amitriptyline. (Elavil, Endep)

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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 in the class of drugs called tricyclic antidepressants (TCAs) and is used for treating depression. Other drugs in the same class include clomipramine (Anafranil), doxepin (Sinequan), imipramine (Tofranil), trimipramine (Surmontil), amoxapine (Amoxapine), desipramine (Norpramin), and protriptyline (Vivactil). Individuals with depression may have an imbalance in neurotransmitters, chemicals that nerves make and use to communicate with other nerves. Like all TCAs, amitriptyline increases levels of norepinephrine and serotonin, two neurotransmitters, and blocks the action of acetylcholine, another neurotransmitter. It is believed that by restoring the balance of these different neurotransmitters in the brain that depression is alleviated (for example, the mood is elevated). Amitriptyline was approved by the FDA in May 1983.



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

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

PRESCRIBED FOR: Amitriptyline is used to elevate the mood of patients with depression. It is also used off-label (non-FDA-approved) for treating postherpetic neuralgia, attention deficit hyperactivity disorder (ADHD), migraine headache, and eating disorders.

DOSING: Amitriptyline may be taken with or without food. The recommended adult dose is 100-300 mg daily in divided doses or at bedtime. The initial dose is 50-100 mg at bedtime that may be increased by 25 or 50 mg at bedtime as needed. The lowest effective dose should be used.

DRUG INTERACTIONS: Amitriptyline should not be used with monoamine oxidase inhibitors (MAOIs). High fever, convulsions and even death can occur when these two types of 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 by preventing the elimination of amitriptyline.

PREGNANCY: Safety of amitriptyline 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 (orthostatic hypotenstion). Rash, hives, seizures, and hepatitis are rare side effects.

Medically Reviewed by a Doctor on 7/28/2014

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