can be very important or fairly insignificant. Make sure your doctor knows about all other medicines you are taking. The most important medicines are listed below: alcohol medicines for anxiety or sleeping problems, such as diazepam or temazepam medicines for colds and breathing difficulties medicines for hay fever and other allergies medicines for mental problems and psychotic disturbances medicines for movement abnormalities as in Parkinson's disease, or for gastrointestinal problems other medicines for mental depression oseizure (convulsion) or epilepsy medicine thyroid hormones Tell your doctor or pharmacist- About all other medicines you are taking, including non-prescription medicines; if you are a frequent user of drinks with caffeine or alcohol; if you smoke; or if you use illegal drugs. These may affect the way your medicine works. Check before stopping or starting any of your medicines. What side effects may I notice from taking amitriptyline?

Serious side effects with amitriptyline include: abnormal production of milk in females blurred vision or eye pain breast enlargement in both males and females confusion, hallucinations (seeing or hearing things that are not really there) difficulty breathing oskin rash or itching oweight gain or loss Let your doctor know about these side effects if they do not go away or if they annoy you. What do I need to watch for while I take amitriptyline? Visit your doctor for regular checks on your progress. It can take several days before you feel the full effect of amitriptyline. If you have been taking amitriptyline regularly for some time, do not suddenly stop taking it. You must gradually reduce the dose or you may get severe side effects. Ask your doctor for advice. Even after you stop taking amitriptyline it can still affect your body for several days. You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how amitriptyline affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells.

Alcohol may increase dizziness and drowsiness. Avoid alcoholic drinks. Do not treat yourself for coughs, colds or allergies without asking your doctor or pharmacist for advice. Some ingredients can increase possible side effects. Your mouth may get dry. Chewing sugarless gum or sucking hard candy, and drinking plenty of water will help. Amitripyline may cause dry eyes and blurred vision. If you wear contact lenses you may feel some discomfort. Lubricating drops may help. See your ophthalmologist if the problem does not go away or is severe. Amitriptyline may make your skin more sensitive to the sun. Keep out of the sun, or wear protective clothing outdoors and use a sunscreen. Do not use sun lamps or sun tanning beds or booths. If you are diabetic, check your blood sugar more often than usual, especially during the first few weeks of treatment with amitriptyline. Amitriptyline can affect blood glucose (sugar) levels. Call your doctor for advice if you notice a change in the results of blood or urine glucose tests. If you are going to have surgery, tell your doctor or dentist that you are taking amitriptyline. Where can I keep my medicine?

Keep out of the reach of children in a container that small children cannot open. Store at room temperature between 15 and 30ï¿½C (59 and 86ï¿½F). Throw away any unused medicine after the expiration date. Interactions- trimipramine xylometazoline Barbiturates and carbamazepine induce hepatic microsomal enzymes and increase the metabolism of tricyclic antidepressants. Plasma concentrations of the tricyclic antidepressant are reduced and may require an increased dosage to achieve equivalent therapeutic effects. In addition, tricyclic antidepressants can lower the seizure threshold, however, this is a concern mainly after acute overdoses. Nevertheless, concomitant use with anticonvulsants may require increased concentrations of the anticonvulsant to achieve equivalent effects. Cimetidine can inhibit the systemic clearance of tricyclic antidepressants, resulting in increased plasma levels of the antidepressant. In some cases, clinical symptoms of toxicity were observed. Patients should be monitored for tricyclic antidepressant toxicity if cimetidine is added.

It does not appear that the other H2-receptor antagonists affect the pharmacokinetics of the tricyclics. A potentially serious interaction can occur between clonidine and tricyclic antidepressants (reported with desipramine and imipramine). Administration of tricyclic antidepressants to hypertensive patients stabilized on clonidine can lead to hypertension, especially during the second week of tricyclic antidepressant therapy. Occasionally, the hypertension will occur within the first few days of tricyclic antidepressant therapy. Guanabenz and guanfacine possess a mechanism of action similar to clonidine, although the alpha2/alpha1 affinity ratio is much higher for guanfacine than the other two (agonism at alpha2-receptors reduces blood pressure, while agonism at alpha1-receptors increases blood pressure.) Despite an absence of reports, clinicians should assume that there is the possibility for a similar hypertensive response if a tricyclic antidepressant is added to patients stabilized on either guanabenz or guanfacine. The risk of developing cardiac arrhythmias is increased when cocaine is used in patients receiving tricyclic antidepressants.

