Most common side effects of amitriptyline. Amitriptyline: Common Side Effects, Dosage, and Usage Guide

12.12.197627.10.2021 by alexxlab

What are the most common side effects of amitriptyline. How is amitriptyline used to treat pain and prevent migraine. What is the recommended dosage for amitriptyline. How should amitriptyline be taken for optimal effectiveness.

Содержание

Understanding Amitriptyline: A Versatile Pain and Migraine Medication

Amitriptyline is a widely prescribed medication that serves multiple purposes in the medical field. Its primary uses include treating chronic pain conditions and preventing migraines. As a tricyclic antidepressant, amitriptyline works by altering the balance of certain chemicals in the brain, which can help alleviate pain and reduce the frequency of migraine attacks.

Despite its effectiveness, it’s crucial for patients to be aware of the potential side effects and proper usage guidelines to maximize the benefits of this medication while minimizing risks.

Proper Administration of Amitriptyline: Timing and Method

How should amitriptyline be taken for optimal effectiveness? The recommended approach is to take amitriptyline once daily, preferably before bedtime. This timing is strategic, as the medication can induce drowsiness, making it an ideal choice for nighttime administration. For those who experience lingering drowsiness in the morning, taking the dose earlier in the evening might be beneficial.

Amitriptyline is generally well-tolerated by the stomach, allowing for flexible consumption with or without food. The tablets should be swallowed whole with water, as chewing them can result in a bitter taste. For liquid formulations, a plastic syringe or spoon is provided to ensure accurate dosing. It’s important to avoid using regular kitchen teaspoons, as they may not provide the correct amount.

Key Points for Taking Amitriptyline:

Take once daily, preferably before bedtime
Can be taken with or without food
Swallow tablets whole with water
Use provided measuring tools for liquid formulations

Dosage Guidelines: Finding the Right Amount for Your Needs

What is the recommended dosage for amitriptyline? The medication comes in various strengths to accommodate different treatment needs. Tablets are available in 10mg, 25mg, and 50mg strengths, while the liquid formulation offers the same strengths per 5ml.

For adults and older children (12-17 years), the typical starting dose is 10mg daily. This can be adjusted by a healthcare provider if more effective pain relief is required. Younger children’s dosages are determined based on their weight and symptoms, with specific instructions provided by the prescribing doctor.

When treating pain, the maximum daily dose of amitriptyline is 75mg. However, for migraine prevention, higher doses may be prescribed under medical supervision.

Dosage Overview:

Starting dose for adults and older children: 10mg daily
Maximum dose for pain treatment: 75mg daily
Migraine prevention may require higher doses
Pediatric dosing based on weight and symptoms

Managing Missed Doses and Avoiding Overdose

How should patients handle missed doses of amitriptyline? If a dose is forgotten, it should be taken as soon as remembered, unless it’s close to the time for the next scheduled dose. In such cases, skip the missed dose and continue with the regular dosing schedule. It’s crucial never to take two doses simultaneously or an extra dose to compensate for a missed one.

For individuals who experience drowsiness from amitriptyline and need to operate vehicles or machinery, it’s advisable to skip the missed dose if taking it would impair their ability to function safely.

To prevent missed doses, setting alarms or using pill organizers can be helpful. Pharmacists can also provide additional strategies for remembering to take the medication regularly.

Overdose Precautions:

Taking excessive amounts of amitriptyline can lead to severe side effects, including changes in heart rhythm, seizures, or fits. It’s crucial to adhere strictly to the prescribed dosage and seek immediate medical attention if an overdose is suspected.

Common Side Effects: What to Expect When Taking Amitriptyline

What are the most common side effects of amitriptyline? While the medication is generally well-tolerated, some patients may experience certain side effects, particularly during the initial stages of treatment. Understanding these potential effects can help patients better manage their expectations and recognize when to seek medical advice.

Frequently Reported Side Effects:

Dry mouth
Drowsiness
Dizziness
Weight gain
Increased appetite
Headache

These side effects are typically mild and often diminish as the body adjusts to the medication. However, if they persist or become bothersome, consulting a healthcare provider is recommended.

Less Common but Notable Side Effects

While less frequent, some patients may experience other side effects that warrant attention. These can range from cardiovascular effects to changes in sexual function.

Infrequent Side Effects:

Slow heartbeat or abnormal heart rhythm
Low blood pressure
Difficulty emptying the bladder completely
Changes in libido
Constipation
Difficulty concentrating
Insomnia
Excessive sweating

These side effects, while less common, should be monitored closely. Patients experiencing any of these symptoms should discuss them with their healthcare provider to determine if adjustments to the treatment plan are necessary.

Rare but Serious Side Effects: When to Seek Immediate Medical Attention

In rare cases, amitriptyline may cause more severe side effects that require prompt medical intervention. Being aware of these potential reactions can help patients recognize when urgent care is needed.

Rare but Serious Side Effects Include:

Serotonin syndrome (high levels of serotonin in the body)
Suicidal thoughts
Severe allergic reactions (angioedema)
Heart attack or stroke symptoms
Seizures
Severe liver problems
Unusual bleeding or bruising

If any of these severe side effects occur, it’s crucial to seek immediate medical attention. These reactions, while uncommon, can be potentially life-threatening if left unaddressed.

Special Considerations and Precautions

Certain groups of patients may need to exercise extra caution when taking amitriptyline. Healthcare providers should be informed of any pre-existing conditions or medications to ensure safe and effective treatment.

Special Considerations Include:

Elderly patients (may be more sensitive to side effects)
Patients with heart conditions
Those with a history of seizures
Individuals with glaucoma
Patients with liver or kidney problems
Pregnant or breastfeeding women

In these cases, alternative medications or adjusted dosages may be considered to minimize risks while still providing effective treatment.

Understanding the proper usage, potential side effects, and precautions associated with amitriptyline is crucial for patients to make informed decisions about their treatment. By working closely with healthcare providers and reporting any concerns promptly, patients can maximize the benefits of this versatile medication while minimizing potential risks.

As with any medication, individual experiences may vary, and the guidance of a healthcare professional should always be sought for personalized advice and treatment adjustments. Regular follow-ups and open communication with medical providers are key to ensuring the safe and effective use of amitriptyline for pain management and migraine prevention.

Amitriptyline: a medicine used to treat pain and prevent migraine

It’s usual to take amitriptyline once a day. It’s best to take it before bedtime because it can make you feel sleepy. If you find that you are still feeling drowsy in the morning you could try taking it earlier in the evening.

This medicine does not usually upset your stomach. You can take it with or without food.

Swallow the tablets whole, with a drink of water. If you chew them, they taste bitter.

The liquid comes with a plastic syringe or spoon to help you measure out the right dose. If you don’t have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give the right amount.

Dosage

Amitriptyline tablets come in 3 different strengths – 10mg, 25mg or 50mg.

The liquid also comes in 3 different strengths – containing 10mg, 25mg or 50mg of amitriptyline in a 5ml spoonful.

The usual starting dose for adults and older children (aged 12 to 17 years) is 10mg a day. This dose can be increased by your doctor if you need better pain relief.

The starting dose for younger children depends on their weight and symptoms. The doctor will tell you how much to give them.

The maximum dose of amitriptyline for treating pain is 75mg a day. Your doctor may give you a higher dose if you’re taking it to prevent migraine.

What if I forget to take it?

If you forget to take your amitriptyline, take it as soon as you remember, unless it’s nearly time for your next dose. In this case, just leave out the missed dose and take your next one as normal.

If amitriptyline usually makes you sleepy and you need to drive, cycle or use tools or machinery, skip the missed dose and then take the next dose as normal.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Taking too much amitriptyline can cause serious side effects such as a change in your heartbeat, seizures or fits.

Common and Rare Side Effects for amitriptyline oral

COMMON side effects

If experienced, these tend to have a Severe expression i

Sorry, we have no data available. Please contact your doctor or pharmacist.

If experienced, these tend to have a Less Severe expression i

dry mouth
drowsiness
dizziness
weight gain
increased hunger
headache

INFREQUENT side effects

If experienced, these tend to have a Severe expression i

slow heartbeat
abnormal heart rhythm
low blood pressure
an inability to completely empty the bladder

If experienced, these tend to have a Less Severe expression i

over excitement
altered interest in having sexual intercourse
constipation
difficulty concentrating
difficulty sleeping
low energy
excessive sweating
taste impairment
vomiting
heartburn
diarrhea
nervousness

RARE side effects

If experienced, these tend to have a Severe expression i

a disorder with excess antidiuretic hormone called syndrome of inappropriate antidiuretic hormone
large purple or brown skin blotches
decreased blood platelets
very low levels of granulocytes, a type of white blood cell
low levels of white blood cells
increased eosinophils in the blood
mental problems from taking the drug
suicidal thoughts
tardive dyskinesia, a disorder characterized by involuntary movements of the face, mouth and tongue
extrapyramidal disease, a type of movement disorder
serotonin syndrome, a type of disorder with high serotonin levels
increased pressure in the eye
a heart attack
a type of slowed heart rhythm disorder called heart block
abnormal heart electrical signals
rapid ventricular heartbeat
ventricular fibrillation, a heart rhythm disorder
sinus tachycardia, a type of fast heart rate
prolonged QT interval on EKG
a stroke
inflammation of the liver called hepatitis
increased sensitivity of the skin to the sun
hallucinations
seizures
swelling of the tongue
slurred speech
abnormal liver function tests
a type of allergic reaction called angioedema
secondary angle-closure glaucoma, a type of eye disorder
accidental falls
fast heartbeat

If experienced, these tend to have a Less Severe expression i

delusions
nightmares
agitation
aggressive behavior
feelings of hostility
disturbance in the ability of the eye to focus
dilated pupils
high blood pressure
inflammation of the parotid gland
stomatitis, a condition with painful swelling and sores inside the mouth
a discolored tongue
fainting
loss of muscle coordination
decreased appetite
weight loss
a type of speech disorder called dysarthria
heart throbbing or pounding
nausea
a feeling of pins and needles on skin
irritability
an inability to control impulsive behavior
anxious feelings

Amitriptyline Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Amitriptyline – StatPearls – NCBI Bookshelf

Continuing Education Activity

Amitriptyline is FDA approved medication to treat depression in adults. The Non-FDA approved indications are anxiety, post-traumatic stress disorder, insomnia, chronic pain (diabetic neuropathy, fibromyalgia), irritable bowel syndrome, interstitial cystitis (bladder pain syndrome), migraine prophylaxis, postherpetic neuralgia, and sialorrhea. This activity reviews the indications, contraindications, activity, adverse events, and other key elements of amitryptiline in the clinical setting related to the essential points needed by members of an interprofessional team managing the care of patients that can benefit from amitriptyline therapy.

Objectives:

Identify the mechanism of action of amitriptyline.
Describe FDA-approved and off-label indications of amitriptyline.
Review the appropriate adverse drug reactions of amitriptyline.
Outline interprofessional team strategies for improving patient outcomes.

Access free multiple choice questions on this topic.

