Names and pronunciation
(a-mee-trip′ti-leen) Elavil , Levate
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Individual generic drug information
Extracted information for amitriptyline only.
(a-mee-trip′ti-leen) Elavil , Levate
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Func. class.: Antidepressant— tricyclic
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Chem. class.: Tertiary amine
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Do not confuse: amitriptyline/nortriptyline/aminophylline
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ACTION: Blocks reuptake of norepi- nephrine, serotonin into nerve endings, thereby increasing action of norepineph- rine, serotonin in nerve cells
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USES: Major depressive disorder
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Extracted information for amitriptyline only.
CONTRAINDICATIONS: Hyper- sensitivity to tricyclics; recovery phase of myocardial infarction Precautions: Pregnancy, breastfeed- ing, geriatric patients, seizure disor- ders, prostatic hypertrophy, schizophre- nia, psychosis, severe depression, increased intraocular pressure, closed- angle glaucoma, urinary retention, renal/hepatic/cardiac disease, hyperthy- roidism, electroshock therapy, elective surgery
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Black Box Warning: Children <12 yr, suicidal patients Black Box Warning: Suicidal thinking, behavior: mood, sensorium, affect, suicidal tendencies; increase in psychiatric symp- toms: depression, panic; suicidal tendencies are higher in those ≤24 yr, restrict amount of product available, avoid use in child <12 yr • Urinary retention, constipation: con- stipation is most likely to occur in chil- dren and geriatric patients • Withdrawal symptoms: headache, nausea, vomiting, muscle pain, weak- ness; do not usually occur unless product was discontinued abruptly • Alcohol consumption: if alcohol is consumed, hold dose until morning • Pain syndromes (unlabeled): intensity, location, severity; use pain scale; product may be taken for 1-2 mo before effective • Sexual dysfunction: erectile dysfunc- tion, decreased libido • Beers Avoid in older adults; highly anticholinergic, sedating, orthostatic hy- potension Black Box Warning: To watch for sui- cide; advise to watch closely for suicidal thinking, behavior, making a plan or at- tempts, panic attacks, change in mood • That follow-up examinations will be needed • That all health care professionals should be notified the product is being used
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SIDE EFFECTS CNS: Dizziness, drowsiness, confusion, headache, anxiety, tremors, weakness, insomnia, EPS (geriatric patients), sei- zures, suicidal thoughts, anxiety CV: Orthostatic hypotension, ECG changes, tachycardia, hypertension, palpitations, dys- rhythmias, QT prolongation EENT: Blurred vision, tinnitus, mydriasis GI: Constipation, dry mouth, weight gain, nausea, vomiting, paralytic ileus, epigastric distress, hepatitis, diarrhea, constipation GU: Urinary retention, sexual dysfunc- tion HEMA: Agranulocytosis, thrombocytopenia, eosinophilia, leukopenia, aplastic anemia INTEG: Rash, urticaria, sweating, photosensitivity SYST: Hypersensitivity
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INTERACTIONS Increase: Hyperpyretic crisis, seizures, hypertensive episode—MAOIs; do not use within 14 days of MAOIs Increase: risk for agranulocytosis—anti- thyroid agents Increase: QT prolongation—procain- amide, quiNIDine, amiodarone, tricyclics, class IA, III antidysrhythmics; may need dosage change Increase: amitriptyline levels, toxicity— cimetidine, FLUoxetine, phenothiazines, oral contraceptives, antidepressants, car- BAMazepine, class IC antidysrhythmics, ritonavir Increase: effects of direct-acting sympa- thomimetics (EPINEPHrine), alcohol, barbiturates, benzodiazepines, CNS depressants, opioids, sedative/hypnotics Increase: serotonin syndrome—line- zolid, methylene blue; use cautiously Increase: hypertensive crisis—cloNIDine Drug/Herb Increase: serotonin syndrome—SAM-e, St. John’s wort, yohimbe; avoid concur- rent use Increase: CNS depression—kava, hops, chamomile, lavender, valerian Drug/Lab Test Increase: blood glucose, LFTs Decrease: WBCs, platelets, granulocytes, blood glucose
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TREATMENT OF OVERDOSE: ECG monitoring, lavage; administer anti- convulsant, sodium bicarbonate
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Extracted information for amitriptyline only.
DOSAGE AND ROUTES Depression • Adult: PO Initially, 75 mg/day divided, or 50-100 mg daily at bedtime, max outpatient 150 mg/day, max inpatient 300 mg/day • Adolescents: PO 10 mg tid and 20 mg at bedtime, then titrate • Geriatric: PO Initially, 10-25 mg at bedtime; may increase by 10-25 mg weekly, max 150 mg/day
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Available forms: Tablets 10, 25, 50, 75, 100, 150 mg
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Administer: • Increase fluids, bulk in diet if consti- pation, urinary retention occur, espe- cially in geriatric patients • With food, milk for GI symptoms • Crushed if patient unable to swallow A medication whole, give with food, flu- ids • Dosage at bedtime if oversedation oc- curs during day; may take entire dose at bedtime; geriatric patients may not toler- ate once-daily dosing; use tapering when withdrawing product • Store at room temperature; do not freeze
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Extracted information for amitriptyline only.
Assess: • B/P lying, standing; pulse if systolic B/P drops 20 mm Hg, hold product, no- tify prescriber; take vital signs more fre- quently with CV disease; ECG baseline and frequently in cardiac patients; avoid use immediately after MI • Blood studies: CBC, leukocytes, dif- ferential, cardiac enzymes if patient is receiving long-term therapy, thyroid function tests • Hepatic studies: AST, ALT, bilirubin • Weight weekly; appetite may increase with product • EPS primarily in geriatric patients: ri- gidity, dystonia, akathisia • Paralytic ileus, glaucoma exacerbation
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Evaluate: • Therapeutic response: decrease in de- pression, absence of suicidal thoughts
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To take medication as directed (usu- ally at bedtime); not to double dose; that therapeutic effects may take 2-3 wk; not to discontinue medication quickly after long-term use, usually used for at least 3-4 mo: may cause nausea, headache, malaise • To use caution when driving, perform- ing other activities that require alertness because of drowsiness, dizziness, blurred vision; to avoid rising quickly from sitting to standing (especially geriatric patients); how to manage anticholinergic effects • To avoid alcohol, other CNS depressants • To wear sunscreen or large hat when outdoors; photosensitivity occurs • Pregnancy/breastfeeding: Identify if pregnancy is planned or suspected or if breastfeeding
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Extracted information for amitriptyline only.
PHARMACOKINETICS Onset 45 min; peak 2-12 hr, protein binding >95%; metabolized by liver to nortriptyline; excreted in urine, feces; crosses placenta; excreted in breast milk; half-life 30-46 hr; antidepressant action up to 30 days, peak 2-6 wk, duration up to several weeks
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Filter the extracted dose blocks for this individual drug.
Depression
• Adult: PO Initially, 75 mg/day divided, or 50-100 mg daily at bedtime, max outpatient 150 mg/day, max inpatient 300 mg/day
Candidate age grouping · source page 75