Amitriptyline: indications for use, side effects

Action of amitriptyline

The main effect of amitriptyline is antidepressant.
It also has a sedative (calming), hypnotic and anti-anxiety effect. It has no effect on a healthy person with a normal psychological state. These effects appear only in the presence of depression, restlessness, anxiety and insomnia, respectively. In addition to the effects of amitriptyline, there are other effects:

• Anesthetic.
• Vegetative stabilizing.
• Antidiarrheal (fixing).
• Removes psychosomatic symptoms: skin rash, high blood pressure, restores appetite, etc.
• Effective for some forms of enuresis (bedwetting).

Description of the drug AMITRIPTYLIN

Use with caution in cases of coronary artery disease, arrhythmia, heart block, heart failure, myocardial infarction, arterial hypertension, stroke, chronic alcoholism, thyrotoxicosis, during therapy with thyroid drugs, and with impaired liver and/or kidney function.

During amitriptyline therapy, caution is required when suddenly moving to a vertical position from a lying or sitting position.

If you stop taking it abruptly, withdrawal syndrome may develop.

Amitriptyline in doses of more than 150 mg/day reduces the seizure threshold; the risk of developing epileptic seizures in predisposed patients should be taken into account, as well as in the presence of other factors that increase the risk of developing convulsive syndrome (including brain damage of any etiology, simultaneous use of antipsychotic drugs, during the period of ethanol withdrawal or drug withdrawal, having anticonvulsant activity).

It should be taken into account that patients with depression may experience suicide attempts.

Should only be used in combination with electroconvulsive therapy under close medical supervision.

In predisposed patients and elderly patients, it can provoke the development of drug-induced psychoses, mainly at night (after discontinuation of the drug, they disappear within a few days).

May cause paralytic ileus, primarily in patients with chronic constipation, the elderly, or those forced to bed rest.

Before performing general or local anesthesia, the anesthesiologist should be warned that the patient is taking amitriptyline.

With long-term use, an increase in the incidence of caries is observed. The need for riboflavin may increase.

Amitriptyline can be used no earlier than 14 days after discontinuation of MAO inhibitors.

Should not be used simultaneously with adrenergic and sympathomimetics, incl. with epinephrine, ephedrine, isoprenaline, norepinephrine, phenylephrine, phenylpropanolamine.

Use with caution simultaneously with other drugs that have anticholinergic effects.

Avoid drinking alcohol while taking amitriptyline.

Impact on the ability to drive vehicles and machinery

During the treatment period, you should refrain from potentially hazardous activities that require increased attention and rapid psychomotor reactions.

Indications for use

As doctors and scientists accumulate experience in the use of amitriptyline and clarify the mechanisms of development of many diseases, the indications for its use are constantly expanding. Main indications:

• Endogenous depression.
• Depressive psychosis.
• Anxiety disorders: generalized anxiety disorder, panic disorder, phobias, obsessive-compulsive disorder.
• Organic anxiety and depression.
• Schizotypal disorder, schizophrenia with depressive symptoms.
• Addictions (alcohol, drug, polydrug addiction).
• Neuroses.
• Personality disorders (psychopathy).
• Somatoform and psychosomatic diseases.
• Eating disorders.
• Pain syndrome.
• Enuresis.

"Amitriptyline" tablets: instructions for use

When determining the normal dosage, the stage of treatment, the characteristics of the patient’s condition and the form of the drug are taken into account:

1. At the first stage, adult patients are given from 25 to 50 mg of the active substance (taken at night).
2. Then, over the course of 5 days, the norm is increased to a maximum of 200 mg, and taken 3 times a day.
3. If the effect does not occur within 14 days, then the norm is increased to 300 mg.

In the case of a solution, the dosage ranges from 20 to 40 mg at a time (the total number of injections is 4 per day). Then the patient switches from injections to tablets. The general course of treatment lasts a maximum of 8 months in a row.

Attention!

For the treatment of headaches, migraines, and chronic pain syndromes, the dosage can be set in the range from 12.5 mg to 100 mg every day.

Compound

Amitriptyline dragees and tablets contain 10 or 25 mg of the active substance in the form of amitriptyline hydrochloride.
Additional substances in the tablets are: microcrystalline cellulose, talc, lactose monohydrate, silicon dioxide, magnesium stearate, pregelatinized starch.

Additional substances in the dragees are: magnesium stearate, potato starch, talc, polyvinylpyrrolidone, lactose monohydrate.

1 ml of solution contains 10 mg of active substance. Additional substances are: hydrochloric acid (sodium hydroxide), dextrose monohydrate, water for infusion, sodium chloride, benzethonium chloride.

Contraindications

According to the annotation, the medicine is not used:

• for myocardial infarction ;
• intolerance to the main component;
• for angle-closure glaucoma ;
• acute intoxication with psychoactive, analgesic, hypnotics;
• for acute alcohol intoxication;
• during breastfeeding;
• severe disturbances of intraventricular conduction and antioventricular conduction;
• with pathology of the cardiovascular system;
• with suppression of bone marrow hematopoiesis;
• manic-depressive psychoses;
• bronchial asthma;
• chronic alcoholism;
• decreased motor function of the digestive system;
• stroke;
• liver and kidney pathologies;
• intraocular hypertension;
• urinary retention;
• prostatic hyperplasia;
• with hypotension of the bladder;
• thyrotoxicosis;
• pregnancy.