Indications

Amitriptyline is FDA approved medication to treat major depressive disorder(MDD) in adults.[1] The non-FDA-approved indications are anxiety, post-traumatic stress disorder, insomnia, chronic pain (diabetic neuropathy, fibromyalgia), irritable bowel syndrome, interstitial cystitis (bladder pain syndrome), migraine prophylaxis, postherpetic neuralgia, and sialorrhea.[2]

Mechanism of Action

Amitriptyline is in the tricyclic antidepressant(TCA) drug classification and acts by blocking the reuptake of both serotonin and norepinephrine neurotransmitters. The three-ring central structure, along with a side chain, is the basic structure of tricyclic antidepressants. Amitriptyline is a tertiary amine and has strong binding affinities for alpha-adrenergic, histamine (h2), and muscarinic (M1) receptors.[3]

Amitriptyline increases noradrenergic or serotonergic neurotransmission by blocking the norepinephrine or serotonin transporter (NET or SERT) at presynaptic terminals. Chronic treatment with amitriptyline desensitizes presynaptic autoreceptors and heteroreceptors, producing long-lasting changes in monoaminergic neurotransmission.[4] It is more sedating and has increased anticholinergic properties compared to other TCAs. Like other antidepressants, the onset of therapeutic action typically begins at approximately 2 to 4 weeks.

There have been comprehensive studies of brain-derived neurotrophic factor(BDNF), a major neurotrophic factor that plays an essential role in the formation and survival of neurons during development and synaptic plasticity. The neurotrophic hypothesis of depression suggests that stress-related alterations in BDNF levels occur in key limbic structures to contribute to the pathogenic processes in major depressive disorder(MDD). Chronic treatment with antidepressants increases the BDNF levels, which improves the symptoms associated with MDD.[5]

Administration

Amitriptyline dosage formulations come in various forms, the most common being oral form. The initial dose recommended for depression is 25 mg/day at bedtime. For off-label use, such as for chronic pain, therapy can initiate a much lower dose of 10 to 20 mg/day. It can be increased by 25 mg every 3 to 7 days, with a maximum of 150 to 300 mg/day. If the dose needs to be adjusted, it is preferable to change the dose at bedtime.

Once the patient is stable, amitriptyline should be continued for three months or longer to prevent depression. In cases of therapy cessation, the clinician should gradually taper to avoid withdrawal.[6] Amitriptyline is not FDA-approved for pediatric depression. Therefore, the recommendation is to start with a lower dosage (around 10 mg/day) in the pediatric and geriatric population.[7]

Amitriptyline has a half-life of 10 to 28 hours, and it gets metabolized to nortriptyline. Its metabolism is primarily by CYP3A4 and CYP2C19.[8] Amitriptyline can be administered by the intramuscular route (peak concentration occurs within 2 to 12 hours of administration) and an intravenous route.[9] Administer amitriptyline at night time, as it can lead to sedation.[10]

Adverse Effects

The most commonly encountered side effects of amitriptyline include weight gain, gastrointestinal symptoms like constipation, xerostomia, dizziness, headache, and somnolence.

The following is a list of other adverse effects, including serious adverse drug reactions of amitriptyline:

Amitriptyline, due to its alpha-adrenergic receptor blockade, can cause orthostatic hypotension, dizziness, and sedation. It can also cause heart rate variability, slow intracardiac conduction, induce various arrhythmias, and cause QTc (corrected QT) prolongation.
Anticholinergic side effects include blurred vision, dry mouth, urinary retention, tachycardia, acute angle glaucoma, confusion, and delirium. [11]
Antihistamine side effects secondary to its histamine(h2) receptor binding property include sedation, increased appetite, weight gain, confusion, and delirium.[12]
Amitriptyline can decrease the seizure threshold in a dose-dependent manner; therefore, caution is required in patients with a seizure disorder. Seizure rate is 1 to 4% at 250 to 450 mg/day doses.[13]
Abnormalities in liver function tests. . Usually, the effect on the liver is mild, asymptomatic, transient, and reverses with discontinuation. Liver function tests are usually under three times the upper limit of normal It rarely causes acute liver injury.[14]
It can increase the risk of bone fracture and (rare) bone marrow suppression.[15]
Amitriptyline gets metabolized through CYP3A4. Several drugs alter the activity of CYP3A4, and thus dose should be cautiously regulated, as well as the entire patient medication regimen checked for CYP3A4 inducers and inhibitors.
Black box warning – The FDA has issued a black box warning regarding the use of amitriptyline in adolescents and young adults (ages less than 24 years). It can increase the risk of suicidal ideation and behavior.[16]
As an antidepressant, amitriptyline can rarely induce mania. Risk factors are the history of bipolar disorder, family history of mania, pharmacologically induced hypomania.[17]

Contraindications

Contraindication considerations are one of the most critical aspects while administering a drug to a patient. The following are significant considerations for amitriptyline:

Monitoring

Patients with a history of cardiac problems or patients over 50 years of age should have a baseline electrocardiogram to get the value of baseline QTc.[26]
Considering the drug’s side effect profile, the following parameters require monitoring – BMI, liver function test, thyroid function test, and serum amitriptyline concentrations.[19]
While a patient is on amitriptyline, one should monitor for increased suicidality and unusual behavior changes, especially during the first 1 to 2 months of starting medication or during periods of dosage adjustment. [27]

Toxicity

Amitriptyline toxicity is measurable by a dose of over 5 mg/kg. The clinical features of amitriptyline toxicity include neurological, cardiac, and anticholinergic signs and symptoms. Neurological symptoms include sedation, seizure, coma. Cardiac symptoms include tachycardia, hypotension, conduction abnormalities include QTc prolongation. Anticholinergic symptoms include dilated pupils, dry mouth, decreased (or absent) bowel sounds, urinary retention.

Amitriptyline toxicity can be serious and even fatal. In treating the toxicity, it is imperative to stabilize the patient, and the patient may need admission to the ICU for monitoring. The most important steps include – protecting the airways, breathing, and stabilizing circulation. Some patients may need tracheal intubation; if required, administer supplemental oxygen. If the patient is hypotensive, an IV bolus of isotonic crystalloid is a therapeutic option. If the patient remains hypotensive despite fluid resuscitation, vasopressors are the next choice. If QRS exceeds 100 msec, intravenous sodium bicarbonate is the appropriate intervention. It is cardioprotective (it increases extracellular sodium concentration) and diminishes the effect of amitriptyline on the cardiac membrane, which results in less blockage of the sodium channel.[28][29].

All patients suspected of tricyclic antidepressant overdose should receive gastrointestinal decontamination. This should include large volume gastric lavage followed by activated charcoal.[30] Seizures secondary to overdose are treatable with diazepam or lorazepam.[31][32]

Enhancing Healthcare Team Outcomes

Amitriptyline is a tricyclic antidepressant that is FDA approved to treat depression in adults. It is also used off-label to treat chronic pain syndrome, anxiety, and insomnia. It has a considerable side effect profile and is no longer commonly used as a first-line agent to treat depression. It may be useful for patients who have insomnia, severe depression, treatment-resistant depression, and patients with co-morbid chronic pain syndromes. Patients on amitriptyline can have anticholinergic, antihistaminic, and alpha-adrenergic blocking adverse effects. It may not be appropriate for patients with cardiac problems. It has many potential drug interactions, which can increase the risk of arrhythmias and serotonin syndrome. Toxicity can be life-threatening, and patients will need to be stabilized and monitored closely. Health care providers also need to know the increased risk of suicidality in children, adolescents, and young adults, which will require discussion with families.[27]

When a clinician(MDs, DOs, NPs, PAs) determines to start a patient on amitriptyline, they should counsel the patient about risks associated with amitriptyline therapy. It is always prudent to obtain psychiatry consultation when prescribing amitriptyline for major depressive disorder. There are significant drug-drug interactions of other medicines with amitriptyline; therefore, pharmacists should report back to the clinician if there is any concern. Pharmacists should also perform medication reconciliation and ensure appropriate dosage.

Specially trained nurses can provide medication counseling, evaluate patient adherence, and monitor for side effects on follow-up visits. The nurse should report to clinicians in the case of concern regarding therapy. In acute overdose of amitriptyline, emergency medicine physicians and triage nurses should rapidly stabilize the patient. Critical care physician supervision is necessary if the patient remains in the ICU. In severe overdose, clinicians should obtain a medical toxicologist consultation and contact the poison control center. In case of intentional overdose, the clinician should obtain a psychiatrist consultation.

As depicted above, there needs to be excellent communication between multiple healthcare providers involved in taking care of the patient receiving amitriptyline. Each provider should understand their responsibility and work collaboratively. When the interprofessional team collaborates in therapeutic decisions, amitriptyline can effectively treat depression, and patients can achieve optimal outcomes with minimal adverse events. [Level 5]

