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prozactruth.comamitriptyline.htmOpen ↗
Amitriptyline Elavil. Find out the true side effects. Elavil side effects, warnings, precautions,
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Indications In the drug management of depressive illness. Amitriptyline may be used in depressive
illness of psychotic or endogenous nature and in selected patients with neurotic depression.
Endogenous depression is more likely to be alleviated than are other depressive states.
Amitriptyline, because of its sedative action, is also of value in alleviating the anxiety component
of depression.
As with other tricyclic antidepressants, amitriptyline may precipitate hypomanic episodes in
patients with bipolar depression. These drugs are not indicated in mild depressive states and
depressive reactions.
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Contraindications Back to top of page In patients who have shown prior hypersensitivity to it. It
should not be given concomitantly with a MAO inhibiting compound. Hyperpyretic crises, severe
convulsions, and deaths have occurred in patients receiving tricyclic antidepressant and MAO
inhibiting drugs simultaneously. When it is desired to substitute amitriptyline for a MAO inhibitor,
a minimum of 14 days should be allowed to elapse after the latter is discontinued. Amitriptyline
should then be initiated cautiously with gradual increase in dosage until optimum response is
achieved. This drug is not recommended for use during the acute recovery phase following myocardial
infarction and in the presence of acute congestive heart failure.
See Pregnancy under Warnings.
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Warnings Back to top of page Amitriptyline should be used with caution in patients with a history of
seizures, impaired liver function, a history of hepatic damage or blood dyscrasias and, because of
its atropine-like action, in patients with a history of urinary retention, or with narrow-angle
glaucoma or increased intraocular pressure. In patients with narrow-angle glaucoma, even average
doses may precipitate an attack. There has been a report of fatal dysrhythmia occurring as late as
56 hours after amitriptyline overdose.
Patients with cardiovascular disorders should be watched closely. Tricyclic antidepressant drugs,
including amitriptyline, particularly when given in high doses, have been reported to produce
arrhythmias, sinus tachycardia, and prolongation of the conduction time.
A few instances of unexpected deaths have been reported in patients with cardiovascular disorders.
Myocardial infarction and stroke have also been reported with drugs of this class. Therefore, these
drugs should be used with caution in patients with a history of cardiovascular disease, such as
myocardial infarction and congestive heart failure.
Concurrent administration of amitriptyline and electroshock therapy may increase the hazards of
therapy. Such treatment should be limited to patients for whom it is essential.
Close supervision is required when amitriptyline is given to hyperthyroid patients or those
receiving thyroid medication.
Occupational Hazards: Back to top of page
May impair mental and/or physical abilities required for performance of hazardous tasks, such as
operating machinery or driving a motor vehicle.
Pregnancy: There are no well-controlled studies in pregnant women; therefore, in administering the
drug to pregnant patients or women who may become pregnant, the potential benefits must be weighed
against the possible hazards to mother and child.
Lactation: Amitriptyline is detectable in breast milk. Because of the potential for serious adverse
reactions in infants from amitriptyline, a decision should be made whether to discontinue nursing or
discontinue the drug.
Children: In view of the lack of experience with the use of this drug in the treatment of depression
in children, amitriptyline is not recommended for depressed patients under 12 years of age.
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Precautions Back to top of page The potency of amitriptyline is such that addition of other
antidepressant drugs generally does not result in any additional therapeutic benefit. Untoward
reactions have been reported after the combined use of antidepressant agents having varying modes of
activity. Accordingly, combined use of amitriptyline and other antidepressant drugs should be
undertaken only with due recognition of the possibility of potentiation and with a thorough
knowledge of the pharmacology of both drugs. There has been no reports of untoward events when
patients receiving amitriptyline were changed immediately to protriptyline or vice versa. When
amitriptyline is used to treat the depressive component of schizophrenia, activation or aggravation
of existing psychotic manifestation may occur. Likewise, manic depressive patients may experience
hypomanic or manic episodes and hyperactive or agitated patients may become overstimulated. Paranoid
delusions, with or without associated hostility, may be exaggerated. A reduction in dose or
discontinuation of amitriptyline may be indicated and administration of a neuroleptic such as a
phenothiazine, be considered under these circumstances.
Seriously depressed patients should be carefully supervised. The possibility of suicide in depressed
patients remains during treatment. Patients should not have access to large quantities of this drug
during treatment.
Discontinue the drug several days before elective surgery if possible.
Drug Interactions: Back to top of page
Amitriptyline may block the antihypertensive action of guanethidine or similarly acting compounds.
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.
Note: Included in this listing which follows are a few adverse reactions which have not been
reported with this specific drug. However, pharmacological similarities among the tricyclic
antidepressant drugs require that each of the reactions be considered when amitriptyline is
administered.
Behavioral: Drowsiness, fatigue, activation of latent schizophrenia, disorientation, confusional
states, hallucinations, delusions, hypomanic reactions, disturbed concentration, nightmares,
insomnia, restlessness, agitation, excitement, jitteriness, anxiety, giddiness.
Neurological: Epileptiform seizures, coma, dizziness, tremors, numbness, tingling, paresthesias of
the extremities, peripheral neuropathy, headache, ataxia, alteration in EEG patterns, extrapyramidal
symptoms including abnormal involuntary movements and tardive dyskinesia, dysarthria, tinnitus,
incoordination, and slurred speech.
Anticholinergic: Urinary retention, dilatation of the urinary tract, constipation, paralytic ileus,
especially in the elderly, hyperpyrexia, dry mouth, blurred vision, disturbance of accommodation,
increased intraocular pressure, precipitation of latent glaucoma, aggravation of existing glaucoma,
and mydriasis.
Cardiovascular: Quinidine-like effect and other non-specific ECG changes and changes in AV
conduction, prolonged conduction time, asystole, hypotension, syncope, hypertension, palpitation,
arrhythmias, heart block, ventricular tachycardia, fibrillation, myocardial infarction, stroke,
unexpected death in patients with cardiovascular disorders.
Hematologic: Bone marrow depression, including agranulocytosis, leukopenia, eosinophilia, purpura,
thrombocytopenia.
Allergic: Skin rash, urticaria, photosensitization, edema of the face and tongue, itching.
Gastrointestinal: Nausea, epigastric distress, heartburn, vomiting, hepatitis (including altered
liver function and jaundice), anorexia, stomatitis, peculiar taste, diarrhea, parotid swelling,
black tongue may occur.
Endocrine: Testicular swelling, gynecomastia and impotence in the male, breast enlargement and
galactorrhea in the female, increased or decreased libido, elevation and lowering of blood sugar
levels, syndrome of inappropriate ADH (antidiuretic hormone) secretion.
Miscellaneous: Weakness, increased perspiration, edema, urinary frequency, alopecia, increased
appetite, weight gain, weight loss.
Withdrawal Symptoms: Abrupt cessation of treatment after prolonged administration may produce
nausea, headache, and malaise. Gradual dosage reduction has been reported to produce, within 2
weeks, transient symptoms including irritability, restlessness, and dream and sleep disturbance.
These symptoms are not indicative of addiction. Rare instances have been reported of mania or
hypomania occurring within 2 to 7 days following cessation of chronic therapy with tricyclic
antidepressants.
Aloha,
Rich
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The best defense to logic is ignorance.