Medications and Drugs

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Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD

GENERIC NAME: amitriptyline

BRAND NAME: Endep (Elavil: This brand name drug is no longer available in the U.S.)

DRUG CLASS AND MECHANISM: Amitriptyline is an antidepressant drug. Depression is an all-pervasive sense of sadness and gloom. It is believed that in some patients with depression, abnormal levels of neurotransmitters (chemicals that nerves use to communicate with each other) may relate to their depression. Amitriptyline elevates mood by raising the level of neurotransmitters in nerves of the brain. Amitriptyline was approved by the FDA in May 1983.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Tablets: 10, 25, 50, 75, 100, and 150mg.

STORAGE: Amitriptyline should be stored at room temperature in a tight, light resistant container. Avoid storage at temperatures above 30°C (86°F).

PRESCRIBED FOR: Amitriptyline is used to elevate the mood of patients with depression.

DOSING: Amitriptyline may be taken with or without food. The recommended adult dose is 40-150 mg daily in divided doses. The lowest effective dose should be used.

DRUG INTERACTIONS: Amitriptyline should not be used with monoamine oxidase inhibiting drugs. High fever, convulsions and even death can occur when these two drugs are used together. Epinephrine should not be used with amitriptyline, since together they can cause severe high blood pressure. Alcohol blocks the antidepressant action of amitriptyline but increases its sedative effect. Cimetidine (Tagamet) can increase blood levels of amitriptyline and its side effects.

PREGNANCY: Safety in pregnancy and children is not established.

NURSING MOTHERS: Amitriptyline is secreted in human milk and potentially can adversely affect the nursing infant.

SIDE EFFECTS: Sometimes troublesome side effects include fast heart rate, blurred vision, urinary retention, dry mouth, constipation, weight gain or loss, and low blood pressure on standing. Rash, hives, seizures, and hepatitis are rare side effects.

Amitriptyline is used with caution in patients with seizures since it can increase the risk of seizures. Amitriptyline is used with caution in patients with prostate enlargement because of the risk of increasing retention of urine due to the inability to urinate. Amitriptyline can cause elevated pressure in the eyes of certain patients with glaucoma.

Antidepressants increased the risk of suicidal thinking and behavior in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of amitriptyline or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thinking or behavior, and unusual changes in behavior.

If amitriptyline is discontinued abruptly, dizziness, headache, nausea, and restlessness may occur. Withdrawal symptoms may occur when even a few doses are missed. Therefore, it is recommended that the dose of antidepressant be reduced gradually when therapy is discontinued.

Reference: FDA Prescribing Information