References

1.: Dopheide JA. Recognizing and treating depression in children and adolescents. Am J Health Syst Pharm. 2006 Feb 01;63(3):233-43. [PubMed: 16434782]
2.: Radley DC, Finkelstein SN, Stafford RS. Off-label prescribing among office-based physicians. Arch Intern Med. 2006 May 08;166(9):1021-6. [PubMed: 16682577]
3.: Gillman PK. Tricyclic antidepressant pharmacology and therapeutic drug interactions updated. Br J Pharmacol. 2007 Jul;151(6):737-48. [PMC free article: PMC2014120] [PubMed: 17471183]
4.: Hamon M, Blier P. Monoamine neurocircuitry in depression and strategies for new treatments. Prog Neuropsychopharmacol Biol Psychiatry. 2013 Aug 01;45:54-63. [PubMed: 23602950]
5.: Levy MJF, Boulle F, Steinbusch HW, van den Hove DLA, Kenis G, Lanfumey L. Neurotrophic factors and neuroplasticity pathways in the pathophysiology and treatment of depression. Psychopharmacology (Berl). 2018 Aug;235(8):2195-2220. [PMC free article: PMC6061771] [PubMed: 29961124]
6.: Wolfe RM. Antidepressant withdrawal reactions. Am Fam Physician. 1997 Aug;56(2):455-62. [PubMed: 9262526]
7.: Williams GO. Management of depression in the elderly. Prim Care. 1989 Jun;16(2):451-74. [PubMed: 2664841]
8.: Venkatakrishnan K, Schmider J, Harmatz JS, Ehrenberg BL, von Moltke LL, Graf JA, Mertzanis P, Corbett KE, Rodriguez MC, Shader RI, Greenblatt DJ. Relative contribution of CYP3A to amitriptyline clearance in humans: in vitro and in vivo studies. J Clin Pharmacol. 2001 Oct;41(10):1043-54. [PubMed: 11583471]
9.: Deisenhammer EA, Whitworth AB, Geretsegger C, Kurzthaler I, Gritsch S, Miller CH, Fleischhacker WW, Stuppäck CH. Intravenous versus oral administration of amitriptyline in patients with major depression. J Clin Psychopharmacol. 2000 Aug;20(4):417-22. [PubMed: 10917402]
10.: Leucht C, Huhn M, Leucht S. Amitriptyline versus placebo for major depressive disorder. Cochrane Database Syst Rev. 2012 Dec 12;12:CD009138. [PubMed: 23235671]
11.: Güloglu C, Orak M, Ustündag M, Altunci YA. Analysis of amitriptyline overdose in emergency medicine. Emerg Med J. 2011 Apr;28(4):296-9. [PubMed: 20923818]
12.: Zechnich R. Delirium and tricyclic antidepressants. Am J Psychiatry. 1984 Dec;141(12):1642-3. [PubMed: 6507674]
13.: Nishimura T, Maruguchi H, Nakao A, Nakayama S. Unusual complications from amitriptyline intoxication. BMJ Case Rep. 2017 Oct 10;2017 [PMC free article: PMC5652553] [PubMed: 29018010]
14.: Voican CS, Corruble E, Naveau S, Perlemuter G. Antidepressant-induced liver injury: a review for clinicians. Am J Psychiatry. 2014 Apr;171(4):404-15. [PubMed: 24362450]
15.: Rabenda V, Nicolet D, Beaudart C, Bruyère O, Reginster JY. Relationship between use of antidepressants and risk of fractures: a meta-analysis. Osteoporos Int. 2013 Jan;24(1):121-37. [PubMed: 22638709]
16.: Fornaro M, Anastasia A, Valchera A, Carano A, Orsolini L, Vellante F, Rapini G, Olivieri L, Di Natale S, Perna G, Martinotti G, Di Giannantonio M, De Berardis D. The FDA “Black Box” Warning on Antidepressant Suicide Risk in Young Adults: More Harm Than Benefits? Front Psychiatry. 2019;10:294. [PMC free article: PMC6510161] [PubMed: 31130881]
17.: Nasrallah HA, Lyskowksi J, Schroeder D. TCA-induced mania: differences between switchers and nonswitchers. Biol Psychiatry. 1982 Feb;17(2):271-4. [PubMed: 7074184]
18.: Kiyan S, Aksay E, Yanturali S, Atilla R, Ersel M. Acute myocardial infarction associated with amitriptyline overdose. Basic Clin Pharmacol Toxicol. 2006 May;98(5):462-6. [PubMed: 16635104]
19.: Sabah KMN, Chowdhury AW, Islam MS, Saha BP, Kabir SR, Kawser S. Amitriptyline-induced ventricular tachycardia: a case report. BMC Res Notes. 2017 Jul 14;10(1):286. [PMC free article: PMC5513042] [PubMed: 28709467]
20.: Graham PM, Potter JM, Paterson J. Combination monoamine oxidase inhibitor/tricyclic antidepressants interaction. Lancet. 1982 Aug 21;2(8295):440. [PubMed: 6124828]
21.: Michalets EL, Williams CR. Drug interactions with cisapride: clinical implications. Clin Pharmacokinet. 2000 Jul;39(1):49-75. [PubMed: 10926350]
22.: Alderman CP, Lee PC. Comment: Serotonin syndrome associated with combined sertraline-amitriptyline treatment. Ann Pharmacother. 1996 Dec;30(12):1499-500. [PubMed: 8968471]
23.: Dougherty JA, Young H, Shafi T. Serotonin syndrome induced by amitriptyline, meperidine, and venlafaxine. Ann Pharmacother. 2002 Oct;36(10):1647-8. [PubMed: 12243617]
24.: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda (MD): Mar 1, 2016. Amitriptyline. [PubMed: 31643729]
25.: Yoshida A, Hisatome I, Nawada T, Sasaki N, Taniguchi S, Tanaka Y, Manabe I, Ahmmed GU, Sato R, Mori A, Hattori K, Ueta Y, Mitani Y, Watanabe M, Igawa O, Fujimoto Y, Shigemasa C. Amitriptyline inhibits the G protein and K+ channel in the cloned thyroid cell line. Eur J Pharmacol. 1996 Sep 19;312(1):115-9. [PubMed: 8891586]
26.: Unterecker S, Pfuhlmann B, Kopf J, Kittel-Schneider S, Reif A, Deckert J. Increase of Heart Rate and QTc by Amitriptyline, But Not by Venlafaxine, Is Correlated to Serum Concentration. J Clin Psychopharmacol. 2015 Aug;35(4):460-3. [PubMed: 26035054]
27.: Montgomery SA. Suicide and antidepressants. Ann N Y Acad Sci. 1997 Dec 29;836:329-38. [PubMed: 9616807]
28.: Sasyniuk BI, Jhamandas V, Valois M. Experimental amitriptyline intoxication: treatment of cardiac toxicity with sodium bicarbonate. Ann Emerg Med. 1986 Sep;15(9):1052-9. [PubMed: 3017159]
29.: Ramasubbu B, James D, Scurr A, Sandilands EA. Serum alkalinisation is the cornerstone of treatment for amitriptyline poisoning. BMJ Case Rep. 2016 Apr 11;2016:10.1136/bcr-2016-214685. [PMC free article: PMC4840635] [PubMed: 27068728]
30.: Hultén BA, Adams R, Askenasi R, Dallos V, Dawling S, Heath A, Volans G. Activated charcoal in tricyclic antidepressant poisoning. Hum Toxicol. 1988 Jul;7(4):307-10. [PubMed: 3410479]
31.: Lynch R. Tricyclic antidepressant overdose. Emerg Med J. 2002 Nov;19(6):596. [PMC free article: PMC1756300] [PubMed: 12421805]
32.: Kerr GW, McGuffie AC, Wilkie S. Tricyclic antidepressant overdose: a review. Emerg Med J. 2001 Jul;18(4):236-41. [PMC free article: PMC1725608] [PubMed: 11435353]

Amitriptyline: MedlinePlus Drug Information

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: http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm.

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.

Amitriptyline (Oral Route) Side Effects

Side Effects

Drug information provided by: IBM Micromedex

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Incidence not known

Abdominal or stomach pain

agitation

black, tarry stools

bleeding gums

blood in urine or stools

blurred vision

burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings

change in consciousness

changes in patterns and rhythms of speech

chest pain or discomfort

chills

cold sweats

coma

confusion

confusion about identity, place, and time

continuing ringing, buzzing, or other unexplained noise in ears

convulsions

cool, pale skin

cough or hoarseness

dark urine

decrease in frequency of urination

decrease in urine volume

decreased urine output

difficulty in breathing

difficulty in passing urine (dribbling)

difficulty in speaking

disturbance of accommodation

disturbed concentration

dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly

double vision

drooling

dry mouth

excitement

fainting

false beliefs that cannot be changed by facts

fast, slow, or irregular heartbeat

fear or nervousness

fever with or without chills

flushed, dry skin

fruit-like breath odor

general feeling of tiredness or weakness

headache

hearing loss

high fever

high or low blood pressure

hostility

inability to move arms, legs, or facial muscles

inability to speak

increased hunger

increased need to urinate

increased ocular pressure

increased sweating

increased thirst

increased urination

irritability

lack of coordination

lethargy

light-colored stools

lip smacking or puckering

loss of appetite

loss of balance control

loss of bladder control

loss of consciousness

lower back or side pain

mental depression or anxiety

muscle spasm or jerking of all extremities

muscle tightness

muscle trembling, jerking, or stiffness

muscle twitching

nausea and vomiting

nightmares or unusually vivid dreams

overactive reflexes

painful or difficult urination

passing urine more often

pinpoint red spots on skin

poor coordination

pounding in the ears

puffing of cheeks

rapid or worm-like movements of tongue

rapid weight gain

restlessness

seeing, hearing, or feeling things that are not there

seizures

severe muscle stiffness

shakiness and unsteady walk

shivering

shortness of breath

shuffling walk

sleeplessness

slow speech

slurred speech

sore throat

sores, ulcers, or white spots on lips or in mouth

stiffness of limbs

stupor

sudden loss of consciousness

sweating

swelling of face, ankles, or hands

swelling or puffiness of face

swollen glands

talking or acting with excitement you cannot control

trouble in speaking

trouble sleeping

troubled breathing

twisting movements of body pain or discomfort in arms, jaw, back, or neck

unable to sleep

uncontrolled chewing movements

uncontrolled movements, especially of arms, face, neck, back, and legs

unexplained weight loss

unpleasant breath odor

unsteadiness, trembling, or other problems with muscle control or coordination

unusual bleeding or bruising

unusual tiredness or weakness

unusually pale skin

upper right abdominal pain

vomiting of blood

weakness in arms, hands, legs, or feet

weight gain or loss

yellow eyes and skin

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of Overdose

Clumsiness

drowsiness

low body temperature

muscle aches

muscle weakness

sleepiness

tiredness

weak or feeble pulse

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not known

Bigger, dilated, or enlarged pupils (black part of eye)

black tongue

bloating

breast enlargement in females

constipation

decreased interest in sexual intercourse

diarrhea

hair loss, thinning of hair

hives or welts

inability to have or keep an erection

increased in sexual ability, desire, drive, or performance

increased interest in sexual intercourse

increased sensitivity of eyes to light

loss in sexual ability, desire, drive, or performance

loss of sense of taste

redness or other discoloration of skin

severe sunburn

skin rash

swelling of testicles

swelling of the breasts or breast soreness in males

swelling of the parotid glands

swelling or inflammation of the mouth

unexpected or excess milk flow from breasts

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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Portions of this document last updated: Sept. 01, 2021

Side-effects, uses, time to work

Amitriptyline (a-muh-trip-tuh-leen) is a drug that can reduce your pain and discomfort, and help you get a good night’s sleep.

You can discuss the benefits and risks of taking amitriptyline with healthcare professionals before you start treatment, so you’re able to make an informed decision.

Amitriptyline is a type of drug called a tricyclic antidepressant. These drugs were originally developed to treat anxiety and depression, but when taken at a low dose they can reduce or stop pain.

Amitriptyline works by increasing the amount of serotonin your brain makes. Serotonin is a chemical, called a neurotransmitter, that the brain sends out to nerves in the body. It’s thought to improve your mood, emotional state, sleep and the way your body responds to pain.

By raising your serotonin levels, amitriptyline should change your body’s reaction to pain. The low dose won’t treat depression, but it should reduce your pain, relax your muscles and improve your sleep.

It’s safe to be prescribed to adults or children. It should help you sleep as soon as you start taking it, but significant changes to your pain and mood can take up to six weeks.

Amitriptyline is prescribed for many painful, long-term conditions that affect your muscles or bones. These include:

arthritis (arth-rye-tus)
back pain
fibromyalgia (fie-bruh-my-al-juh)
tension headaches and migraines
damage to nerve endings in limbs, which may be described to you as peripheral neuropathy (pe-rif-er-ul new-ro-pa-thee).

You may not be able to take amitriptyline if:

you’ve had an allergic reaction to a medication in the past
you have heart problems, as it can make them worse
you have uncontrolled bipolar disorder
you have the rare inherent blood disorder porphyria (por-fear-ee-ya) which affects the nervous system
you have liver or kidney problems
you have epilepsy, as it can increase the risk of seizures
you’ve had or are having treatment for depression, as some medicines can interact badly with it
you have glaucoma (glor-co-ma), as it can increase the pressure in your eye
you have extreme mood swings, thoughts of self-harming or suicide.

If you’re pregnant, breastfeeding, or want to try for a baby, you may be prescribed another medicine instead of amitriptyline.

90,000 60 reviews, instructions for use

From the side of the central nervous system and peripheral nervous system: drowsiness, asthenia, fainting, anxiety, disorientation, agitation, hallucinations (especially in elderly patients and in patients with Parkinson’s disease), anxiety, motor restlessness, manic state, hypomanic state, aggressiveness, memory impairment, depersonalization, increased depression, decreased ability to concentrate, insomnia, nightmares, yawning, activation of psychosis symptoms, headache, myoclonus, dysarthria, tremor (especially of the hands, head, tongue), peripheral neuropathy (paresthesias), myasthenia gravis, myoclonus, ataxia, extrapyramidal syndrome, increased frequency and intensification of epileptic seizures, changes in the EEG.

On the part of the cardiovascular system: orthostatic hypotension, tachycardia, conduction disturbances, dizziness, nonspecific ECG changes (ST interval or T wave), arrhythmia, blood pressure lability, disturbance of intraventricular conduction (expansion of the QRS complex, changes in the PQ interval, blockade of the legs bundle of His).

From the digestive system: nausea, heartburn, vomiting, gastralgia, increased or decreased appetite (increased or decreased body weight), stomatitis, taste changes, diarrhea, darkening of the tongue; rarely – liver dysfunction, cholestatic jaundice, hepatitis.