If local anesthesia with cocaine is essential in a patient receiving a tricyclic antidepressant, lower doses of cocaine and/or electrocardiographic monitoring may be necessary. Limited data suggest that tricyclic antidepressants used concomitantly with disulfiram can produce transient delirium. This has been reported with amitriptyline. Pharmacokinetic interactions have been noted between disulfiram and imipramine, and disulfiram and desipramine (imipramine's metabolite) but the clinical significance of these data are uncertain. Disulfiram is known to inhibit cytochrome isozyme CYP2C9, the enzyme responsible for metabolism of amitriptyline and imipramine. Ethanol or other CNS depressants should be combined cautiously with tricyclic antidepressants because this could cause additive depressant effects and possible respiratory depression or hypotension. Tricyclic antidepressants (with the exception of doxepin <150 mg/day) block the uptake of guanadrel, guanethidine, and methyldopa into norepinephrine neurons, preventing the expected antihypertensive effects.

The antihypertensive effects of reserpine and other rauwolfia alkaloids may also be decreased in the presence of tricyclic antidepressants. The antimuscarinic activity of tricyclic antidepressants can decrease gastric motility, decreasing the bioavailability of levodopa. In addition, severe hypertension occurred in a limited number of patients who received levodopa in combination with a tricyclic antidepressant. The pressor response to norepinephrine infusions is greatly exaggerated in patients currently receiving tricyclic antidepressants. One drug information reference suggests that tricyclics potentiate the pharmacologic effects of direct-acting sympathomimetics (e.g., epinephrine and norepinephrine) but decrease the pressor response to indirect-acting sympathomimetics (e.g., amphetamines), however, the data are not consistent. Concomitant use of tricyclic antidepressants with other sympathomimetics (e.g., isoproterenol, or phenylephrine), therefore, should be avoided whenever possible.

Clinicians should presume that the pressor effects of ophthalmic or nasal vasoconstrictors (e.g., naphazoline, oxymetazoline, phenylephrine, or xylometazoline) may be potentiated by tricyclic antidepressants. Methylphenidate has been reported to inhibit the metabolism of imipramine in vitro, however, the clinical significance of this is lacking. Depending on the specific agent, additive anticholinergic effects may be seen when drugs with antimuscarinic properties are used concomitantly with other antimuscarinics.

The following drugs are known to possess antimuscarinic properties and should be used together cautiously: atropine and other similar antimuscarinics; some H1-blockers (e.g., carbinoxamine, clemastine, diphenhydramine, methdilazine, promethazine, trimeprazine); some phenothiazines (e.g., mesoridazine, promazine, thioridazine, triflupromazine); some tricyclic antidepressants (e.g., amitriptyline, amoxapine, clomipramine, protriptyline); and other drugs with substantial antimuscarinic properties such as clozapine, cyclobenzaprine, and disopyramide. Drugs with minor degrees of anticholinergic effects include amantadine, bupropion, chlorpromazine, doxepin, imipramine, maprotiline, nortriptyline, procainamide, and trimipramine. Clinicians should note that antimuscarinic effects may be seen not only on GI smooth muscle, but also on bladder function, the eye, and temperature regulation.

In addition to additive drowsiness, combining tricyclic antidepressants with opiate agonists may lead to additive effects on intestinal motility or bladder function. The anticholinergic (i.e., antimuscarinic) effects of tricyclic antidepressants vary; amitriptyline exhibits the strongest and desipramine exhibits the weakest. Depending on the specific agent, this antimuscarinic action may interfere with the therapeutic effects of prokinetic agents such as cisapride, erythromycin (when used to improve GI motility), or metoclopramide. Amitriptyline may also antagonize some of the effects of parasympathomimetics such as bethanechol or cholinesterase inhibitors such as neostigmine, however, bethanechol has been used therapeutically to offset some of the adverse antimuscarinic effects of tricyclic antidepressants.

