Drug Index

Amitriptyline

 
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Mechanism :

Amitriptyline is an antidepressant with sedative effects. Amitriptyline inhibits the membrane pump mechanism responsible for uptake of norepinephrine and serotonin in adrenergic and serotonergic neurons.


Indication :

• Depression

• Nocturnal enuresis

• Idiopathic musculoskeletal pain syndrome

• Analgesia for chronic pain

• Migraine prophylaxis


Contraindications :

Amitriptyline is contraindicated in patients who have shown prior hypersensitivity to it and in acute porphyria, hepatic impairment and cardiovascular disease.


Dosing :

Depressive disorders:

Adolescent: 25-50 mg/day orally in divided doses initially. Then gradually increase to 100 mg/day in divided doses.

Children (off-label): 1 mg/kg/day in divided doses every 8 hourly for first 3 days, followed by 1.5 mg/kg/day oral in divided doses every 8 hours.

Analgesia for chronic pain (off-label):

0.5-2 mg/kg every day at bedtime. Start with 0.1 mg/kg every day at bedtime, titrate slowly over 2-3 weeks.

Idiopathic musculoskeletal pain syndromes:

10-50 mg at bedtime, start at lower dose.

Migraine prophylaxis (off-label):

0.25 mg/kg/day at bedtime; may increase dose by 0.25 mg/kg/day; not to exceed 1 mg/kg/day.

Nocturnal enuresis: Try for 3 months.

For 6-12 years: 10-25 mg PO.

For 12-18 years: 25-50 mg at bedtime PO.


Adverse Effect :

Mainly anticholinergic effects: sedation, postural hypotension, tremor, sweating, arrhythmia, increased appetite and weight gain. Lowered seizure threshold, agranulocytosis, thrombocytopenia, elevated LFTs.


Interaction :

MAOIs: Hyper pyretic crises, severe convulsions, and deaths have occurred in patients receiving tricyclic antidepressant and monoamine oxidase inhibiting drugs simultaneously.
OCPs, Calcium Channel Blockers, Cimetidine, Phenothiazines, SSRIs: Plasma concentration of amitriptyline increased.
Rifampicin, Anti-Coagulants: Decreased plasma concentration of amitriptyline.
Sedatives, Hypotensive, Drugs that prolong QT interval: Increased effects of these drugs.


07/19/2019 03:16:17 Amitriptyline
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