From the endocrine system: testicular edema, gynecomastia, breast enlargement, galactorrhea, changes in libido, decreased potency, hypo- or hyperglycemia, hyponatremia (decreased vasopressin production), syndrome of inappropriate ADH secretion.

From the hematopoietic system: agranulocytosis, leukopenia, thrombocytopenia, purpura, eosinophilia.

Allergic reactions: skin rash, pruritus, urticaria, photosensitivity, swelling of the face and tongue.

Effects due to anticholinergic activity: dry mouth, tachycardia, accommodation disturbances, blurred vision, mydriasis, increased intraocular pressure (only in persons with a narrow angle of the anterior chamber of the eye), constipation, paralytic obstruction, urinary retention, decreased sweating, confusion , delirium, or hallucinations.

Others: hair loss, tinnitus, edema, hyperpyrexia, swollen lymph nodes, pollakiuria, hypoproteinemia.

Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ^®, contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

Elavil [DSC]

Trade names: Canada

AG-Amitriptyline; Amitriptyline-10; Amitriptyline-25; APO-Amitriptyline; BIO-Amitriptyline; Elavil; JAMP-Amitriptyline; Levate; Mar-Amitriptyline; NOVO-Triptyn [DSC]; PMS-Amitriptyline; PRIVA-Amitriptyline; TEVA-Amitriptyline

Warning

Drugs like this have increased the likelihood of suicidal thoughts or actions in children and young people.This risk may be higher in people who have attempted suicide or have had suicidal thoughts in the past. All people taking this drug must be closely monitored. Call your doctor right away if you have signs such as depressed mood (depression), nervousness, anxiety, grumpiness, or anxiety attacks, or if other mood or behavior changes occur or worsen. Call your doctor immediately if you have suicidal thoughts or attempted suicides.
This drug is not approved for use in children. Consult your doctor.

What is this drug used for?

The drug is used to treat depression.
This medicinal product can be used for other indications. Consult your doctor.

What do I need to tell my doctor BEFORE taking this drug?

If you are allergic to this drug, any of its ingredients, other drugs, foods or substances.Tell your doctor about your allergy and how it manifested itself.
If you have recently had a myocardial infarction.
If you have taken a drug for depression or Parkinson’s disease in the past 14 days. These include isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline. An episode of very high blood pressure may occur.
If you are taking any of the following drugs: linezolid or methylene blue.
If you are taking cisapride.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Tell your doctor and pharmacist about all medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems. You need to make sure that this drug is safe for your medical conditions and in combination with other drugs you are already taking.Do not start or stop taking any drug or change the dosage without your doctor’s approval.

What do I need to know or do while taking this drug?

Tell all healthcare providers that you are taking this drug. These are doctors, nurses, pharmacists and dentists. You may need to stop taking this drug before doing certain types of surgery as directed by your doctor.If you stop taking this drug, your doctor will tell you when you can resume taking this drug after you have surgery or procedure.
Avoid driving or other activities that require increased attention until you see how this drug affects you.
To reduce the risk of dizziness or loss of consciousness, get up slowly from a lying or sitting position. Use caution when climbing and descending stairs.
Do not stop taking this drug suddenly without talking to your doctor. You may be at increased risk for withdrawal symptoms. If necessary, this drug should be stopped gradually as directed by your doctor.
If you have high blood sugar (diabetes), your blood sugar should be checked regularly.
Consult your doctor if you have signs of high or low blood sugar, such as fruity breath, dizziness, rapid breathing, tachycardia, confusion, drowsiness, feeling weak, flushing, headache, increased thirst or hunger , frequent urination, shivering, or sweating.
Consult your doctor before using alcohol, marijuana or other forms of cannabis, or prescription and over-the-counter drugs that may slow you down.
The risk of eye problems may be increased in some patients with this drug. Your doctor may order you to see an ophthalmologist to see if you are at increased risk of developing these eye problems. Call your doctor right away if you have eye pain, change in vision, swelling, or redness around the eye.
You can easily get sunburn with this drug. Be careful if you are in the sun. If you get sunburn easily with this drug, talk to your doctor.
Exercise caution in hot weather and during vigorous activity. Drink plenty of fluids to stay hydrated.
Some people may develop a serious muscle disorder called tardive dyskinesia.This effect may decrease or disappear after the drug is discontinued, but it may persist. People with diabetes and older people, especially older women, are at increased risk. The risk increases with long-term use or high doses, but can also occur with short-term low doses. See your doctor right away if you experience uncontrolled body movements or abnormalities in the muscles of the tongue, face, mouth, or jaw, such as protruding tongue, swollen cheeks, lips compressed into a tube, or involuntary chewing movements.
If you are 65 years of age or older, use this drug with caution. You may have more side effects.
Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding. The benefits and risks for you and your child will need to be discussed.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can have serious and sometimes deadly side effects.Call your doctor or doctor right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
Signs of high or low blood pressure, such as very severe headache or dizziness, fainting, or vision changes.
Signs of liver problems such as dark urine, feeling tired, lack of appetite, nausea or abdominal pain, light stools, vomiting, yellowing of the skin and eyes.
Weakness on one side of the body, difficulty speaking or thinking, trouble maintaining balance, drooping one side of the face, or blurred vision.
Chest pain, angina pectoris, tachycardia or irregular heartbeat.
Feeling confused, unable to concentrate, or changes in behavior.
Obstruction of the urinary tract.
Fever, chills, sore throat; the appearance of bruising and bleeding for unexplained reasons; a pronounced feeling of tiredness or weakness.
Inflammation.
Shiver.
Convulsions.
Hallucinations (a person sees or hears something that is not in reality).
Unusual burning, numbness, or tingling sensations.
Change in sex drive.
Lack of ability to achieve or maintain an erection.
Testicular edema.
Breast enlargement or nipple discharge.
Severe constipation or abdominal pain. These may be signs of a severe bowel disorder.
Lack of perspiration during physical exertion or at high ambient temperatures.
Sleep disorders.
Nightmares.
Ringing in the ears.
Changing the color of the tongue.
Excessive sweating.
Joint pain.

What are some other side effects of this drug?

Any medicine can have side effects. However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:

Constipation, diarrhea, abdominal pain, nausea, vomiting, or decreased appetite.
Feeling dizzy, sleepy, tired, or weak.
Dry mouth.
Headache.
Anxiety.
Nervous tension and agitation.
Changes in the ability to perceive taste.
Weight gain or loss.
Ulcers in the mouth.

This list of potential side effects is not comprehensive. If you have any questions about side effects, please contact your doctor.Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you.Follow all instructions strictly.

If taken once a day, take this medication 30 minutes before bedtime.
Continue taking this drug as directed by your doctor or other healthcare professional, even if you feel well.

What should I do if a dose of a drug is missed?

Take the missed dose as soon as you can.
If it is time for your next dose, do not take the missed dose and then return to your normal dose schedule.
Do not take 2 doses at the same time or an additional dose.

How do I store and / or discard this drug?

Store at room temperature in a dry place. Do not store in the bathroom.
Store all medicines in a safe place. Keep all medicines out of the reach of children and pets.
Dispose of unused or expired drugs.Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicinal products

If your health does not improve or even worsens, see your doctor.
You should not give your medicine to anyone and take other people’s medicines.
Some medicines may come with other patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
A separate patient instruction sheet is attached to the product. Please read this information carefully. Reread it every time you replenish your supply. If you have questions about this drug, talk with your doctor, pharmacist, or other healthcare professional.
If you think an overdose has occurred, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are suitable for a particular patient.This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient. Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a treatment guide and does not replace information provided to you by your healthcare professional.For complete information on the possible risks and benefits of taking this drug, consult your doctor. Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

Copyright

90,000 Whom antidepressants will not help – Gazeta.Ru

The number of visits to doctors due to depression is growing from year to year.Most often, experts fight it with antidepressants, but treatment is not always effective. How to recognize depression and who will not be helped by pills, Gazeta.Ru figured out with the help of an expert.

Today almost everyone has heard about depression – the frequency of complaints of depressive symptoms is growing year after year. At the same time, however, not everyone understands what actually lies behind this diagnosis, and they are also afraid to take antidepressants, considering them almost narcotic drugs.

“People began to complain of depression more often, but I don’t think it’s because there are more depressions,” psychotherapist Pavel Beschastnov told Gazeta.Ru. – People have increased psychological literacy and awareness. Modern antidepressants are easier to use — they have fewer side effects and are easier to start taking. ”

Depression has been known since ancient times – it was described in detail by Hippocrates under the name “melancholy”. He also identified the main symptoms: depression, insomnia, irritability, anxiety, and sometimes aversion to food.Hippocrates, however, believed that the cause of the disease was an excess of “black bile” in the body and suggested treating it with a special diet and herbal infusion with a laxative and vomiting effect in order to remove excess bile from the body.

References to depressive states are found even in ancient Egyptian papyri – there, however, it is recommended to treat it by expelling demons from a sick person.

More recent treatments for depression have not been particularly effective either. In the Middle Ages, depression was treated with prayers, abstinence from certain foods, “moderation” in sexual activity.During the Renaissance, depression came to be considered a disease of the aristocrats, and treatment was appropriate – sunbathing, wine, theater performances.

Later approaches became more radical – patients were spun in centrifuges, watered with cold water and even infected with scabies and lice as an external irritant. In the 19th century, emetic tartar, henbane, camphor solution in tartaric acid became popular “medicines”. Later, cocaine was added to them – however, at the suggestion of Sigmund Freud, they tried to treat many ailments.

The main risk factor for the development of depression is difficult experiences both in childhood and in adulthood. Episodes of violence, death of loved ones, significant changes for the worse – all of this can provoke a depressive episode. But in about a third of cases, depression occurs without noticeable external shocks. In the first case, depression is called reactive, in the second – endogenous.

Depression can also occur against the background of alcoholism, drug use, a number of medications, or be the result of diseases affecting the brain (Alzheimer’s disease, traumatic brain injury, atherosclerosis of the arteries of the brain, etc.).NS.).

Depression differs from the usual bad mood in its duration and influence on the usual way of life.

“The simplest things required colossal efforts. I remember I burst into tears because a bar of soap was washed off in my bathroom. I was crying because a key on the computer keyboard sank for a second. Everything was devastatingly difficult for me. For example, the desire to pick up the phone required an effort comparable to the need to squeeze a two-hundred-kilogram barbell lying down, “- American writer Andrew Solomon described his condition during his illness in his book” The Demon of the Midday.Anatomy of Depression “.

“If a condition interferes with normal daily life, affects decisions made, work, in general, goes beyond the usual norm – you should see a doctor,” says Beschastnov. – The second criterion is continuity, constancy. If a bad mood does not go away for two weeks or more, it is no longer just a bad mood. Because normally, whatever the blues, it cannot last continuously. When a person is lousy day after day, this is already a pathological condition. “

Recurrent or chronic course of depression is detected in at least 20% of patients. A protracted course or frequent relapses of depressive attacks, separated by incomplete remissions, can ultimately lead to complete disability.

The most tragic outcome of depression is suicide. Suicide attempts are undertaken by 30-70% of patients suffering from depression (every seventh patient makes such an attempt), and the frequency of completed suicides is 15%.Younger depressed patients attempt suicide more often than adults.

Of the 10-20 million suicide attempts made annually (one million of which are successful), up to 50% are among patients suffering from depression.

Due to the combined influence of suicidal risk factors and increased vulnerability to other diseases (hypertension, endocrine, dermatological and other diseases), depression reduces life expectancy by 10 years.