Concurrent use of monoamine oxidase inhibitors (MAOIs), such as furazolidone, phenelzine, procarbazine, selegiline, or tranylcypromine, with tricyclic antidepressants can cause hyperpyrexia, hypertension, or seizures. In the rare patient for whom this combination therapy is necessary, the interaction can be minimized by initiating therapy with a tricyclic antidepressant and then beginning MAOI therapy at low doses, followed by a very gradual increase. The tricyclic antidepressant should inhibit the uptake of tyramine from food in the GI tract; subsequent addition of a MAOI should not lead to high levels of tyramine. Conversely, tricyclic antidepressants should not be added to an exisiting MAOI regimen because the reuptake blockade will be unopposed due to the existing inhibition of the main elimination pathway. An interval of 14 days is recommended between cessation of an irreversible MAOI agent and initiation of tricyclic antidepressant therapy. Clinicians should be alert for pharmacokinetic interactions between tricyclic antidepressants and the selective serotonin reuptake inhibitors (SSRIs) class of antidepressants.

The SSRIs are known to inhibit isozymes of the cytochrome P-450 mixed-function oxidase system including CYP2D6 and/or CYP3A4, the isozymes responsible for metabolism of many of the tricyclic antidepressants. Cytochrome CYP2D6 is impaired most by fluoxetine and least by sertraline and is the isozyme most responsible for metabolism of tricyclic antidepressants. In several cases, symptoms of toxicity, including seizures, were reported when drugs from these 2 categories were used together. At least one case report exists of a death thought to be due to impaired clearance of amitriptyline by fluoxetine. The CYP2D6 isozyme is a common pathway for both of these drugs and norfluoxetine also inhibits this enzyme. Patients receiving a tricyclic antidepressant should be monitored closely for toxicity if a SSRI-type drug is added. Clinicians should be particularly cautious in patients with fluoxetine due to the extremely long elimination half-life of its metabolite, norfluoxetine (7ï¿½9 days).

Older literature describes a variety of responses when tricyclic antidepressants are used concomitantly with thyroid hormones. One limited study states that small doses of thyroid hormone accelerated the onset of action of tricyclic antidepressants while several case reports have described cardiovascular toxicity as a result of this drug combination while still other reports describe no interaction. Although this drug combination appears to be safe, clinicians should be aware of the remote possibility of exaggerated cardiovascular side effects such as arrhythmias and CNS stimulation. Animal data indicate that some tricyclic antidepressants (amitriptyline, nortriptyline) can inhibit the metabolism of warfarin, however, clinical data are extremely limited. A major review of warfarin drug interactions published in 1994 did not include tricyclic antidepressants as an offending agent. It appears that warfarin can be used safely in patients taking tricyclic antidepressants. Adverse Reactions- withdrawal xerostomia A wide variety of cardiovascular side effects can result from the use of tricyclic antidepressants due to their direct quinidine-like action, their potent anticholinergic properties, and their ability to potentiate norepinephrine.

Ventricular tachycardia, palpitations, hypertension, and orthostatic hypotension all can be precipitated, with the possibility of more severe reactions occurring such as myocardial infarction, congestive heart failure, or stroke. Imipramine, and possibly other tricyclic antidepressants, can cause both PR prolongation and QT prolongation. Imipramine and nortriptyline are known to prolong the QRS interval. Other tricyclics would be expected to produce similar ECG changes. The cardiovascular response to tricyclic antidepressants depends on the specific agent and the dose. Although all tricyclic antidepressants are thought to be proarrhythmic after acute overdoses, at therapeutic doses, their actions on the conducting system of the heart may vary. Imipramine has been utilized therapeutically for its antiarrhythmic effect. The cardiovascular response to tricyclic antidepressants is varied, and patients most at risk have preexisting cardiovascular disease. While amitriptyline is included on lists of drugs associated with either QT prolongation or torsade de pointes, this reaction is rare at therapeutic doses.

Drowsiness is the most frequent adverse CNS effect during therapy with tricyclic antidepressants. Sedation can be made into a desirable effect by administration of the tricyclic antidepressant at bedtime, which minimizes undesirable drowsiness and sedation during the day. Dizziness is usually due to orthostatic hypotension and can be reduced by having the patient change positions more slowly. Some patients exhibit excitation and anxiety. Confusion is most apparent in the elderly. Peripheral nervous system adverse reactions can occur during therapy with tricyclic antidepressants. Tremor may result from norepinephrine reuptake blockade. Rarely, extrapyramidal symptoms can occur in both young and elderly patients. Parkinsonism is more likely to occur in the elderly, especially if they are receiving high doses. Seizures and EEG changes have been observed more commonly in children than in adults during therapy with tricyclic antidepressants. Patients who have a preexisting seizure disorder may require increased concentrations of their anticonvulsant to maintain seizure control.

