Always consult your physician before using alcohol concomitantly with Amitriptyline. Because it is known that beverages containing alcohol can alter the action of Amitriptyline and may induce or worsen adverse effects of Amitriptyline.
Also you can experience extreme drowsiness, confusion, uneven heartbeats, feel of agitation, vomiting, sweating, blurred vision, muscle stiffness, feeling light-headed, and even seizures; in any of these cases treating physician should be consulted.
You should never exceed recommended dosages of this medicinal product and also to avoid alcohol. Furthermore, it is preferable to avoid activities requiring increased mental alertness, and quick reactions, for example driving machine or operating hazardous and precise machinery.
What is Amitriptyline
Amitriptyline is a tricyclic antidepressant also having a pronounced sedative, hypnotic and anti-anxiety effect. Amitriptyline helps in eliminating night urinary incontinence and reducing appetite. Besides, it has some analgesic action. It is used in addition to other medications for pain. When used in general anesthesia, it reduces blood pressure and body temperature.
Each amitriptyline tablet contains the active substance of amitriptyline hydrochloride, 25 mg, and excipients: lactose, corn starch, calcium phosphate dibasic, gelatin, talc, magnesium stearate, silicon dioxide colloidal anhydrous, polyethylene glycol 6000, Opadry Blue (hydroxypropyl methylcellulose, titanium dioxide, talc, polyethylene glycol, brilliant blue).
At the moment, amitriptyline is considered the most reliable and affordable tricyclic antidepressant. In the tricyclic class, amitriptyline is second only to trimipramine and fluorocycin by the strength of the sedative, hypnotic and anti-anxiety effect. Amitriptyline is taken by mouth. Antidepressant effect develops within 2-3 weeks after the beginning of application.
The mechanism of antidepressant action is associated with an increase in the concentration of noradrenaline and / or serotonin in the central nervous system (CNS) (a decrease in their reverse absorption).
Amitriptyline has the properties of antiarrhythmic drugs like e.g. quinidine. In therapeutic doses, it slows down the ventricular conduction (in case of an overdose it can cause severe intraventricular blockade).
Coated tablets, blue, with a biconvex surface, with a risk on one side. The risk on the pill is intended solely to facilitate halving.
Clinical application and indications
Amitriptyline is applied mainly to treat major depressive disorder but can also be used in the treatment of depression of any other etiology. Especially effective in anxiety-depressive states; amitriptyline eliminates anxiety, psychomotor agitation, inner tension and fear, insomnia and other depressive manifestations. It is also used for the treatment of phobic disorders, children's enuresis (except for children with hypotonic urinary bladder), psychogenic anorexia, bulimic neurosis, chronic pain syndrome of a neurogenic nature, and also for the prevention of migraine.
Usually amitriptyline does not cause exacerbation of delusions, hallucinations and other productive symptoms, which is possible with the use of antidepressants with a predominant stimulating effect (imipramine, etc.)
Before prescribing amitriptyline, always inform your doctor about the following changes in your health
- propensity to develop orthostatic hypotension and sedation during treatment with amitriptyline;
- chronic constipation;
- hyperplasia of the prostate;
- diseases of the cardiovascular system;
- hypothyroidism, reception of thyroid hormone preparations;
- hepatic or renal insufficiency.
Before prescribing amitriptyline, always inform your doctor about the use of any of the medicines listed below
- Hypotensive drugs for the treatment of hypertension;
- Atropine and other atropine-like substances (sedative H1-histamine, antiparkinsonic, anticholinergic, spasmolytic atropine agents, disopyramide, phenothiazine neuroleptics) for the treatment of allergies, Parkinson's disease, eye diseases, mental disorders.
- Depressants of the central nervous system (morphine derivatives – analgesics, antitussives, barbiturates, benzdiazepines, anxiolytics, sedative antidepressants (doxipin, miaserin, mirtazapine, trimipramine), antipsychotics, sedative H1-antihistamines, antigilertenzivnye means of central action, thalidomide) for analgesia, treatment of cough, depression, allergies, hypertension.
- Baclofen – muscle relaxant.
- Beta-blockers (bisoprolol, carvedilol, metoprolol) for the treatment of heart diseases.