There are several theories explaining the mechanism of depression.According to the most popular of them, depression occurs as a result of a malfunction in the metabolic mechanism of neurotransmitters, substances that are responsible for the transmission of signals between neurons. With depression, serotonin, norepinephrine, dopamine, and other neurotransmitters do not reach the synapses in sufficient quantities. This leads to apathy, depression, anxiety, social phobias. In different patients, the balance of neurotransmitters is different, and therefore depression has its own “shade” in each of them.

The main problem is considered to be a lack of serotonin, therefore, most modern antidepressants are directed to increase its concentration in synapses (however, many also affect the concentration of other neurotransmitters).

The first antidepressants appeared in the USA in the 1950s. It happened by accident while testing new anti-tuberculosis drugs. It turned out that they not only effectively fight tuberculosis, but also contribute to an increase in mood and a surge of energy in patients. In the 1960s, antidepressants also appeared in the USSR.

Early antidepressants had many side effects, from sleep disturbances and seizures to liver damage and even heart attacks, and helped a small number of patients.As psychiatry advanced and the understanding of the mechanisms of depression increased, safer and more effective drugs have emerged.

The most modern antidepressants are selective serotonin reuptake inhibitors (SSRIs). They block the reuptake of serotonin by the neurons secreting it, which leads to an increase in its amount in the synaptic cleft. Common side effects of SSRIs include nausea, anxiety, and decreased sex drive.

“The side effects in modern drugs are generally tolerable.In about 40% of cases, it turns out that there are unpleasant effects, but in order to improve his condition, the patient is ready to endure. In 10-15% percentages, the effects are such that the patient refuses the drug and needs to look for another one. Despite the abundance of drugs, there are difficulties in the selection. There are also resistant depressions that simply do not respond to treatment, ”says Beschastnov.

Now doctors are more willing to prescribe antidepressants than 20 years ago – they have entered into widespread practice.

Contrary to popular belief, antidepressants are not “happiness pills” that boost mood and energize. Their task is to align the disturbed balance of neurotransmitters in the brain. They will have no effect on a person who is not depressed. They will help a patient with depression get rid of melancholy, lethargy and irritability, and increase mental activity.

There are also drugs that affect the seizure of norepinephrine, dopamine, or several neurotransmitters at once.Not all of them are tolerated as well as SSRIs, so they are rarely the first choice.

There is a lot of debate around antidepressants about their effectiveness. Some studies and even meta-analyzes show that they do not work much better than placebos and may only be recommended in the most severe cases. Specifically, in 2017, Danish scientists 90,099 published 90,100 meta-analyzes of 131 studies, which concluded that the possible small beneficial effects of SSRIs were outweighed by serious side effects.

In response, a much more extensive meta-analysis of , which included 522 double-blind randomized trials, compared the effectiveness of 21 antidepressants with placebo and each other in treating clinical depression, was the answer. Including used and unpublished in journals data available at the disposal of pharmaceutical companies.

Each of the drugs was shown to be 15–55% more effective than placebo.

The most effective were agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, the least effective were fluoxetine, fluvoxamine, reboxetine, trazodone.

Researchers, however, remind that the effectiveness of a particular drug may differ from patient to patient – this is influenced by the severity of the condition, gender, age and other characteristics. In the analysis, mean values were considered. In addition, the study investigated a two-month period of taking antidepressants, while in reality they are sometimes taken for years.

“It still works. There is a consensus on this issue in the professional society.

Indeed, there are studies that show that antidepressants are useless, but against them there is a huge body of work supporting their effectiveness.Here you need to consider each study separately – the design of the experiment, how correctly the questions were posed, how the subjects were examined, – Beschastnov notes. “In my experience, antidepressants are undoubtedly effective. This is not a panacea, but in certain situations, they help. In twenty years of work, I have prescribed them thousands of times and have seen the results many times, like all my colleagues. ”

One of the problems with SSRIs is that up to a third of patients do not respond to therapy. The reasons for this are not yet clear, but scientists from the Salk Institute for Biological Research believe that it may be in the structure of serotonergic neurons.They came to such conclusions by taking skin samples from 800 patients with depressive disorders, reprogramming them into pluripotent stem cells and growing serotonergic neurons from them. Study participants responded to varying degrees of SSRI therapy, and researchers found a correlation between neuronal structure and drug efficacy.

Also, researchers have identified genes that determine the characteristics of the structure of neurons. They expect that in the long term this will help to select the most suitable drugs for patients with depression, as well as to find out the reason for the immunity of neurons to SSRIs.

British specialists complain that psychiatrists do not warn patients about withdrawal from drugs – they mistake its symptoms for a new depressive episode and return to drugs again. It is believed that the withdrawal syndrome is mild and goes away within a week, but the experience of patients shows that this is not so – nausea, anxiety attacks, insomnia, “flashes” in the head, similar to electric shocks, and other unpleasant sensations can haunt them for a long time …

Experts call on the National Institute for Health and Clinical Excellence (NICE) of the UK Ministry of Health to revise clinical guidelines and bring them in line with reality, and to oblige doctors to inform patients about possible symptoms so that they are not afraid of their appearance.

Symptoms and their severity in withdrawal symptoms are very individual.

However, the longer the drug is taken, the higher the likelihood of encountering them.To alleviate the condition, it is necessary to give up the drug gradually, reducing its dosage by a quarter or a third over several weeks. When prescribing an antidepressant, it takes from two weeks to a month for it to take effect – about the same time it takes to “get off” from it. If the withdrawal syndrome worsens, the dosage should be reduced even more slowly.

Psychotherapy can facilitate the process of quitting antidepressants.

The most effective cognitive-behavioral therapy, which allows you to develop new patterns of behavior in response to external factors.

Also, during the period of withdrawal from antidepressants, it is recommended to devote more time to physical activity, proper nutrition, and hobbies. A mood diary will allow you to track your condition, notice in time if it worsens, and seek help.

Amitriptyline instructions for use, price in pharmacies in Ukraine, analogues, composition, indications | Amitriptyline film-coated tablets of the company “OZ GNTSLS”

Amitriptyline is a tricyclic antidepressant that was synthesized in 1960.and was approved for use in medical practice back in 1961 in the United States. Amitriptyline is still one of the prescribed antidepressants today. It is also often used as a comparator in studies of the therapeutic effect of new antidepressants (Leucht C. et al., 2012). It is believed that drugs of the antidepressant group (amitriptyline) are more effective in patients with severe forms of depression (Leucht C. et al., 2012). Interestingly, in many recent studies of the effectiveness of antidepressants, it was noted that the response rate to placebo increased.A commentary on this trend can be that the trend in the treatment of mild forms of depression is increasing, when, perhaps, there is still no urgent need for drug treatment and preference should be given to psychotherapeutic methods. However, the results of previous studies indicate the superiority of amitriptyline over placebo. There is no convincing evidence of an increase in mortality among patients due to adverse drug reactions (Leucht C. et al., 2012).

Depression: symptoms and urgency of the problem

Depression is a mental disorder with a wide range of symptoms.The main signs of depression are depressed mood and decreased / loss of interest or pleasure. The disease is often accompanied by a number of other manifestations, such as fatigue, loss of appetite and body weight, poor concentration, decreased libido, sleep problems, inadequate guilt and suicidal thoughts, mental retardation and decreased motor activity, pessimistic attitude towards others, low self-esteem. Depression is a common mental disorder.15-18% of the total number of people in the world have experienced depression symptoms at least once during their life that require medical intervention. In 2005, the World Health Organization (WHO) estimated that more than 120 million people worldwide are affected by depression. In the same years, it was predicted that by 2020 depression may become the most common disease in the world after diseases of the cardiovascular system. For example, depressive disorders in Germany ranked third in the list of diseases of a massive nature, after diseases of the cardiovascular system and digestive organs (Leucht C.et al., 2012). Suicide rates are significantly higher in persons with major depression than in the general population.

Various methods of diagnosis and therapy of this disease are available today. As a rule, complex treatment is carried out using drug therapy and psychotherapeutic methods. Among the psychotherapeutic methods of treatment, the most effective is the use of cognitive-behavioral therapy.

The basis of pharmacological treatment is the appointment of antidepressants (various groups).The first tricyclic antidepressant (TCA) was imipramine (1955). Soon after, other drugs belonging to this group were synthesized. Amitriptyline , an antidepressant belonging to the same group, was used in 1961 and is actively prescribed today. For example, it was the third most frequently prescribed antidepressant in Germany after citalopram and mirtazapine in 2008 (Leucht C. et al., 2012). In addition to the treatment of depressive disorder, amitriptyline has also been prescribed for the treatment of other forms of depression, chronic pain, migraine and anxiety disorders, although there is no official indication for this (instruction).

In the last three decades, the TCA group has been partially replaced by newer drugs, in particular selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors or selective serotonin and norepinephrine reuptake inhibitors. The main advantage of SSRIs is their overall better tolerability compared to TCAs. Today there is no consensus on whether amitriptyline can be more effective than SSRIs, in particular, in patients with severe depression (Guaiana G.et al., 2007).

It is believed that new antidepressants should be prescribed only to patients with severe depression, and not in mild forms, when they are often prescribed. This opinion was also criticized by other researchers (Leucht C. et al., 2012). Perhaps other drugs should be selected for the treatment of mild forms of depression, since the poor tolerance of amitriptyline and its side reactions should be taken into account.

One of the theories of the etiology of depression is dysfunction of the monoamine system of the brain (monoamine theory), including the neurotransmitters serotonin and norepinephrine.Amitriptyline increases the concentration of these neurotransmitters in the synaptic cleft, suppressing their reuptake into the presynaptic neuron. Inhibition of reuptake is achieved by blocking the carriers of norepinephrine and serotonin. Amitriptyline has a relative affinity for these two receptors, whereas clomipramine, for example, has a much higher affinity for serotonin compared to the norepinephrine transporter.

Amitriptyline – antagonist against various other neuroreceptors, such as histamine H ₁ -receptors, muscarinic cholinergic receptors, α ₁ -adrenergic receptors and 5-HT2A receptors, this action is presumably associated with the development of side reactions during therapy …

Treatment of neuropathic pain in adults

In 2011, the International Association for the Study of Pain named neuropathic pain as “pain caused by an injury or disease of the somatosensory system”. Neuropathic pain is pain resulting from abnormal firing of neurons in the peripheral or central nervous system.

Many people with neuropathic pain conditions have had moderate to severe pain for many years. Chronic pain is one of the most common causes of disability, reduced quality of life, disability and increased costs of therapy.According to different authors, it is believed that neuropathic pain is noted in 3-10% of the population (Moore R. et al., 2015). The most common pathological conditions in which this type of pain occurs are diabetic neuropathy, postherpetic neuralgia, pain after a stroke, and neuropathic pain can develop as a consequence of trauma, surgery, amputation (phantom pain), in spinal patients, with trigeminal neuralgia, HIV. Signs of neuropathic pain can be detected in patients with joint pain.Sometimes neuropathic pain is idiopathic when the cause is unknown.

Neuropathic pain differs from pain that occurs when tissue is damaged, for example, with injuries from a fall or injection, with arthritis of the knee joint, which is not accompanied by damage to the nerve fiber itself. It is known that drugs that are often used for pain relief, such as paracetamol or ibuprofen, are usually ineffective for neuropathic pain. This type of pain is difficult to treat.Only a small number of patients experience clinically significant improvement with drug therapy. Today it is proposed to combine drug therapy with physical or cognitive techniques. Sometimes, however, some patients have seen a therapeutic effect from the use of a lidocaine patch or topical application of preparations containing capsaicin (an alkaloid found in various types of capsicum). Treatment is often given with antidepressants such as amitriptyline or duloxetine, or antiepileptic drugs (Moore R.et al., 2015). Amitriptyline is often prescribed for the treatment of neuropathic pain conditions. It has been a first-line treatment for neuropathic pain for many years; recommended for this purpose in many manuals. For example, antidepressants for the treatment of this disease are offered as first-line drugs in the latest Canadian guidelines and updated guidelines of the International Association for the Study of Pain. It is also worth noting that with this pathology, antidepressants should be prescribed in doses lower than those prescribed for depression.

