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Amitriptyline

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Amitriptyline, Elavil

  • See Also
  1. Tricyclic Antidepressant
  2. Nortriptyline
  3. Antidepressant
  4. SNRI
  5. Tricyclic Antidepressant Overdose
  • Indications
  1. Migraine Headache Prophylaxis
  2. Fibromyalgia
  3. Chronic Pain (esp. neuropathic pain)
  4. Insomnia
  5. Major Depression (historical use, replaced by SSRI and SNRI Antidepressants)
  6. Panic Disorder with Agoraphobia
  7. Obsessive Compulsive Disorder
  • Precautions
  1. See Tricyclic Antidepressants
  2. See Tricyclic Antidepressant Overdose
  3. Serious cardiotoxicity in overdosage
  • Mechanism
  1. See Tricyclic Antidepressant
  2. Amitriptyline primarily inhibits Serotonin reuptake
  3. Amitriptyline is demethylated to Nortriptyline, which primarily inhibits Norepinephrine reuptake
  • Pharmacokinetics
  1. Serum Half Life: 30 to 45 hours
  2. Therapeutic plasma level: 110 to 250
  • Safety
  1. Pregnancy Category C
  2. Avoid in Lactation
  1. Start at 25 mg orally at bedtime for 3 days
  2. Next: 50 mg orally at bedtime for 3 days
  3. Therapeutic Target Dose: 75 mg orally at bedtime (range 50 to 100 mg/day)
  1. Initial: 25 mg orally at bedtime
  2. Morning Hangover Effect: Taper to 10 mg orally at bedtime
  1. Avoid for Major Depression given adverse effects
    1. SSRIs and other new Antidepressants are preferred
  2. Adults
    1. Start 50-100 mg orally at bedtime (or 25 mg orally three times daily)
    2. Titrate to 150 mg orally at bedtime (or in divided doses)
    3. Max Dose: 300 mg daily
  3. Elderly and Children over age 12 years
    1. Start 10 mg orally three times daily and 25 mg orally at bedtime
    2. Titrate dose as needed
    3. Max Dose: 200 mg daily
  • Adverse Effects
  1. See Tricyclic Antidepressants
  2. Tricyclic Antidepressant Overdose
  3. Amitriptyline is among the most Anticholinergic of the Tricyclic Antidepressants (including Sedative effects)
    1. Consider Nortriptyline as an alternative
  4. Significant adverse effects
    1. Sedation and morning grogginess
    2. Anticholinergic Symptoms
    3. Orthostatic Hypotension
    4. Cardiac Arrhythmia
    5. Weight gain
  • Drug Interactions
  1. See Tricyclic Antidepressants
  • Resources
  1. Amitriptyline (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1e6d2c80-fbc8-444e-bdd3-6a91fe1b95bd
  • References
  1. (2023) Med Lett Drugs Ther 62(1592): 25-32
  2. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 36-7
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia