Treatment of various forms of depression, often in conjunction with psychotherapy; analgesic for certain chronic and neuropathic pain, prophylaxis against migraine headaches.

Amitriptyline should not be abruptly discontinued in patients receiving high doses for prolonged periods. Use with caution in patients with cardiac conduction disturbances; an EKG prior to initiation of therapy is advised; use with caution in patients with a history of hyperthyroidism, renal or hepatic impairment. The most

anticholinergic and sedating of the antidepressants; pronounced effects on the cardiovascular system (hypotension), hence, many psychiatrists agree it is best to avoid in the elderly

Hypersensitivity to amitriptyline (cross-sensitivity with other tricyclics may occur); patients receiving MAO inhibitors within past 14 days; narrow-angle glaucoma; avoid use during pregnancy and lactation

Anticholinergic effects may be pronounced; moderate to marked sedation can occur (tolerance to these effects usually occurs). >10%: Central nervous system: Dizziness, drowsiness, headache Gastrointestinal: Xerostomia, constipation, increased appetite, nausea, unpleasant taste, weight gain Neuromuscular & skeletal:Weakness

1% to 10%: Cardiovascular: Hypotension, postural hypotension, arrhythmias, tachycardia Central nervous system: Nervousness, restlessness, parkinsonian syndrome, insomnia, sedation, fatigue, anxiety, impaired cognitive function, seizures have occurred occasionally, extrapyramidal symptoms are possible Gastrointestinal: Diarrhea, heartburn Genitourinary: Sexual dysfunction, urinary retention Neuromuscular & skeletal: Tremor Ocular: Eye pain, blurred vision Miscellaneous: Diaphoresis (excessive)
<1%: Alopecia, photosensitivity, breast enlargement, galactorrhea, rarely SIADH, trouble with gums, decreased lower esophageal sphincter tone may cause GE reflux, testicular edema, leukopenia, eosinophilia, rarely agranulocytosis, cholestatic jaundice, increased liver enzymes, increased intraocular pressure, tinnitus, allergic reactions, sudden death.

Decreased effect: Phenobarbital may increase the metabolism of amitriptyline; amitriptyline blocks the uptake of guanethidine and thus prevents the hypotensive effect of guanethidine Increased toxicity: Clonidine -> hypertensive crisis; amitriptyline may be additive with or may potentiate the action of other CNS depressants such as sedatives or hypnotics; with MAO inhibitors,

hyperpyrexia, hypertension, tachycardia, confusion, seizures, and deaths have been reported; amitriptyline may increase the prothrombin time in patients stabilized on warfarin; amitriptyline potentiates the pressor and cardiac effects of sympathomimetic agents such as isoproterenol, epinephrine, etc; cimetidine and methylphenidate may decrease the metabolism of amitriptyline; additive anticholinergic effects seen with other anticholinergic agents

Symptoms of overdose include agitation, confusion, hallucinations, urinary retention, hypothermia, hypotension, ventricular tachycardia, seizures. Following initiation of essential overdose management, toxic symptoms should be treated. Sodium bicarbonate is indicated when QRS interval is >0.10 seconds or QTc >0.42 seconds. Ventricular arrhythmias often respond to phenytoin

Take exactly as directed (do not increase dose or frequency); may take several weeks to achieve desired results; may cause physical and/or psychological dependence. Do not use alcohol, excess caffeine, and other prescription or OTC medications not approved by prescriber.Maintain adequate hydration (2-3 L/day of fluids

unless instructed to restrict fluid intake). May turn urine blue-green (normal). You may experience drowsiness, j

lightheadedness, impaired coordination, dizziness, or blurred vision (use caution when driving or engaging in tasks requiring alertness until response to drug is known); constipation (increased exercise, fluids, or dietary fruit and fiber may help); urinary retention (void before taking medication); postural hypotension (use caution climbing stairs or when changing position from lying or sitting to standing); altered sexual drive or ability (reversible); or photosensitivity (use sunscreen, wear protective clothing and eyewear, and avoid direct sunlight). Report persistent CNS effects (eg, nervousness, restlessness, insomnia, anxiety, excitation, headache, agitation, impaired coordination, changes in cognition); muscle cramping, weakness, tremors, or rigidity; ringing in ears or visual disturbances; chest pain, palpitations, or irregular heartbeat; blurred vision; or worsening of condition. Pregnancy/breast-feeding precautions: Do not get pregnant while taking this medication; use appropriate barrier contraceptive measures. Breast-feeding is not recommended.