Amitriptyline probably does not work for neuropathic pain associated with human immunodeficiency virus (HIV) or cancer treatment. However, it must be remembered that amitriptyline helps relieve pain in about 1 in 4 (25%) patients to whom it was prescribed, and about 25% of patients report the development of side effects that are usually not serious.

Adverse reactions

During drug therapy, a number of side effects are observed, which may include agitation, anxiety, delirium, problems with learning and assimilation of new information, anticholinergic effects (constipation, dry mouth, nasal congestion, problems with urination, vision problems).It is also possible to develop such undesirable reactions as blurred or blurred vision, delirium, dizziness and sedation, tachycardia, arterial hypotension, sexual dysfunction and weight gain. Cases of suicidal thoughts or behavior have been reported during therapy or immediately after discontinuation.

Method of administration and recommended doses

Treatment begins with minimum doses, followed by an increase. The therapy takes place under the clinical supervision of the effectiveness and development of adverse reactions.

For adults, the starting dose is 25 mg per dose, 3 r / day. The dose is increased every other day (every 2nd day) by 25 mg / day to a daily dose of 150 mg. Daily doses above 150 mg should be used exclusively in a hospital setting.

The duration of therapy is usually determined by clinical need. The antidepressant effect when taking the drug usually develops during the first 2-4 weeks. At the same time, the course of treatment can last up to 6 months and even up to several years with recurrent unipolar depression.

Neuropathic pain. The starting dose is 25 mg of the drug, taken in the evening. The dose can be gradually increased until the onset of a therapeutic effect. The maximum dose of amitriptyline recommended for the treatment of chronic pain is 100 mg 1 p / day (usually taken in the evening). For elderly patients, half of this dose is recommended.

Amitriptyline is approved for use in children from 7 years of age for the treatment of nocturnal enuresis.For children aged 7-12 years – 25 mg 1 p / day, for children over 12 years old – 50 mg 30-60 minutes before bedtime (duration of therapy – no more than 3 months). At the same time, the drug is not recommended for use in children and adolescents for the treatment of depression, since there is no information on the effectiveness in this age group. In addition, in pediatric patients, the risk of side effects is increased.

Antidepressants – stopstress.lv

They must be taken every day. Since the use of antidepressants, depending on the time of day, can change their effect on the body, it is necessary, if possible, to take antidepressants at the exact time of day at which your doctor recommended.

You need to know that antidepressants are non-addictive and are prescribed for long-term treatment.

Antidepressants, like other medicines, have their own side effects. The most common side effect that a patient may encounter at the very beginning of treatment is loss of appetite and nausea. The mechanism of this side effect is well understood. Most antidepressants increase the amount of serotonin, which is associated with the effect of normalizing mood and improving well-being.But since 90% of the body’s serotonin receptors are located in the gastrointestinal tract, too rapid an increase in serotonin leads to irritation of these receptors in the first days of taking the medication. Within 1-2 weeks after starting the antidepressant, this side effect spontaneously usually disappears In almost all cases, nausea passes rather quickly with a slower increase in doses of the drug at the very beginning of its use. It is extremely rare cases of intolerance to antidepressants, when nausea does not decrease and lasts more than two weeks, in these cases it is necessary to consult with your doctor.This side effect has nothing to do with any stomach ailment and disappears completely when the drug is discontinued.

Another side effect that patients taking antidepressants should be aware of is various sexual dysfunctions. They appear in both men and women. The mechanism of this phenomenon is also well understood and is also associated with an increase in serotonin in the body. This phenomenon does not decrease and does not disappear with further administration of antidepressants in the same doses, however, when the drug is discontinued, it disappears without a trace.In no case should you refuse to use the drug, but you should not continue to experience this side effect either. It is necessary to inform the attending physician about this in order to find the most suitable solution for this problem. Currently, many ways are known how to deal with this. The doctor may suggest that you, for example, change the dose of the drug, replace the antidepressant, add other medications to reduce the manifestation of this side effect, or, in certain cases, with a stable state of health, on certain days he will recommend refusing to use the medication, given that these days the action side effect is significantly reduced.

In patients with arterial hypertension, when taking antidepressants, blood pressure usually normalizes, and, perhaps, from time to time, it will be necessary to reduce doses and even cancel antihypertensive drugs. Although in rare cases, when taking some antidepressants, it is also possible to increase blood pressure.

If you are taking antidepressants and you begin to notice puffiness in your legs, weight gain, or unusual vivid dreams, you need to pay attention to this by your doctor, since these manifestations, in all likelihood, may be associated with the use of these drugs.The possible increase in body weight when taking antidepressants is due to the fact that with the improvement of the condition in patients, anxiety and anxiety are significantly reduced or generally disappear. And the body no longer burns calories, but begins to accumulate them, so you need to monitor your weight and calorie intake.

When using antidepressants, allergic manifestations are usually not observed, and in the case of allergies, another cause must be sought.

AKOS – instructions for use, description, reviews of patients and doctors, analogues

Form of issue, composition and packaging

The drug Amitriptyline AKOS is available in the form of a clear, colorless liquid intended for intramuscular injection.The solution is poured into hermetically sealed 2 ml glass ampoules made of transparent, chemically neutral glass. Ampoules are packed in polymeric contour packages, 5 pieces in each, which, in turn, are packed in white and blue cardboard boxes, 2 packages for each. In addition to the ampoules, a special scarifier is put into the pack to open them (except for situations when an alternative way of opening the ampoule is pre-installed in the design of the ampoule), and the official instructions for use, which must be read.The description posted on the website of our pharmacy is posted for informational purposes, and may not contain specific details of the use of this medication, therefore, before buying and using Amitriptyline AKOS, you need to consult a doctor and read the official annotation.
In our pharmacy, you can buy Amitriptyline AKOS at a bargain price, having previously specified its availability via the Internet, and having booked the required number of packs of medicine. The pharmacists of our pharmacy will provide each client with a specialized consultation, explain the features of a particular drug, tell you what reviews other buyers have left on Amitriptyline AKOS.For privileged categories of citizens, we have a delivery service in Moscow and the region – this service does not apply to prescription drugs.
The main active ingredient in Amitriptilin Akos is amitriptyline hydrochloride, a substance belonging to the class of tricyclic antidepressants. 1 milliliter of working solution contains 10 active substances. The auxiliary substances are:
• Glucose monohydrate;
• Sodium chloride;
• Benzethonium chloride;
• Purified and prepared water for injection.The mass fraction of auxiliary components per milliliter of solution can be found in the official instructions from the manufacturer.

Pharmacological action

The tricyclic antidepressant amitriptyline, which is the main active component of the drug Amitriptyline AKOS and its analogues, has a number of properties that allow it to be used to treat depression, nervous disorders, and in some cases, peptic ulcer and enuresis.The main effect of amitripiline is to slow down the reuptake reactions of norepinephrine, seratonin and other monoamines, in which these hormones, after entering the synaptic cleft, partially return to neurons. Weakening the reuptake process helps to increase the level of these hormones in the body. With a long course of treatment, the drug also reduces the activity of specific receptors for serotonin, adrenaline, and their derivatives. The drug also affects histamine, m-anticholinergic, and some other receptors, which explains its additional properties.So, the blockade of histamine and m-cholinolytic receptors allows you to weaken pain in the abdominal region caused by ulcerative erosions, and to accelerate their healing, or to reduce the sensitivity of the bladder, increasing the limit of its expansion and the tone of the sphincters. Amitriptyline AKOS is able to provide both stimulating and sedative effects, depending on the dose. At the same time, the sedative effect in the case of this drug is more pronounced, and, in general, prevails.

Pharmacokinetics

The drug has a high absorption rate.The bioavailability of a solution of Amitriptyline AKOS 10 mg / ml 2ml 10pcs is higher than that of analogues containing the same active ingredient, but produced in a different dosage form. When it enters the blood, it actively forms bonds with the protein components of the plasma, accumulates in tissues, the concentration in which is capable of exceeding the concentration in the blood serum. The active substance amitriptyline and its metabolites demonstrate the ability to penetrate the histocytic barriers, including the nervous system, pass through the placenta, and are excreted in breast milk
To achieve the maximum concentration of the active substance amitriptyline in the blood, it is necessary, on average, from 2 to 8 hours.With constant intake, the equilibrium concentration is reached within 1-2 weeks after the start of administration. A pronounced antidepressant effect develops 2-4 weeks after the start of the course. The drug undergoes active metabolism in the liver – the active metabolite nortriptyline becomes the main product of these processes. Isozymes of the cytochrome system are actively involved in metabolic processes, which must be taken into account when taking this antidepressant together with any inhibitors of the P450 system.The process of excretion of amitriptyline and its active and inactive metabolites by 80 percent occurs through the kidneys, with urine. The intestines are the second most important elimination channel. The half-life of amitriptyline in a patient with intact liver and kidney function is 10 to 28 hours. The main active metabolite is excreted longer – its half-life is from 16 to 80 hours.

Readings

The drug Amitriptyline AKOS is recommended for use when:
• Depression of an endogenous nature;
• Depression caused by other reasons;
• Disorders of the schizophrenic spectrum, as an element of comprehensive treatment;
• Emotional disorders;
• Disorders of attention;
• Enurese;
• Bulimia;
• Chronic pain;
• Ulcer of the stomach or intestines.Due to the predominance of the sedative component, the drug effectively reduces anxiety, helps to cope with the painful need to move, relieves fears, and helps to cope with insomnia.

Contraindications

Amitriptyline AKOS is not recommended for use with:
• Allergic reactions to any of the components of the drug;
• Heart attack, or in the process of recovery after it;
• Severe heart failure, heart block;
• Severe increase in blood pressure;
• Adenoma of the prostate;
• Weakening of the walls of the bladder;
• Violations of the motor function of the intestines, which provoked its obstruction;
• Narrowing of the opening between the stomach and the duodenum;
• Acute attacks of stomach ulcers;
• Severe liver failure;
• Severe renal failure.Taking any tricyclic antidepressants in conjunction with monoamine oxidase inhibitors can lead to serious side effects, including death, therefore, the joint use of these drugs is strictly prohibited.
The Food and Drug Administration of the United States of America has assigned category C amitriptyline.This means that there is no data regarding the safety of the drug during pregnancy, since there have been no relevant controlled clinical studies in humans.Animal studies have shown the ability of amitriptyline to negatively affect fetal development. These data cannot be fully extrapolated to humans, but the use of this antidepressant for the treatment of pregnant women is not recommended, especially in the 1st and 3rd trimesters. If the use of the drug is caused by a vital necessity, the woman should be warned of the possible risks, and she and the unborn child should be provided with appropriate medical supervision. Before starting the course of treatment, women of childbearing age are advised to undergo an appropriate pregnancy test, and during the course – to use reliable contraceptives.If pregnancy was detected during the course of treatment, the antidepressant should be stopped and the doctor should be contacted for a specialized consultation.
Amitriptyline is also able to be excreted in breast milk at a significant concentration. It is reported that children whose mothers took this antidepressant showed a tendency to drowsiness and the occurrence of specific side effects, therefore, it is recommended to interrupt breastfeeding during treatment.The drug is also not recommended for administration to children under 12 years of age.
Before you buy a solution of Amitriptyline AKOS 10 mg / ml 2ml 10pcs – be sure to consult a doctor who can prescribe the necessary examinations, determine the presence of contraindications, and make an informed decision about the advisability of taking the drug.