Ocular manifestations of the anticholinergic actions of tricyclic antidepressants can result in blurred vision due to cycloplegia, mydriasis, and increased intraocular pressure. Ocular hypertension can precipitate a crisis in patients with angle-closure glaucoma. Ophthalmological examination is recommended when there are visual changes. Gastrointestinal manifestations of tricyclic antidepressants' anticholinergic activity include dry mouth (xerostomia), constipation, urinary retention, adynamic ileus, abdominal pain or cramps, nausea/vomiting, anorexia, diarrhea, and jaundice. Constipation is more commonly observed in elderly patients. If these symptoms become severe, discontinuation of the drug may be required. Allergic reactions to tricyclic antidepressants can include photosensitivity, vasculitis, erythema, urticaria, fever, and/or pruritus. Fever also may indicate a blood dyscrasia.

The effects of tricyclic antidepressants on the endocrine system can result in sexual dysfunction including libido decrease, impotence, testicular swelling, ejaculation dysfunction (no or painful ejaculation), breast enlargement, and galactorrhea in females or gynecomastia in males. The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) has been reported. Glucose metabolism can be altered and should be monitored in patients with diabetes mellitus. Patients receiving prolonged therapy with high doses of tricyclic antidepressants can experience withdrawal symptoms following abrupt discontinuation of the tricyclic antidepressant. Symptoms of cholinergic rebound such as nausea, vomiting, or diarrhea can occur. This particularly occurs with the tertiary amine tricyclic antidepressants: amitriptyline, imipramine, clomipramine, trimipramine, and doxepin. Product Identification- Amitriptyline - Pain Concern Amitriptyline 4.86/5 (510) 4.86/5510 The information in this leaflet is currently under review. We review all of our leaflets every three years to ensure that our information is kept up to date.

Download a pdf version of this leaflet here . Many people living with chronic pain are daunted by the prospect of long term or even permanent drug therapy. What are these drugs, are they safe and how do they work? Concerns such as these can stop people persevering with medicines that may offer a real, life-enhancing solution to their condition. Dr Mick Serpell explains how amitriptyline works and gives reassurance about the side effects that you might experience, especially in the early stages The main aims in managing chronic pain are to relieve or to reduce the pain and, just as importantly, to improve your quality of life and get you doing more. There are four approaches to pain management: 1) physical therapy (physiotherapy, acupuncture, TENS (transcutaneous electrical nerve stimulation), etc. 2) drug therapy 3) regional analgesia (injection of drugs around nerves or other tissues) 4) psychological therapies (techniques which improve coping with pain). Two types of pain Doctors describe pain as either nociceptive, neuropathic, or a combination of the two. It is important to distinguish between the two types of pain, as they need different medicines.

Nociceptive pain is pain that starts off as a response to tissue damage or a painful stimulus like a hot surface. Examples include mechanical low back pain and degenerative or inflammatory joint pain, and so it is easy to understand why nociceptive pain is the most common form of chronic pain. Although these pains may begin as purely nociceptive, over time there may be changes within the nervous system that may result in neuropathic pain. Neuropathic pain may also be the result of nerve damage that makes the nerve overactive. Therefore the drugs used for neuropathic pain are aimed at stabilisation or “calming” of the overactive nerves. Perhaps it should be no surprise that drugs used in other conditions where nervous tissue is overactive or “excited”, such as epilepsy or depression, have turned out to be useful medicines for chronic pain where the nerves have become overactive. Drug therapy Conventional painkillers such as codeine and ibuprofen are used for nociceptive pain. They are often not effective for neuropathic pain. Most of the drugs used for the relief of neuropathic pain were originally developed to treat different conditions.