Dosing and Administration
The dose of the drug is determined by the doctor. Take it during or after a meal with water. To improve sleep, the drug can be taken in the evening. An increase in the dose is usually achieved by taking the drug in the evening or before bedtime. In maintenance therapy, you can take the drug once a day. The withdrawal of the drug is carried out gradually under the supervision of a doctor.
Treatment begins with low doses with a gradual increase in them under the close supervision of the doctor to assess the effectiveness and tolerability of therapy.
Usually the dose is 75-150 mg per day; higher doses are used in hospital. The average daily dose in adults is usually 75 mg (25 mg 3 times per day). After 3 weeks of effective treatment, the daily dose can be individually revised.
In children, the effective daily dose is not more than 1 mg/kg body weight.
Treatment with antidepressants is symptomatic. The duration of treatment is about 6 months in order to prevent relapse.
Nocturnal enuresis in children
Amitriptyline doses used in enuresis are lower than in the treatment of depression. The daily dose in children aged 6 to 10 years with a body weight of 25 kg or more is 25 mg per day (1 tablet); 11 to 16 years is 25 to 50 mg per day (1-2 tablets).
The drug is taken before bedtime. The duration of therapy is not more than 3 months.
Special categories of patients
In patients older than 65 years, the initial dose should be reduced (down to 50% of the minimum). The daily dose can be divided into several times or taken once before bedtime. If necessary, the dose is increased gradually, under careful medical supervision due to the possibility of serious side effects in this category of patients (fainting, confusion). With impaired liver and kidney function, a careful selection of an individual dose is recommended, which can be reduced compared to patients with normal function of these organs.
If you overdosed Amitriptyline
If the number of tablets a day you took exceeds the amount that your doctor recommended, or your child swallowed the pill, immediately consult a doctor or call an ambulance! Do not stop taking the medication immediately! Symptoms of overdose are likely to be manifested by dry mouth, accommodation disorders, tachycardia, heart rhythm disturbances, decreased blood pressure, increased sweating, and a delay in urination. Confusion and coma are possible. As the first aid, the following measures can be taken: gastric lavage, taking a suspension of activated charcoal, laxatives, maintaining body temperature, monitoring blood pressure, ECG.
If you missed a dose of Amitriptyline
Take a pill as soon as you remember about it, making sure that there is a time interval before taking another dose. If the time before taking another dose is short, take it according to the doctor's prescription. Do not take a double dose in case of missing the next dose!
Possible adverse reactions
Amitriptyline can cause side reactions similar to those that occur when taking other tricyclic antidepressants. Some of the following side effects (headache, tremor, impaired concentration, constipation and decreased libido) may also be symptoms of depression and weaken as the depression slows down.
- dry mouth, constipation, accommodation disorders, tachycardia, increased sweating, urinary retention;
- orthostatic hypotension, decreased sexual function;
- drowsiness or sedation, tremor, spasms in predisposed persons, confusion, loss of consciousness, dysarthria;
- risk of development of suicidal behavior / thoughts, change of mood with the appearance of a manic episode, the manifestation of anxiety;
- weight gain;
- violation of conduction and rhythm of the heart (in high doses);
- breast augmentation, milk production from the mammary glands;
- allergic skin reactions;
- an increase in the number of eosinophils, a decrease in the number of leukocytes and platelets in the blood.
Adverse reactions in elderly patients
In patients aged 50 years and older, there is an increased risk of bone fractures when taking selective serotonin reuptake inhibitors or tricyclic antidepressants. The mechanism of this side effect is not clear.
Special precautions for taking Amitriptyline
Depression is associated with an increased risk of suicidal behavior, autoaggression and suicide. This risk can exist until a stable remission is achieved and occur spontaneously throughout the course of therapy, especially in the early stages of remission or when the dosage is changed. When treating antidepressants, you need to carefully monitor your condition, especially at the beginning of therapy: mood changes, behavior, clinical deterioration and / or the appearance of suicidal thoughts, the development of side effects. Ask your loved ones to help you assess your condition against the background of treatment. At any change of a status, in case of doubt in the estimation of it, please, address to the doctor or inform relatives!
When you see, at the beginning of treatment, the signs of insomnia or nervousness, it is recommended to see a doctor to reduce the dose of the drug and to carry out the necessary symptomatic treatment.