Dosage and administration

This form of the drug is administered intramuscularly by injection.It is forbidden to give subcutaneous and intravenous injections, or use the solution in any other way not described in the instructions. It is recommended to administer the drug 4 times a day. The dosage can range from 10 to 30 mg of the active substance in a single dose – the attending physician should prescribe the exact dose. He also decides to increase the dose of the medicine. This should be done gradually, without exceeding the maximum dose of 150 milligrams of amitriptyline per day.
Amitriptyline AKOS in the form of intramuscular injections is recommended for the relief of severe depressions.After 1-2 weeks, the patient is recommended to switch to the oral analogue of the drug. The oral version is also recommended for the treatment of bedwetting in children under 12 years of age. If, a month after the start of treatment, there is no persistent effect from it, you should consult a doctor to adjust the treatment plan. The course of treatment can last up to 6-8 months.
Patients aged 65+ and people suffering from renal and hepatic insufficiency may need to reduce the dose of antidepressants compared to healthy people, since in their case the drug is metabolized and excreted from the body more slowly.

Side effects

The drug Amitriptyline AKOS is capable of causing a number of unwanted side effects. The most common ones are:
• Increased appetite;
• Weight gain;
• Trembling of the limbs;
• Pain in the head;
• Drowsiness;
• Clouding of consciousness;
• Difficulties with orientation in space;
• Disturbances of attention;
• Obsessive desire to move;
• A burning sensation of the skin;
• Increased symptoms of epilepsy;
• Violation of the coordination of muscle movements;
• Acute dystonia;
• Difficult work of the speech apparatus;
• Dilatation of the pupils;
• Decreased visual acuity;
• Orthostatic collapses;
• Heart rhythm disturbances;
• Nausea;
• Dry mucous membranes in the mouth;
• Constipation;
• Damage to tooth enamel;
• Atrophic changes in the gums;
• Increased sweating;
• Problems with erection;
• Decreased sex drive.In rare cases, the drug can cause more serious side effects such as heart attack, liver inflammation; intestinal paralysis. A complete list of unwanted side effects can be found in the official instructions. If any undesirable effects appear, you should immediately contact your doctor who can assess the safety of continuing the course of treatment.
With an abrupt termination of the course of treatment, some patients experience a “withdrawal syndrome”, which includes such symptoms as:
• Nausea;
• Vomit;
• Diarrhea;
• Pain in the head;
• Sleep problems;
• Nightmares;
• Irritability;
• Outbursts of aggression and irritability.In order to avoid the occurrence of this syndrome, one should exit the course of treatment gradually – this will avoid most of the undesirable effects, or reduce their intensity.

Overdose

If the recommended dose of the drug is exceeded, symptoms such as:
• Insomnia;
• oppression of consciousness;
• Coma;
• Hallucinations;
• Epileptic seizures;
• Confused consciousness;
• Loss of orientation in space;
• Violation of the heart rhythm;
• Drop in pressure;
• Violation of the conduction of impulses in the heart muscle;
• Cardiac arrest;
• Vomit;
• Increased body temperature;
• Coloring of the skin in a bluish color;
• Sweating;
• Delayed urine separation.Overdose symptoms in the victim occur, on average, 4 hours after poisoning. They gradually increase, the peak is observed one day after taking an increased dose of antidepressants. Symptoms of poisoning can persist from 4 days to a week.
Due to the ability of the active substance amitriptyline to accumulate in body tissues, hemodialysis and other similar procedures are ineffective in case of poisoning. The victim must be taken to a medical facility and placed under medical supervision.First of all, cardiac and respiratory function are subject to control. The treatment used depends on the symptoms observed; in some cases, the patient may require artificial ventilation of the lungs, or other resuscitation measures.

Drug interactions

The drug Amitriptyline AKOS can significantly increase the effect of other antidepressants or drugs that depress the central nervous system, therefore, it is not recommended to combine such drugs.Also, during the course of treatment, it is contraindicated to consume alcoholic beverages. An increase in the effect is also possible when the drug is combined with anticholinergics; therefore, such combinations of drugs require caution and constant medical monitoring of the patient’s condition.
If it is necessary to conduct a course of treatment with monoamine oxidase inhibitors, the antidepressant should be discontinued at least 2 weeks before the start of a new course of treatment, otherwise the risk of dangerous side effects, including death, increases.The use of the drug in a place with any isochrome inhibitors can cause poisoning, since the active substance amitriptyline begins to be processed more slowly by the body and accumulates in it.
Before you buy a solution of Amitriptyline AKOS 10 mg / ml 2ml 10pcs at a bargain price – be sure to consult with your doctor and tell him about all the medications you are taking.

Special instructions

When taking Amitriptyline AKOS, it is recommended to avoid an abrupt change in the position of the body in space, since there is a risk of developing orthostatic collapse.Because of the drug’s ability to block the transmission of nerve impulses in the heart muscle, patients suffering from heart problems should take this antidepressant with care.
When taking amitriptyline, the likelihood of developing seizures increases, especially in patients prone to epilepsy. Patients aged 65+ should take the drug with caution – they have an increased chance of developing intoxication due to a slowdown in metabolic processes. The elderly also have a higher risk of developing drug psychosis.Patients prone to constipation More often than others, they suffer from such an adverse reaction as intestinal obstruction.
Amitriptyline AKOS causes dizziness, increased fatigue, clouding of consciousness, and other side effects that can directly affect the reaction rate and decision-making time. During the course of treatment, it is not recommended to drive or perform other tasks requiring an increased reaction speed.

Terms and conditions of storage

The shelf life of the drug is 2 years from the date of issue.Store the ampoules at room temperature, in a place protected from the sun.

Prices for Amitriptyline-AKOS in Moscow

Favorable prices

Certificates and licenses

90,000 Amitriptyline is… What is Amitriptyline?


Amitriptyline
Chemical compound
IUPAC	5- (3-Dimethylaminopropylidene) -10,11-dihydrodibenzocycloheptene
Gross- Formula	C ₂₀ H ₂₃ N
Mol. mass	277.403 g / mol
CAS	50-48-6
PubChem	2160
DrugBank	APRD00227
Classification
ATX	N06AA09
Pharmacokinetics
Bioavailability		30-60%
Metabolism		Liver
Half-life		10-26 h
Excretion		Kidney
Dosage forms
tablets (dragees) 10, 25, 50, 75 mg; retard capsules 50 mg; 1% solution in ampoules, 2 ml.
Route of administration
inside, intramuscularly, intravenously (drip)
Trade names
Amitriptyline, Amisole, Amyrol, Saroten retard, Tripisol, Elivel

Amitriptyline (lat. Amitriptylinum ) is one of the main representatives of tricyclic antidepressants, along with imipramine and clomipramine.

The thymoanaleptic (antidepressant) effect is combined with a pronounced sedative, hypnotic and anxiolytic (anti-anxiety) effect, due to the strong anticholinergic and antihistamine activity.

Pharmacological action

Is an inhibitor of the neuronal reuptake of neurotransmitter monoamines, including norepinephrine, dopamine, serotonin, etc. Does not cause MAO inhibition.

Significant M-cholinolytic (anticholinergic), antihistamine and alpha-adrenolytic activity is characteristic.

At the same time, amitriptyline is not completely devoid of a stimulating, psycho-energizing effect. The stimulating effect is especially pronounced in a certain interval of doses (this interval is individual for each patient) and is partially associated with an increase at these doses of the concentration of the main active metabolite of amitriptyline – nortriptyline, which has a pronounced stimulating and psycho-energizing effect, partly with the antidepressant and stimulating-energizing effect of amitriptyline itself.When the upper limit of this “window” of doses is exceeded, the sedative effect of amitriptyline again begins to prevail, and the visible stimulating (and sometimes antidepressant) effect weakens. At low doses, below a certain individual “antidepressant threshold”, neither stimulating nor antidepressant effect is practically observed – only nonspecific sedative, hypnotic and anti-anxiety.

In terms of the strength of the sedative, hypnotic and anti-anxiety effect, amitriptyline in the class of tricyclics is second only to trimipramine and fluoroacizine, and in terms of the strength of the stimulating and psycho-energizing effect it is inferior to clomipramine, imipramine and tricyclics of the subgroup of secondary amines (nortriptyline, desnuramine).That is, amitriptyline is closer to the “sedative” end of the tricyclic spectrum, but not at the very end of the spectrum.

Clinical use and indications

It is used mainly for endogenous depression, but it is also used for the treatment of depression of any other etiology. Especially effective for anxiety-depressive conditions; reduces anxiety, psychomotor agitation (agitation), internal stress and fear, insomnia and depressive manifestations themselves. It is also used for the treatment of phobic disorders, infantile enuresis (with the exception of children with hypotonic bladder), psychogenic anorexia, bulimic neurosis, chronic pain syndrome of a neurogenic nature, as well as for the prevention of migraine.

Usually amitriptyline does not cause exacerbation of delusions, hallucinations and other productive symptoms, which is possible with the use of antidepressants with a predominance of the stimulating effect (imipramine, etc.).

Dosage and administration

Inside is taken after meals, starting from 50-75 mg per day. Then the dose is increased daily by 25-50 mg / day (with a predominant increase in the evening dose), until the “working” dose is 150-200-250 (up to 300) mg / day. With poor tolerance of amitriptyline, as well as in the elderly or somatically weakened patients, in adolescents and young people, in primary (previously untreated) patients, or with relatively mild depression, when there is time to wait for the effect, you can choose a slower rate of increasing doses (for example, on 25 mg every 2-3 days).Conversely, in severe, suicidal depressions, in situations requiring the most rapid antidepressant effect, as well as in patients previously treated with tricyclics and well tolerating this group of drugs, it is permissible to prescribe a full therapeutic dose from the first days of therapy or start at a higher dose (say, 100 mg / day) and a faster and more aggressive build-up to the “working” dose.

The value of the “working” dose, which should be stopped when increasing doses, is determined by the severity of depression and the experience of treatment of previous depressive phases in this particular patient, as well as the tolerance of the drug to these patients.The average daily dose in the treatment of endogenous depression is 0.15-0.25 g (150-250 mg), divided into 2-3-4 doses (during the day and before bedtime). Sometimes you can give the entire daily dose at night, before bedtime. In severe depressions, it is permissible to increase the daily dose of amitriptyline to 400-450 mg / day, if tolerance allows, which is more than the maximum dose of 300 mg / day prescribed by the instructions.

The therapeutic effect of amitriptyline usually occurs after 2-3-4 weeks (sometimes within a week), counting from the moment the “working” antidepressant dose is reached (not less than 150 mg / day).

In severe depression, you can start with the introduction of the drug intramuscularly or intravenously at a dose of 20-40 mg 3-4 times a day. Injections are gradually replaced by taking the drug inside.

Elderly patients are prescribed the drug in smaller doses; for children, the dose is reduced according to age.

Amitriptyline is relatively widely used in somatic medicine for depressive and neurotic conditions. Assign orally in relatively small doses (12.5-6.25 mg, ie ½-¼ tablets).

