| name | Amitriptyline |
| classification | Tricyclic Antidepressant (TCA) |
| pharmacokinetics | Amitriptyline is a lipophilic compound, readily absorbed from the gastrointestinal tract. It undergoes extensive first-pass metabolism in the liver. Significant hepatic metabolism leads to the formation of active metabolites, which contribute to the drug's duration of action. The primary elimination route is via hepatic metabolism, with excretion primarily in the urine. The plasma half-life is variable, ranging from 12 to 40 hours. |
| suggested dosage | | male patient 25y 70kg | | initial | 25-50 mg at bedtime | | titration | Increase gradually, usually 25 mg increments every 1-3 days. Max 150 mg daily. | | comments | Individual patient response and tolerance are crucial in dosage determination. Monitoring for side effects is essential during titration. |
|
|
| indications | Amitriptyline is primarily indicated for the treatment of major depressive disorder, but it also has other uses, including: chronic neuropathic pain, fibromyalgia, anxiety disorders, insomnia. |
| safety pregnancy | Amitriptyline use during pregnancy should be avoided unless the potential benefits outweigh the potential risks. It may cause fetal harm. Consult with a physician for appropriate alternative options and careful risk-benefit analysis. |
| safety breastfeeding | Amitriptyline passes into breast milk. The potential risks and benefits need to be weighed carefully before prescribing to nursing mothers. Alternative therapies should be considered. |
| side effects | | 1 | Drowsiness, dizziness, orthostatic hypotension, dry mouth, constipation, blurred vision, weight gain, sexual dysfunction, tremor, confusion, headache, urinary retention | | 2 | Caution: These side effects vary in severity and frequency in individual patients. They should be monitored and managed promptly by healthcare providers. |
|
| alternatives | |
| contraindications | | 1 | Known hypersensitivity to tricyclic antidepressants | | 2 | Severe hepatic or renal dysfunction | | 3 | Concomitant use with MAOIs (monoamine oxidase inhibitors) | | 4 | Myocardial infarction or unstable angina in the recent past | | 5 | Narrow-angle glaucoma |
|
| interactions | Amitriptyline can interact with numerous medications, including other antidepressants, anticholinergics, antihistamines, alcohol, and certain medications for cardiac conditions. Consult the physician regarding the concomitant use of other drugs. |
| warnings precautions | | 1 | Potential for suicidal ideation or attempts, especially in adolescents and young adults. Close monitoring of patients for changes in mood and behavior is essential. | | 2 | Orthostatic hypotension and potential for falls. Monitor blood pressure and advise on postural changes, especially in the elderly. | | 3 | Potential for seizures in patients with pre-existing seizure disorders. Adjust dosage and monitor seizure activity. | | 4 | Caution in patients with a history of urinary retention or prostatic hypertrophy. Regular monitoring is required for urinary function. |
|
| additional information | The use of tricyclic antidepressants should be monitored by a physician for efficacy, side effects, and compliance. Patients should be instructed to report any concerns or changes in health status. |
| patient profile | |