For instance, amitriptyline is an antidepressant drug but is now probably used more commonly for pain than for its original use. The situation is the same for some anticonvulsant drugs, which are used more frequently for neuropathic pain than epilepsy. Change your lifestyle Always remember that the medicine alone will not be enough. While drug therapy can play a major role in the management of pain, changing your lifestyle (such as building up your fitness and getting more exercise), as well as learning to manage and cope with your pain better, are also vital to the successful outcome. General principles of drug therapy Your doctor will start you off at a low dose of your medicine and this is increased up to a suitable dosage and taken for sufficient duration until you obtain noticeable pain relief (or experience severe side effects). This procedure of increasing the dose step by step while monitoring the effect is called “titrating the dose”. If there is no relief the drug will be stopped. Your doctor is likely to gradually wean you off the medication over one to two weeks, to avoid potential side effects from sudden withdrawal. If you get partial, but inadequate pain relief, a second different drug can be prescribed in addition.

Once you are on the right dose and drug combination for you then you may continue on the medication indefinitely. You and your doctor may decide that you should wean yourself off the medicines gradually every six months or so to ensure they are still necessary for you. Most doctors agree that medication for chronic pain should be taken “round the clock” rather than “as required”. It is easier to keep pain at bay rather than trying to control it after it has been allowed to resurface. Antidepressants The tricyclic antidepressants, such as amitriptyline, are the “gold standard” for neuropathic pain as they are the most effective and best-known drugs for this condition. They can also be useful for chronic nociceptive pain, especially if there is a neuropathic component to it. They appear to work in the nervous system by reducing the nerve cell’s ability to re-absorb chemicals such as serotonin and noradrenaline. These chemicals are called neural transmitters. If they are not reabsorbed they accumulate outside the nerve cell and the result is suppression of pain messages in the spinal cord. All in the mind? The way antidepressants give pain relief is completely separate from the anti-depressant effect.

The dose required for treating depression is much higher (often over 150 milligrams (mg) a day) than the doses used for pain relief. Also, there are many different antidepressant drugs available that are effective for treating depression, but only a small number are also effective pain killers. It is important that the patient is given a full explanation of the rationale for antidepressant therapy. It is not that the doctor believes your pain is due to depression. So do not think that you are not being taken seriously and that the pain is “all in the mind”. Of course, depression can occur with chronic pain, but it is usually an understandable reaction to the pain and improves as the chronic pain improves. However, if severe, it too may require treatment with an antidepressant drug. Starting amitriptyline One in four people will get significant pain relief with amitriptyline, which is regarded as an excellent result for chronic pain conditions. It is started at a low dose (10 or 25 mg a day) and gradually increased in 10 or 25 mg increments each week up towards 75 mg if any side effects are tolerable. Your doctor may advise you to go higher than this dose.

The tablets are small and difficult to cut in half, and will often produce numbness of the tongue due to a local anaesthetic effect, but it is available as a syrup. It is better to use the syrup if small increases of dose are required during the titration (dose build-up) phase. Keep taking it! You may notice pain relief as soon as two weeks after starting, but often it requires amitriptyline to be taken for six to eight weeks at the best dose level before one can say the drug has been given a fair trial. Many people stop taking the medicine because they experience side effects early on but do not feel any benefit. However, if you can persevere, you will often get tolerant to most of the side effects after a few days to weeks and you may then start noticing the benefits of the medicine. Although there are a number of side effects associated with amitriptyline most of them are extremely uncommon. The most common ones, experienced by only 5-15% of people, include dizziness, drowsiness, dry mouth, nausea and constipation. These side effects are generally harmless and, provided you do not exceed the dose, will not cause any damage.

Most people find they adapt to these and eventually they go away. Amitriptyline is not addictive but if discontinued, it should be withdrawn slowly over two to three weeks in order to avoid withdrawal symptoms of headache and malaise. Not for everyone Your doctor will not prescribe this drug for you if you have had an allergic reaction to amitriptyline or related drugs; a recent heart attack; or recent administration of drugs that can interact with amitriptyline. When should I take it? Amitriptyline is long acting, so only needs to be taken once a day. As one of the most common side effects is drowsiness, it is best to take it a couple of hours before bedtime. This effect can be particularly useful if you suffer lack of sleep from your pain. Sometimes there is a “morning after” type of hangover feeling, but this usually wears off with time. Occasionally amitriptyline can cause insomnia; if this happens it is better to take it in the morning. Worth trying If side effects are a problem, there are other similar drugs (for example, nortriptyline and imipramine) that are worth trying.

