Amitriptyline

4
Amitriptyline
Brands

DEA Class;  Rx

Common Brand Names; Elavil, Levate

  • Antidepressants, TCAs

Tertiary amine tricyclic antidepressant; amitriptyline is metabolized to nortriptyline, an active metabolite
FDA-approved for use in adults for the treatment of depression; used off label for neuropathic pain and other uses
Boxed warning for use in pediatric patients and young adults due to risk for suicidality

Indicated for the treatment of major depression.

For the treatment of social phobia (social anxiety disorder) or panic disorder.
For the treatment of postherpetic neuralgia.
For migraine prophylaxis.
For the treatment of fibromyalgia.
For the treatment of insomnia.
For the treatment of persistent singultus (hiccups).
For the treatment of primary nocturnal enuresis.
For the adjunct treatment of bulimia nervosa.
For the improvement of global symptoms of diarrhea-predominant irritable bowel syndrome.

Hypersensitivity

Acute recovery phase following MI

Concurrent use with cisapride

Contraindicated within 14 days of MAOIs; if linezolid or IV methylene blue (MAOIs) must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity; may resume 24 hr after last linezolid or methylene blue dose, or after 2 weeks of monitoring, whichever comes first

  • Extrapyramidal symptoms (EPS)
  • Fatigue
  • Hallucination
  • Headache
  • Hypertension
  • Increased LFTs
  • Insomnia
  • Lethargy
  • Leukopenia
  • MI
  • Nausea
  • Ocular pressure increased
  • Orthostatic hypotension
  • Palpitation
  • Paresthesia
  • Photosensitivity
  • Rash
  • Restlessness

Bone marrow suppression reported

Avoid use in narrow-angle glaucoma

May cause sedation and impair mental and physical abilities

Avoid use with any drugs or conditions that prolong QT interval

May cause orthostatic hypotension

Use caution in patients with cardiovascular disease, diabetes, mania, hepatic and renal impairment, thyroid dysfunction, and seizure disorder

May worsen mania symptoms or precipitate mania in patients with bipolar disorder

Clinical worsening and suicidal ideation may occur despite medication in adolescents and young adults (18-24 years)

Risk of anticholinergic side effects; may cause constipation, urinary retention, blurred vision, and xerostomia

Use caution in patients with urinary retention, open-angle glaucoma, BPH, decreased gastrointestinal motility, or paralytic ileus

Possibility of EPS and neuroleptic malignant syndrome

Abrupt discontinuation of therapy not recommended in patients receiving high doses for prolonged periods

Fractures reported with therapy

Pregnancy category: C

Lactation: Distributed in breast milk; do not nurse (AAP states effect on nursing infants is unknown but may be of concern)

Adults

150 mg/day PO in outpatients; 300 mg/day PO for hospitalized patients.

Geriatric

150 mg/day PO in outpatients.

Adolescents

150 mg/day PO in outpatients.

Children

< 12 years: Safety and efficacy have not been established.

Amitriptyline hydrochloride

tablet

  • 10mg
  • 25mg
  • 50mg
  • 75mg
  • 100mg
  • 150mg
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