Amitriptyline tablets: instructions for use

Amitriptyline refers to antidepressants, and by group affiliation to tricyclic compounds.

The mechanism of therapeutic action is based on the inhibition of the reverse neuronal seizure of norepinephrine and serotonin. As a result, their concentration in the synapses of the central nervous system increases significantly. To the additional positive effects of taking can be attributed central analgesic, anti-bulimic and antiulcer action.

On this page you will find all information about Amitriptyline: the full instructions for use on this medication, average prices in pharmacies, complete and incomplete analogs of the drug, as well as reviews of people who have already used Amitriptyline. Want to leave your opinion? Please write in the comments.

Clinical and pharmacological group

Antidepressant.

Conditions of leave from pharmacies

It is released on prescription.

Price list

How much does Amitriptyline cost? The average price in pharmacies is at the level of30 rubles.

Form of issue and composition

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For 10 tablets with a dosage of 25 mg in a blister pack. 5 blisters of 10 tablets in each is placed in a pack of cardboard.

1 tablet contains amitriptyline hydrochloride as recalculated for amitriptyline-25 mg;
auxiliary substances: lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, hypromelose, magnesium stearate, aerosil, macrogol 6000, titanium dioxide, talc, tween-80, acid red 2 C.

Pharmacological effect

The mechanism of antidepressant action of the drug is based on the inhibition of reverse neuronal seizure of dopamine, norepinephrine and serotonin.

It is an antagonist of muscarinic cholinergic receptors, has antiadrenergic and antihistaminic properties, is effective in bedwetting. Has a central analgesic effect, anti-bulimic and antiulcer action. For full manifestation of antidepressant action, it takes 2-4 weeks.

Indications for use

According to the instructions, Amitriptyline is prescribed for treatment of depressive states of involutional, reactive, endogenous, medicinal nature, and also depressions on the background of alcohol abuse, organic brain damage, accompanied by sleep disorders, agitation, anxiety.

Indications for the use of Amitriptyline are:

Schizophrenic psychosis;
Emotional mixed disorders;
Behavioral disorders;
Nocturnal enuresis (other than that caused by a low tone of the bladder);
Bulimia nervosa;
Chronic pain (migraine, atypical facial pain, pain in cancer patients, posttraumatic and diabetic neuropathy, rheumatic pain, postherpetic neuralgia).

Amitriptyline is also used for peptic ulcer diseases, for relieving headaches and preventing migraine.

Contraindications

Amitriptyline is contraindicated for use in the case of development of such conditions:

individual intolerance of the active substance;
with a marked increase in blood pressure;
with severe violations of the functioning of the liver and urinary system;
heart failure (in the stage of decompensation);
acute infarction and recovery period after a similar condition;
with violations of conduction of cardiac muscles;
exacerbations of peptic ulcer of the stomach and duodenum;
the drug is not used during treatment of pregnant and lactating women, as well as patients who have not reached the age of six.

Strictly contraindicated concomitant use with MAO inhibitors, patients with atony of the bladder, intestinal obstruction and prostatic hypertrophy.

The drug is used with extreme caution in the treatment of people who have an anamnesis of alcoholism, bronchial asthma, a tendency to manic-depressive psychosis, epilepsy, hyperthyroidism, stenocardia, heart failure, angle-closure glaucoma, intraocular hypertension, schizophrenia.

Application in pregnancy and lactation

In pregnant women, the drug should be used only if the intended benefit to the mother exceeds the potential risk to the fetus.

Penetrates into breast milk and can cause drowsiness in infants. To avoid the development of the "cancellation" syndrome in newborns (manifested by shortness of breath, drowsiness, intestinal colic, increased nervous excitability, increased or lowering blood pressure, tremors or spasms), amitriptyline is gradually withdrawn at least 7 weeks before the expected delivery.

Instructions for use Amitriptyline

The instructions for use indicate that Amitriptyline tablets are administered orally (during or after a meal).

The initial daily intake with oral administration is 50-75mg (25mg in 2-3 doses), then the dose is gradually increased by 25-50mg, until the desired antidepressant effect is obtained. The optimal daily therapeutic dose is 150-200 mg (the maximum part of the dose is taken at night).
In severe depression, resistant to therapy, the dose is increased to 300 mg or more, to the maximum tolerated dose. In these cases, it is advisable to start treatment with intramuscular or intravenous administration of the drug, applying with higher initial doses, accelerating the build-up of dosages under the control of the somatic condition. After obtaining a persistent antidepressant effect, after 2-4 weeks the doses gradually and slowly decrease.
In case of signs of depression with decreasing doses, it is necessary to return to the previous dose. If the patient's condition does not improve within 3-4 weeks of treatment, then further therapy is impractical.

In elderly patients with mild disorders, in outpatient practice, the doses are 25-50-100 mg (MAX) in divided doses or once a day at night. For the prevention of migraine, chronic pain of a neurogenic nature (including prolonged headaches) from 12.5-25 mg to 100 mg / day. Interaction with other drugs Amitriptyline potentiates CNS depression by the following drugs: neuroleptics, sedatives and hypnotics, anticonvulsant drugs, central and narcotic analgesics, means for anesthesia, alcohol.