Many of the patients I have seen have stayed on amitriptyline for years and say that it has transformed their lives. When dealing with pain, it is worth giving drug therapy a chance and working with your doctor to try different approaches so that you find the particular approach that is right for you, which brings you the benefits of pain relief, allows you to do more, and gives you the quality of life that you and your doctor both want. Amitriptyline © Michael Serpell. All rights reserved. April 2013. To be reviewed April 2016. If you would like to know more about the sources of evidence consulted for this publication please click here . Elavil for Pain What Type of Back Pain Does Amitriptyline Treat? Pain management medicine for the relieve of chronic neck or back pain is a team project. H. Armstrong Roberts/Classic Stock Archive Photos/Getty Images Elavil is effective for neuropathic type of chronic back pain. For spine pain sufferers, this usually means your pain radiates down an arm or leg. Although Elavil's pain relieving abilities are independent of its antidepressant effect, the drug works by increasing the amount of certain brain chemicals necessary for mental balance.

Amitriptyline is also used to treat fibromyalgia, which is a condition marked by widespread pain and tender points . Amitriptyline Side Effects LEA PATERSON/SCIENCE PHOTO LIBRARY / Getty Images Because amitriptyline is approved by the FDA to treat depression, it can affect mental status, including increasing the risk for suicide. But on the scale of things, amitriptyline likely has a relatively low risk of suicide. For example, 2015 cohort study published in the British Medical Journal found that in people with depression, the absolute risk of suicide for amitriptyline over one year was 0.02% while for mirtazapine, it was 0.19%. If you are pregnant or breastfeeding, it's best to stay away from amitriptyline or Elavil, because the drug could possibly be passed on to your child. Elavil can cause problems for people who have arrhythmia and other forms of heart disease, and it is not generally given to people over the age of 60.

(The newer antidepressants may be a better choice for this age group.) A few less serious Elavil side effects include dry mouth and drowsiness. Amitriptyline and Drug Interactions Gerard Fritz / Getty Images Interactions between Elavil and other drugs you may be taking can increase the amount of amitriptyline in your blood. In turn, this may increase side effects of the medication. Other types of drug interactions are possible, as well. Therefore, it is important to tell your doctor everything you are taking, whether recreational, over-the-counter or prescribed. For example, if you take St. John's Wort, an herbal medication sometimes used for depression, you may run the risk of a drug interaction between it and the Elavil you take. Birth control pills and hormone therapy are further examples of substances that could cause problems when mixed with Elavil. Psychiatric Medications - The Medications - What Meds?

- Stanford University School of Medicine Brand Names: Elavil, Endep, Amitril, Emitrip, Enovil, Etrafon, Etrafon-A, Etrafon-Forte, PMS-Levazine, SK-Amitriptyline, Dohme, Sharpe Overview Elavil is a brand name for Amitriptyline, a tricyclic antidepressant (TCA.) It is a heterocyclic antidepressant - a class of drugs that inhibits the nerve cells' ability to reuptake norepinephrine and serotonin and brings the levels of these neurotransmitters back up to normal. Elavil is very sedating. Elavil effects may be felt after one to two weeks though some patients may take longer to feel its effects depending on the dosage and the patient. Elavil may improve sleep patterns earlier than other symptoms. Why is this drug prescribed? Elavil is FDA-labeled in adults and in adolescents and children above 12 years old for depression. It is used primarily to treat major depression (both psychotic and endogenous), especially depression associated with a sleep disturbance. Because of its sedative effects, it may be useful in treating anxiety associated with depression.

Elavil should not be used for bipolar disorder (manic depression) as it may precipitate a manic episode. Elavil may also be prescribed to treat: Nerve pain (neurogenic pain) Bulimia associated with depression Insomnia It is also useful in treatment for nerve pain, chronic pain syndromes, migraines/migraine prevention, nocturnal enuresis and insomnia. How much of this drug is typically used?

Tablet: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg In Adolescents: Initial: 25-50 mg/day; may give in divided doses; increase gradually to 100 mg/day in divided doses; maximum dose: 200 mg/day In Children: Investigationally: initial doses of 1 mg/kg/day given in 3 divided doses with increases to 1.5 mg/kg/day have been reported in a small number of children (n=9) 9-12 years of age Clinically, doses up to 3 mg/kg/day (5 mg/kg/day if monitored closely) have been proposed Warnings and Precautions Special care should be used in children under twelve years. Elavil must not be used in children under twelve except under the guidance of a child psychiatrist. Adolescents (12-18 years old) have a stronger reaction to Elavil than do adults and may need smaller doses. Elavil is not addictive. However, suddenly discontinuing Elavil may cause withdrawal symptoms. Dosages should be gradually tapered to minimize withdrawal.