Complications and side effects

Amitriptyline is usually well tolerated, but worse than many other tricyclics and than modern selective antidepressants, due to the strong anticholinergic effect of ^[1]. It is necessary to observe certain precautions, a fairly gradual increase in doses at the beginning of therapy and timely prevention or correction of emerging side effects. Due to the presence of a sedative effect, it does not disturb sleep, and it is prescribed throughout the day, including at bedtime.

The main side effects are associated with a pronounced anticholinergic effect. Often (especially at the beginning of therapy and with increasing doses), dry mouth, dilated pupils, impaired accommodation of the eyes (blurred and blurred vision at close range, inability to focus the eyes at close range – for example, when reading and embroidering), constipation, sometimes severe, up to development of paresis or complete atony (paralysis) of the intestine, fecal obstruction and acute dynamic intestinal obstruction.At higher doses, urination may be difficult and delayed up to complete atony of the bladder. Hand tremor also appears at higher doses and is associated with stimulation of the peripheral beta-adrenergic system (removed by beta-blockers). Also often observed (especially at the beginning of therapy) a feeling of intoxication (the so-called “cholinolytic intoxication”, similar to intoxication from cyclodol or atropine), drowsiness, lethargy, apathy due to excessive sedation, dizziness.

Due to the pronounced alpha-adrenolytic effect of amitriptyline, hypotensive action (lowering blood pressure), orthostatic hypotension on standing up to fainting and collaptoid states, tachycardia, weakness are often observed (especially at the beginning of therapy and with a rapid increase in doses).

Paresthesias and allergic reactions may occur.

The most formidable complication of amitriptyline therapy is cardiac arrhythmias, in particular conduction disturbances and lengthening of the QT interval.The appearance of these cardiac arrhythmias dictates the need for either a dose reduction or very careful monitoring of the patient’s condition with frequent ECG recording.

Epileptiform convulsions are also sometimes observed (usually at high and very high doses or with too rapid intravenous drip). In patients with epilepsy and other convulsive conditions or with organic brain lesions, a history of skull trauma, even small doses of amitriptyline can cause convulsions or their equivalents.The appearance of epileptiform seizures during treatment with amitriptyline dictates the need to reduce the dose of amitriptyline or prescribe anticonvulsant drugs at the same time.

Possible increase in appetite and body weight, fever, leukopenia, eosinophilia, thrombocytopenia, hyponatremia (decreased production of antidiuretic hormone), fluctuations in blood sugar. ^[2]

Reversal of the phase sign from depression to mania or hypomania is often observed, or the development of a “mixed” dysphoric-irritable state, or an increase in frequency and acceleration of the cycle with the formation of the course of the disease with a rapid change of phases (rapid-cycling).These side effects are especially common in patients with concomitant thyroid insufficiency, bipolar disorder, bipolar schizoaffective disorder, but can also be observed in a patient who was suspected of having unipolar depression before treatment. At the same time, depending on the clinical situation, it may be necessary to either reduce the dose and even completely cancel amitriptyline and other antidepressants, or add normotimics, thyroid hormones, antipsychotics, or both measures together.A high risk of mania and hypomania in general is characteristic of tricyclic antidepressants: tricyclics in bipolar disorder induce mania or hypomania more often than antidepressants of other groups – for example, SSRI ^[3].

In some cases, when taking amitriptyline, mental and neurological side effects such as hallucinations, delusional disorders, confusion, disorientation, impaired coordination, ataxia, peripheral neuropathy, extrapyramidal disorders, dysarthria, anxiety, and insomnia may occur.^[4]

Interaction with other medicinal products

Incompatible with monoamine oxidase inhibitors (MAOIs). Potentiates the effect of compounds that depress the central nervous system (including sedatives, hypnotics, alcohol), sympathomimetics, antiparkinsonian drugs, weakens – antihypertensive and anticonvulsants. Simultaneous administration of amitriptyline and MAOIs can lead to death, therefore, the interval between courses of treatment with these drugs should be at least 14 days.

Inductors of microsomal oxidation (barbiturates, carbamazepine) reduce, cimetidine increases the concentration of amitriptyline in plasma.

Special instructions and precautions

Amitriptyline is a drug that poses a high risk of death with a relatively small overdose. Taking 1000-1500 mg (40 tablets) leads to the development of deadly poisoning. At the same time, when the patient’s condition improves under the influence of treatment, suicidal ideas often disappear and the mood normalizes much later than the energy and amount of physical strength increase.As a result, the patient may have more energy and strength to commit suicide against the background of still lingering melancholy and bad mood.

Therefore, for patients with severe endogenous depression and a high suicidal risk, treatment with amitriptyline can only be started in a psychiatric hospital (preferably with placement in a supervisory ward) or at least under the condition that it is possible to ensure strict supervision of the patient’s family or relatives over the regular intake of medication and the amount remaining in packaging of the drug.Patients with endogenous depression who are just starting outpatient treatment should not be prescribed amounts of the drug for one prescription (per visit to the doctor) greater than one to two weeks of therapy.

After the improvement of the patient’s condition and the disappearance of the suicidal risk, the severity of supervision can be gradually reduced up to prescribing a monthly or even 2-3 months amount of the drug per prescription.

The speed of reactions while taking amitriptyline can be reduced, therefore driving of vehicles, work with moving mechanisms is prohibited.The effect of alcohol is intensified. For the elderly, the drug is prescribed in smaller doses. It is used with caution in ischemic heart disease, arrhythmias, heart failure (treatment is carried out under ECG control), in the presence of a history of convulsive syndrome, thyroid diseases, pheochromocytoma, porphyria, during ECT and anesthesia, with caution combined with digitalis and baclofen. ^[2]

Contraindications

Amitriptyline as a drug with pronounced anticholinergic activity is contraindicated in glaucoma, prostatic hypertrophy, bladder atony, paralytic intestinal obstruction.

Other contraindications are the acute and recovery period of myocardial infarction, decompensated heart defects, cardiac muscle conduction disorders, hypertension, grade 3 hypertension, acute liver and kidney diseases with severe dysfunction, blood diseases, gastric ulcer and duodenal ulcer, pyloric stenosis, pregnancy and breastfeeding, children under 12 years of age, established hypersensitivity to amitriptyline, manic phase.^[2]

Composition

The preparation consists of active and excipients: the active substance is 25 mg of amitriptyline in the form of hydrochloride 0.0283 g. Excipients are contained in the core and shell of the preparation. Core contains: lactose monohydrate, corn starch, gelatin, calcium stearate, talc, colloidal silicon dioxide. Casing contains: dimethicone SE-2, macrogol, Sepifilm 3048 Yellow (hypromellose, microcrystalline cellulose, polyoxyl 40 stearate, titanium dioxide, quinoline yellow)

Value for money / efficiency / safety.Different opinions

Many doctors and researchers have differing opinions regarding the question of whether amitriptyline should be used frequently. For example, after this drug was included in the list of drugs in Ukraine and ^[5] became unavailable for most patients from October 1, 2011, doctors’ opinions on this matter were divided.

Some doctors and researchers supported these changes, noting that, despite its effectiveness, amitriptyline has numerous side effects, sometimes very dangerous, and worse tolerance and adherence to therapy when it is taken compared to antidepressants of subsequent generations.The drugs of new generations, not inferior in effectiveness, have significantly fewer side effects, allowing you to completely restore the patient’s social functioning and maintain it throughout the entire period of therapy, sometimes very long and lasting for years. It is indicated that, according to international studies, taking amitriptyline increases the risk of cardiovascular complications by 35%, even in those patients who did not have cardiovascular pathology before starting therapy.”What kind of restoration of activity can we talk about if a patient taking amitriptyline, due to its side effects, has difficulty answering the doctor’s questions due to constant sedation, decreased cognitive functioning, dizziness, nausea, dry mouth,” writes D.M. Sci., Professor O.S. Shepherd. “… Most outpatients take TCAs, in particular amitriptyline, 25-50 mg each in order to improve tolerance, which in fact has nothing to do with the antidepressant effect,” the psychiatrist, Ph.D.m. n. S.A. Malyarov. At the same time, the criticism of the use of amitriptyline expressed by these authors is accompanied by open advertising of new antidepressants, mainly melitor (agomelatine). ^[6]

Authors cite 2010 International consensus statement on major depressive disorder (Nutt DJ, Davidson JR et all, International consensus statement on major depressive disorder, J Clin Psychiatry 2010; 71 (suppl E1): e08) : “… The poor tolerance profile and severity of side effects of tricyclic antidepressants significantly impair patient adherence to therapy and lead to an increase in morbidity and even mortality, which does not allow them to be recommended as the first line of therapy, despite their low cost …”.^[6]

V.A. Pekhterev, doctor of the Donetsk Regional Psychoneurological Hospital, a specialist with many years of clinical experience. According to V.A. Pekhterev, amitriptyline is a means of choice for poor patients, an irreplaceable, reliable and proven drug for decades, optimal on the pharmaceutical market of Ukraine in terms of price-quality ratio. “I don’t dare to advise an elderly rural woman, looking straight into her eyes, an antidepressant, which is arguably better than amitriptyline, but undeniably 20 times more expensive.<...> The advertising-biochemical-boring song, which the medical representatives memorizedly pull and which the resourceful carriers of scientific degrees and titles pick up on the backing singing for a bribe, does not “roll” here. <...> If the eyes and ears of the patient are sealed with money, if he is used to protecting himself with them from the slightest discomfort and pain, and also to raise himself with his spending above those around him, then the price of the drug should be taken into account when choosing. For these patients, the most expensive antidepressant is often the best, ”says the author.According to Pekhterev, the ban on amitriptyline is explained by the efforts of people whose production task is to promote their more expensive drugs on the market; amitriptyline is in no way a drug, despite the fact that drug addicts use this drug in “cocktails” like many other drugs – in general, there is no non-medical demand for amitriptyline.

Most common side effects of amitriptyline. Amitriptyline: Common Side Effects, Dosage, and Usage Guide

Understanding Amitriptyline: A Versatile Pain and Migraine Medication

Proper Administration of Amitriptyline: Timing and Method

Key Points for Taking Amitriptyline:

Dosage Guidelines: Finding the Right Amount for Your Needs

Dosage Overview:

Managing Missed Doses and Avoiding Overdose

Overdose Precautions:

Common Side Effects: What to Expect When Taking Amitriptyline

Frequently Reported Side Effects:

Less Common but Notable Side Effects

Infrequent Side Effects:

Rare but Serious Side Effects: When to Seek Immediate Medical Attention

Rare but Serious Side Effects Include:

Special Considerations and Precautions

Special Considerations Include:

Amitriptyline: a medicine used to treat pain and prevent migraine

Dosage

What if I forget to take it?

What if I take too much?

Common and Rare Side Effects for amitriptyline oral

COMMON side effects

If experienced, these tend to have a Severe expression i

If experienced, these tend to have a Less Severe expression i

INFREQUENT side effects

If experienced, these tend to have a Severe expression i

If experienced, these tend to have a Less Severe expression i

RARE side effects

If experienced, these tend to have a Severe expression i

If experienced, these tend to have a Less Severe expression i

Amitriptyline Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Amitriptyline – StatPearls – NCBI Bookshelf

Continuing Education Activity

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Enhancing Healthcare Team Outcomes

References

Amitriptyline: MedlinePlus Drug Information

Amitriptyline (Oral Route) Side Effects

Side Effects

Incidence not known

Symptoms of Overdose

Incidence not known

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Amitriptyline instructions for use, price in pharmacies in Ukraine, analogues, composition, indications | Amitriptyline film-coated tablets of the company “OZ GNTSLS”

Depression: symptoms and urgency of the problem

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Antidepressants – stopstress.lv

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