For epilepsy , Amitriptyline is prescribed with caution.

Interaction

A hypotensive effect, respiratory depression , and a depressant effect on the nervous system are observed with the joint prescription of medications that depress the central nervous system: general anesthetics, benzodiazepines, barbiturates, antidepressants and others.

The drug enhances the severity of the anticholinergic effect when taking amantadine , antihistamines, biperiden , atropine , antiparkinsonian drugs, phenothiazine .

The drug enhances the anticoagulant activity of indadione , coumarin derivatives, and indirect anticoagulants. There is a decrease in the effectiveness of alpha-blockers and phenytoin .

Fluvoxamine , Fluoxetine increase the concentration of the drug in the blood. The risk of developing epileptic seizures increases, and the central anticholinergic and sedative effects also increase when combined with benzodiazepines, phenothiazines, and anticholinergics.

Simultaneous use of methyldopa , reserpine , betanidine , guanethidine , clonidine reduces the severity of their hypotensive effect.

Delirium develops when taking acetaldehydrogenase , Disulfiram . phenylephrine , norepinephrine , epinephrine , and isoprenaline on the cardiovascular system . The risk of hyperpyrexia increases when taking antipsychotics and m-anticholinergics.

Amitriptyline price, where to buy

The price of Amitriptyline in 25 mg tablets in Russia is about 30-40 rubles for 50 pieces.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

ZdravCity

• Amitriptyline solution for intravenous and intramuscular administration.
  10 mg/ml 2 ml 10 pcs. Federal State Unitary Enterprise Moscow Endocrine Plant 50 rub. order
• Amitriptyline tablets 25 mg 50 pcs. OzonOzon LLC

  57 RUR order

  Read also:  Clinical effectiveness of a new form of rimantadine in children “at risk” for severe influenza and acute respiratory diseases

Pharmacy Dialogue

• Amitriptyline (amp. 10 mg/ml 2 ml No. 10) Moscow Endocrine Plant

  46 RUR order

• Amitriptyline (25 mg tablet No. 50) DHF JSC

  62 RUR order

• Amitriptyline (25 mg tablet No. 50) Ozone LLC

  60 rub. order

• Amitriptyline (25 mg tablet No. 50) Ozone LLC

  57 RUR order

• Amitriptyline (25 mg tablet No. 50) Moscow Endocrine Plant

  30 rub. order

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Pharmacy24

• Amitriptyline 25 mg No. 50 tablets PrAT “Technolog”, Uman, Cherkasy region, Ukraine
  20 UAH. order
• Amitriptyline 25 mg N25 tablets TOV Doslidniy, Ukraine/TOV FC Zdorovya, Ukraine

  13 UAH order

PaniPharmacy

• Amitriptyline tablets Amitriptyline h/x tablets. w/o 0.025g No. 50 control. cell unitary enterprise Ukraine, OZ GNTsLS LLC

  23 UAH order

• Amitriptyline ampoule Amitriptyline liquid solution d/in. 10mg/ml amp. 2ml No. 10 Ukraine, Health of the people LLC

  89 UAH order

• Amitriptyline tablets Amitriptyline h/x tablets. 0.025g No. 25 Ukraine, OZ GNTsLS LLC

  15 UAH order

• Amitriptyline liquid solution d/in. 1% amp. 2ml No. 10 Ukraine, OZ GNTsLS

  87 UAH order

• Amitriptyline tablets Amitriptyline h/x tablets. 0.025g No. 50 Ukraine, Health of the people LLC

  21 UAH order

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Cases of overdose

It has been established that due to an overdose, disorders of the nervous system are observed, which leads to the following consequences:

• anxiety;
• falling into a coma, stupor;
• epileptic seizures;
• ataxia;
• appearance of hallucination;
• surges in blood pressure and pulse;
• vomiting, symptoms of poisoning.
• in extremely rare cases, cardiac arrest.

For treatment, urgent gastric lavage and taking appropriate medications are indicated (symptomatic treatment).

Pharmacodynamics and pharmacokinetics

The drug reduces appetite, eliminates nighttime urinary incontinence, and has an antiserotonin effect. The drug has a strong central and peripheral anticholinergic effect.

The antidepressant effect is achieved by increasing the concentration of serotonin in the nervous system and norepinephrine in synapses. Long-term therapy leads to a decrease in the functional activity of serotonin and beta-adrenergic receptors in the brain. Amitriptyline reduces the severity of depressive symptoms, agitation, anxiety in anxiety-depressive conditions . By blocking H2-histamine receptors in the stomach wall (parietal cells), an antiulcer effect is provided. The medication is able to reduce body temperature and blood pressure during general anesthesia. The drug does not inhibit monoamine oxidases. The antidepressant effect appears after 3 weeks of therapy.

The maximum concentration of the substance in the blood occurs after a few hours, usually after 2-12. Excreted as metabolites in urine. Binds well to proteins.