Assign intramuscularly or intravenously.

With severe depression, resistant to therapy: intramuscularly or intravenously (inject slowly!) Is administered at a dose of 10-20-30 mg to 4 times a day, an increase in the dose should be carried out gradually, the maximum daily dose of 150 mg; after 1-2 weeks go to the drug inside. Children over 12 years of age and elderly people are given lower doses and increase them more slowly.

With the combined use of amitriptyline with neuroleptics, and / or anticholinergic drugs, a febrile temperature reaction may occur, paralytic intestinal obstruction. Amitriptyline potentiates the hypertensive effects of catecholamines, but inhibits the effects of drugs acting on the release of norepinephrine.

Amitriptyline may reduce the antihypertensive effect of sympatholytics (octadine, guanethidine and drugs with a similar mechanism of action).

With the simultaneous administration of amitriptyline and cimetidine, an increase in plasma concentration of amitriptyline is possible.

Simultaneous administration of amitriptyline with MAO inhibitors can lead to death. A break in treatment between taking MAO inhibitors and tricyclic antidepressants should be at least 14 days!

Side effects

According to reviews on Amitriptyline, the most common side effects of the drug are: increased intraocular pressure, disorders of accommodation, constipation, urinary retention, dry mouth, intestinal obstruction, drowsiness, fever.

In addition, patients may experience such side effects:

disorders of the central nervous system: dizziness, drowsiness, tremor;
disorders of the gastrointestinal tract: a taste disorder, stomatitis, nausea, vomiting, the development of anorexia, in rare cases, violations of the liver;
disturbances in the work of the cardiovascular system: tachycardia, increased blood pressure, orthostatic hypotension, and so on;
allergic reactions. According to reviews on Amitriptyline, some patients had rash and other allergic reactions;
violations of the endocrine system: a decrease in libido and potency, a change in the secretion of ADH, gynecomastia.

After reading reviews about Amitriptyline, you can find information that a prolonged use of the drug may lead to an increase in body weight.

With caution appoint the drug to people with manic-depressive psychosis, there is a risk of transition of the disease to the manic stage.

It should also be remembered that the use of Amitriptyline in tablets with a daily dose of the drug above 150 mg leads to a decrease in the threshold of convulsive activity. Therefore, patients who have a history of convulsive seizures, as well as those patients who they can happen due to age or injuries, it is necessary to take into account the risk of seizures.

Overdose

It is possible to increase the severity of the described side effects.

Acute poisoning with amitriptyline is a danger to the life of the patient, even with a satisfactory general condition and preservation of respiratory function. Cramps and severe impairment of vital body functions can occur unexpectedly. Sign of severe cardiotoxic effect-prolongation of complex OK5 on ECG-can appear only after 3-5 days (latent period) after taking a toxic dose. -

Treatment: In case of an overdose, call an ambulance immediately.

special instructions

Before carrying out the therapy, it is necessary to control the blood pressure level. Parenteral Amitriptyline is administered solely under the supervision of a physician in the conditions of the hospital. In the first days of treatment, bed rest should be observed. It requires a complete refusal to take ethanol.

Sharp refusal of therapy can cause a syndrome of "cancellation". The drug in a dose of more than 150 mg per day leads to a decrease in the threshold of convulsive activity, which is important to consider when developing epileptic seizures in patients with a predisposition. It is possible to develop hypomanic or manic conditions in persons with cyclical, affective disorders during the depressive phase. If necessary, the treatment is resumed from small doses after the relief of these conditions. Care should be taken when treating patients taking thyroid hormone medications, in the treatment of patients with thyrotoxicosis because of the possible risk of developing cardiotoxic effects.

Medication can provoke the development of paralytic intestinal obstruction in the elderly, and also prone to chronic constipation. It is mandatory to warn anesthesiologists about taking amitriptyline before conducting local or general anesthesia. Long-term therapy provokes the development of caries. Perhaps increased demand for riboflavin. Amitriptyline penetrates into breast milk, in infants causes increased drowsiness. The drug affects the management of motor vehicles.

Drug Interactions

Simultaneous use with clonidine and guanethidine, leads to a decrease in the therapeutic effect of the latter, associated with lowering blood pressure;
Simultaneous use with drugs that have a blocking effect on monoamine oxidase leads to a sharp increase in blood pressure;
Simultaneous application with Sucralfate leads to a significant decrease in absorption of Amitriptyline and an increase in its plasma concentration;
Simultaneous application with fluoxetine, quinidine and cimetidine, leads to an increase in the concentration of amitriptyline and the development of symptoms of poisoning;
With simultaneous use with drugs that have a blocking effect on the acetylcholine receptors, a depressant effect on the central nervous system, lowering blood pressure, drugs, having a therapeutic effect associated with the activity of the heart and preparations containing ethyl alcohol or alcoholic products, there is a significant increase in the therapeutic effect of the latter.
Simultaneous application with carbamazepine leads to an increased excretion of Amitriptyline from the body and a sharp decrease in its therapeutic effects.