Amitriptyline Hydrochloride(a mee trip’ ti leen)
Apo-Amitriptyline (CAN)
PREGNANCY CATEGORY D
Drug Classes
Antidepressant
TCA; tertiary amine
Therapeutic Actions
Mechanism of action unknown; TCAs inhibit the reuptake of the neurotransmitters norepinephrine and serotonin, leading to an increase in their effects; anticholinergic at CNS and peripheral receptors; sedative.
Indications
Relief of symptoms of depression (endogenous most responsive); sedative effects may help when depression is associated with anxiety and sleep disturbance
Unlabeled uses: Control of chronic pain (eg, intractable pain of cancer, central
pain syndromes, peripheral neuropathies, postherpetic neuralgia, tic douloureux); prevention of onset of cluster and migraine headaches; treatment of pathologic weeping and laughing secondary to forebrain disease (due to MS); insomnia; fibromyalgia; adult enuresis; bulimia nervosa
Contraindications and Cautions
Contraindicated with hypersensitivity to any tricyclic drug; concomitant therapy with an MAOI; recent MI; myelography within previous 24 hr or scheduled within 48 hr; lactation.
Use cautiously with electroshock therapy; preexisting CV disorders (severe heart disease, progressive heart failure, angina pectoris, paroxysmal tachycardia); angle-closure glaucoma, increased IOP, urinary retention, ureteral or urethral spasm; seizure disorders; hyperthyroidism; impaired hepatic, renal function; psychiatric patients (schizophrenic or paranoid patients may exhibit a worsening of psychosis with TCA therapy); patients with bipolar disorder; elective surgery (discontinue as long as possible before surgery).
Available Forms
Tablets—10, 25, 50, 75, 100, 150 mg
Dosages
Adults
Depression, hospitalized patients: Initially, 100 mg/day PO in divided doses; gradually increase to 200–300 mg/day as required.
Depression, outpatients: Initially, 75 mg/day PO, in divided doses; may increase to 150 mg/day. Increases should be made in late afternoon or at bedtime. Total daily dosage may be administered at bedtime. Initiate single daily dose therapy with 50–100 mg at bedtime; increase by 25–50 mg as necessary to a total of 150 mg/day. Maintenance dose, 40–100 mg/day, which may be given as a single bedtime dose. After satisfactory response, reduce to lowest effective dosage. Continue therapy for 3 mo or longer to lessen possibility of relapse.
Chronic pain: 75–150 mg/day PO.
Pediatric patients 12 yr and older
10 mg tid PO and then 20 mg at bedtime.
Pediatric patients younger than 12 yr
Not recommended.
Geriatric patients
10 mg tid PO and then 20 mg at bedtime.
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