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20-September-2008 10:21:21 - Amitriptyline Amitriptyline Systematic IUPAC name 3-10,11-dihydro-5H-dibenzoa,d cycloheptene-5-ylidene-N, N-dimethyl-1-propanamine Identifiers CAS number 50-48-6 ATC code N06AA09 PubChem 2160 DrugBank APRD00227 Chemical data Formula C20H23N Mol. mass 277.403 g/mol Pharmacokinetic data Bioavailability 40% Metabolism Hepatic Half life 12-24 hours Excretion Renal Therapeutic considerations Pregnancy cat. DUS Legal status UnscheduledAU POMUK Routes Oral Amitriptyline or Amitryptyline hydrochloride sold as Elavil, Tryptanol, Endep, Elatrol, Tryptizol, Trepiline, Laroxyl is a tricyclic antidepressant drug. It is a white, odorless but tastes like licorice, crystalline compound which is freely soluble in water; it is usually dispensed in tablet form. In terms of its mechanism of action, amitriptyline inhibits serotonin and noradrenaline reuptake almost equally. Contents 1 Uses 1.1 Approved 1.2 Unapproved/off-label/investigational use 2 Side effects 3 Overdose 4 Footnotes 5 References Uses Approved Amitriptyline is approved most commonly for the treatment of depression clinical/endogenous depression, also involutional melancholia 'depression of late life', which is no longer seen as a disease in its own right. Adult typical dosages are 25 to 150 mg daily, with half this initially for elderly or adolescents. It may also be used to treat nocturnal enuresis bed wetting. Children between the ages of 7 to 10 years having a dose of 10 to 20 mg, older children 25 to 50 mg at night. It should be gradually withdrawn at the end of the course, which overall should be of no more than 3 months.1 In some European countries it is also officially approved as a preventive prophylaxis for patients with frequent/chronic migraines, usually 25 to 75 mg. Unapproved/off-label/investigational use Amitriptyline may be prescribed for other conditions such as insomnia, PTSD2, migraine, rebound headache, chronic pain, chronic cough, postherpetic neuralgia persistent pain following a shingles attack, carpal tunnel syndrome, fibromyalgia, vulvodynia, interstitial cystitis, male chronic pelvic pain syndrome, irritable bowel syndrome, diabetic peripheral neuropathy, neurological pain, and painful paresthesias related to multiple sclerosis and at low doses as a preventive prophylaxis for patients with frequent migraines.3 Typically lower dosages are required for pain modification of 10 to 50 mg daily.1 Amitriptyline in low doses is also sometimes prescribed to help ease the symptoms of chronic fatigue syndrome. It is thought to help combat symptoms of insomnia primarily, in addition to other selected symptoms of the affliction. A randomized controlled trial published in June 2005 found that amitriptyline was effective in functional dyspepsia that did not respond to a first-line treatment famotidine or mosapride.4 Side effects Common side effects of using amitriptyline are dry mouth, extreme weight gain, drowsiness, muscle stiffness, nausea, constipation, nervousness, dizziness, blurred vision and insomnia. Some rare side effects include tinnitus, hypotension, mania, psychosis, anticholinergic effects, heart block, arrhythmias, lip and mouth ulcers, extrapyramidal symptoms, depression, and hepatic toxicity. Overdose The symptoms and the treatment of an overdose are largely the same as for the other tricyclic antidepressants. Further information: Tricyclic antidepressant#Overdose Footnotes ^ a b British National Formulary 45 March 2003. ^ National Institute for Clinical Excellence: The Treatment of PTSD in Adults and Children ^ Ziegler D, Hurwitz A, Hassanein R, Kodanaz H, Preskorn S, Mason J 1987. Migraine prophylaxis. A comparison of propranolol and amitriptyline. Arch Neurol 44 5: 486-9. PMID 3579659. ^ Otaka M, Jin M, Odashima M, et al June 2005. New strategy of therapy for functional dyspepsia using famotidine, mosapride and amitriptyline. Aliment. Pharmacol. Ther. 21 Suppl 2: 42-6. doi:10.1111/j.1365-2036.2005.02473.x. PMID 15943846. References PubChem Substance Summary: Amitriptyline National Center for Biotechnology Information. TREPILINE®-10 TABLETS; TREPILINE®-25 TABLETS South African Electronic Package Inserts. 12 May 1978. Revised February 2004. SAROTEN® RETARD 25 mg Capsules; SAROTEN® RETARD 50 mg Capsules South African Electronic Package Inserts. December 1987. Updated May 2000. AMITRIP® Amitriptyline hydrochloride 10 mg, 25 mg and 50 mg Capsules Medsafe NZ Physician Data Sheet. November 2004. Endep Consumer Medicine Information, Australia. December 2005. MedlinePlus Drug Information: Amitriptyline. US National Institutes of Health. January 2008. v d e Psychoanaleptics: antidepressants N06A MAOIs Clorgiline Iproclozide Iproniazid Isocarboxazid Minaprine Nialamide Pargyline Phenelzine Toloxatone Tranylcypromine MAOB: Rasagiline Selegiline RIMAs: Befloxatone Brofaromine Cimoxatone Beta-carbolines Harmaline Moclobemide RIs S RI SS RI Alaproclate, Citalopram, Dapoxetine, Escitalopram, Femoxetine, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Zimelidine TCAs/Tetras Cianopramine, Clomipramine, Nefazodone, Trazodone N RI / A RI Atomoxetine Ciclazindol Maprotiline Nisoxetine Oxaprotiline Reboxetine Talopram Viloxazine TCAs/Tetras Amitriptyline, Amoxapine, Butriptyline, Desipramine/Lofepramine, Dibenzepin, Dosulepin, Doxepin, Imipramine, Iprindole, Melitracen, Nitroxazepine, Nortriptyline, Protriptyline, Trimipramine D RI Medifoxamine Phenmetrazine Vanoxerine TCAs Amineptine SN RI Bicifadine Clovoxamine Desvenlafaxine Duloxetine Milnacipran Nefazodone Venlafaxine ND RI Bupropion Nomifensine SND RI Brasofensine Diclofensine Tesofensine SSREs Tianeptine AAs Tetras Mianserin, Mirtazapine Retrieved from http://en..org/wiki/Amitriptyline Categories: Tricyclic antidepressants | Analgesics Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages العربية Deutsch Español Français Italiano Nederlands 日本語 ‪Norsk nynorsk‬ Polski Português РуÑ?Ñ?кий Svenska This page was last modified on 15 August 2008, at 14:38
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