| name | Amitriptyline |
| classification | TCA |
| pharmacokinetics | | absorption | Rapidly absorbed after oral administration. Peak plasma concentrations within 2-4 hours. | | metabolism | Significant first-pass metabolism in the liver; primarily hepatic with multiple metabolites. | | elimination | Relatively long elimination half-life (10-26 hours), potentially leading to accumulation and needing careful dose titration. |
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| suggested dosage | | initial | 25 mg/day, taken at bedtime or with a bedtime snack. | | titration | Gradual increase every few days/weeks up to a maximum of 150 mg/day, individualizing dosing crucial based on patient response and tolerability. |
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| indications | | 1 | Major depressive disorder | | 2 | Neuropathic pain | | 3 | Fibromyalgia | | 4 | Migraine prophylaxis | | 5 | Anxiety disorders |
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| safety in pregnancy | | category | C | | recommendation | Not recommended during pregnancy. If used, must be under careful medical supervision and risks to the fetus carefully considered. |
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| safety in breastfeeding | | potential transfer | TCAs can pass into breast milk; effects on the infant unknown. | | recommendation | Generally not recommended during breastfeeding. |
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| side effects | | 1 | Drowsiness | | 2 | Dry mouth | | 3 | Blurred vision | | 4 | Constipation | | 5 | Urinary retention | | 6 | Orthostatic hypotension | | 7 | Weight gain | | 8 | Sexual dysfunction | | 9 | Increased appetite | | 10 | Cardiac effects (arrhythmias) | | 11 | Seizures (especially at high doses) | | 12 | Tremor | | 13 | Agitation | | 14 | Confusion | | 15 | Hallucinations | | 16 | Suicidal thoughts (possible in some patients) |
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| alternatives | |
| contraindications | | 1 | Severe cardiovascular disease | | 2 | Narrow-angle glaucoma | | 3 | History of seizures | | 4 | Severe liver or kidney disease | | 5 | Known drug allergy to TCAs |
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| interactions | TCAs interact with many medications, including MAO inhibitors, anticholinergics, benzodiazepines, and other CNS depressants. These interactions can lead to increased sedation or other adverse effects. |
| warnings and precautions | | overdose risk | High risk of overdose and potentially serious cardiac and neurological complications. | | monitoring needed | Close monitoring, especially in patients at risk for suicidal thoughts. | | suicidality | Suicidal ideation and behavior can occur in some patients; careful monitoring for worsening symptoms is critical. |
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| additional informations | Comprehensive evaluation of the patient's medical history and mental status, including assessment of suicidality, is essential. Patient should be closely monitored for treatment response and adverse effects. **IMPORTANT:** This information is for general knowledge and does not constitute medical advice. Consult a qualified healthcare professional. |