Even gradual dosage reduction may produce some withdrawal symptoms. Elavil can cause photosensitivity and can reduce sweating which impairs the body's ability to adapt to heat. Patients should avoid saunas and other very hot environments. Elavil can cause drowsiness and dizziness: a patient taking Elavil should not drive or operate heavy machinery until he knows that it does not impair his ability do engage in these activities. For Pregnant or Nursing Mothers: Controlled studies have not been done in pregnant women, but there have been reports of newborns suffering from muscle spasms and heart, breathing, and urinary problems when their mothers had taken tricyclic antidepressants immediately before delivery. Animal studies show that some tricyclic antidepressants may have undesirable effects on a fetus. Tricyclic antidepressants pass into breast milk and are reported to cause drowsiness in nursing infants.

Contraindications Elavil should not be used for people with the following medical conditions: Impaired liver or kidney function — dosage may need to be lowered Epilepsy Diabetes — Elavil can affect blood glucose levels and blood sugar levels may need to be check more often than usual Recovering from a heart attack, or acute congestive heart failure Narrow-angle glaucoma Schizophrenia — Elavil may aggravate the condition Hyperactivity — Elavil may cause over stimulation Paranoid delusions Interactions with Drugs and Other Substances Drugs or substances that may interact with Elavil are: MAO Inhibitors (within 14 days) serious, even fatal, interactions can occur when taken with Elavil Vitamin C - high doses may blunt the effects of Elavil All atropine like drugs, all sedative drugs, antihistamines, norepinephrine, Dilantin (phenytoin), and Coumadin (warfarin) — Elavil may increase the effects of these drugs Antabuse (disulfiram) - its effects can increase if taken with Elavil and alcohol Catapres (clonidine), Hylorel (guanadrel), Ismelin / Es

imil (guanethidine), Primatene tablets(ephedrine) and Tenex (guanfacine) — Elavil may decrease the effects of these drugs Tagamet (cimetidine), estrogens, Prozac (fluoxetine), Luvox (fluvoxamine), Normodyne (labetalol), Ritalin (methylphenidate), oral contraceptives, phenothiazines, Quinaglute (quinidine), and Zantac (ranitidine) — these drugs may increase the effects of Elavil Norvir (ritonavir) and other protease inhibitors may cause toxicity when taken with Elavil Stimulant drugs (such as cocaine, amphetamines, Proventil, and sutafed) — these medications can cause severe high blood pressure and/or high fever when taken with Elavil Thyroid medications can increase the risk of heart rhythm disorders Demerol (meperidine) can cause a lower rate of breathing when taken with Elavil Alcohol — when taken with Elavil can increase the intoxicating effects of alcohol and combination can depress brain function significantly; alcohol should be avoided completely Smoking accelerates the elimination of this drug from the body and increases

 the dosage required Barbiturate medicines for inducing sleep or treating seizures (convulsions) Blood thinners Medicines for anxiety or sleeping problems, such as diazepam or temazepam Medicines for colds and breathing difficulties Medicines for movement abnormalities as in Parkinson's disease, or for gastrointestinal problems Other medicines for mental depression Seizure (convulsion) or epilepsy medicine Research Studies and Use in Child Psychiatry Amitriptyline is indicated for children above age 12.

In adolescents, the manufacturer recommends 10 milligrams three times daily and 20 milligrams at bedtime as an initial dose regimen. The manufacturer does not recommend the use of amitriptyline in patients under 12 years of age. In a double-blind study in 1984, Amitriptyline 1 mg/kg/day in three divided doses, increased after 3 days to 1.5 mg/kg/day for the remainder of the 4-week study was reported to produce a favorable response in 6 of 9 children (ages 9-12) with depression (Kashani et al, 1984). Controlled clinical trials have not shown tricyclic antidepressants to be superior to placebo for the treatment of depression in children and adolescents (Dopheide, 2006 and Wagner, 2005). Therefore, due to the potential cardiac side effects, currently this medication is rarely used in child psychiatry except for nocturnal enuresis. Sources

Question: What condition is the drug Amitriptyline usually used to treat?
Answer: DEPRESSION