AMITRIPTYLINE DRUG INFO
HOW TO USE AMITRIPTYLINE: Take amitriptyline tablets by mouth. Follow the directions on the prescription label. Swallow the tablets with a drink of water. You can take the tablets with or without food. Take your doses at regular intervals. Do not take your medicine more often than directed. Do not stop taking except on your prescriber's advice.
Contact your pediatrician or health care professional regarding the use of this medicine in children. Special care may be needed.
Adolescents, 12 to 18 years old, and elderly patients over 65 years old may have a stronger reaction to this medicine and need smaller doses.
AMITRIPTYLINE SIDE EFFECTS: Side effects that you should report to your prescriber or health care professional as soon as possible: abnormal production of milk in females; blurred vision or eye pain; breast enlargement in both males and females; confusion, hallucinations (seeing or hearing things that are not really there); difficulty breathing; fainting spells; fever with increased sweating; irregular or fast, pounding heartbeat, palpitations; muscle stiffness, or spasms; pain or difficulty passing urine, loss of bladder control; seizures (convulsions); sexual difficulties (decreased sexual ability or desire, difficulty ejaculating); stomach pain; swelling of the testicles; tingling, pain, or numbness in the feet or hands; unusual weakness or tiredness; yellowing of the eyes or skin.
Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome): anxiety; constipation, or diarrhea; drowsiness or dizziness; dry mouth; increased sensitivity of the skin to sun or ultraviolet light; loss of appetite; nausea, vomiting; skin rash or itching; weight gain or loss.
AMITRIPTYLINE PRECAUTIONS: Visit your prescriber or health care professional for regular checks on your progress. It can take several days before you feel the full effect of amitriptyline.
If you have been taking amitriptyline regularly for some time, do not suddenly stop taking it. You must gradually reduce the dose or you may get severe side effects. Ask your prescriber or health care professional for advice. Even after you stop taking amitriptyline it can still affect your body for several days.
You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how amitriptyline affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol may increase dizziness and drowsiness. Avoid alcoholic drinks.
Do not treat yourself for coughs, colds or allergies without asking your prescriber or health care professional for advice. Some ingredients can increase possible side effects.
Your mouth may get dry. Chewing sugarless gum or sucking hard candy, and drinking plenty of water will help.
Amitripyline may cause dry eyes and blurred vision. If you wear contact lenses you may feel some discomfort. Lubricating drops may help. See your ophthalmologist if the problem does not go away or is severe.
Amitriptyline may make your skin more sensitive to the sun. Keep out of the sun, or wear protective clothing outdoors and use a sunscreen. Do not use sun lamps or sun tanning beds or booths.
If you are diabetic, check your blood sugar more often than usual, especially during the first few weeks of treatment with amitriptyline. Amitriptyline can affect blood glucose (sugar) levels. Call your prescriber or health care professional for advice if you notice a change in the results of blood or urine glucose tests.
If you are going to have surgery or will need an x-ray procedure that uses contrast agents, tell your prescriber or health care professional that you are taking this medicine.
AMITRIPTYLINE DRUG INTERACTIONS: Amitriptyline can interact with many other medicines. Some interactions can be very important. Make sure your prescriber or health care professional knows about all other medicines you are taking. Many important interactions are listed below:
Do not take amitriptyline with any of the following medications: astemizole (Hismanal?; cisapride (Propulsid?; probucol; terfenadine (Seldane?; thioridazine (Mellaril?; medicines called MAO inhibitors-phenelzine (Nardil?, tranylcypromine (Parnate?, isocarboxazid (Marplan?, selegiline (Eldepryl?; other medicines for mental depression (may be duplicate therapies or cause additive side effects).
Amitriptyline may also interact with any of the following medications: alcohol; antacids; atropine and related drugs like hyoscyamine, scopolamine, tolterodine and others; barbiturate medicines for inducing sleep or treating seizures (convulsions), such as phenobarbital; blood thinners, such as warfarin; bromocriptine; bupropion; cimetidine; clonidine; cocaine; delavirdine; diphenoxylate; disulfiram; donepezil; drugs for treating HIV infection; female hormones, including contraceptive or birth control pills and estrogen; galantamine; herbs and dietary supplements like ephedra (Ma huang), kava kava, SAM-e, St. John's wort, valerian, or others ; imatinib, STI-571; kaolin; pectin; labetalol; levodopa and other medicines for movement problems like Parkinson's disease; lithium; medicines for anxiety or sleeping problems; medicines for colds, flu and breathing difficulties, like pseudoephedrine; medicines for hay fever or allergies (antihistamines); medicines for weight loss or appetite control; medicines used to regulate abnormal heartbeat or to treat other heart conditions (examples: amiodarone, bepridil, disopyramide, dofetilide, encainide, flecainide, ibutilide, mibefradil, procainamide, propafenone, quinidine, and others); metoclopramide; muscle relaxants, like cyclobenzaprine; other medicines for mental or mood problems and psychotic disturbances; prescription pain medications like morphine, codeine, tramadol and others; procarbazine; seizure (convulsion) or epilepsy medicine such as carbamazepine or phenytoin; stimulants like dexmethylphenidate or methylphenidate; some antibiotics (examples: erythromycin, gatifloxacin, levofloxacin, linezolid, moxifloxacin, sotalol, sparfloxacin) ; tacrine; thyroid hormones such as levothyroxine.
Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.
AMITRIPTYLINE NOTES: Prescriber needs to know if you have any of these conditions: an alcohol problem; asthma, difficulty breathing; blood disorders or disease; diabetes; difficulty passing urine, prostate trouble; glaucoma; having intramuscular injections; heart disease or previous heart attack; liver disease; over active thyroid; Parkinson's disease; schizophrenia; seizures (convulsions); stomach disease; an unusual or allergic reaction to amitriptyline, other medicines, foods, dyes, or preservatives; pregnant or trying to get pregnant; breast-feeding.
AMITRIPTYLINE MISSED DOSE: If you miss a dose normally taken at bedtime to avoid daytime drowsiness, it may be better to miss that dose. If you take more than one dose a day and miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Follow your prescriber's advice on missed doses. Do not take double or extra doses.
AMITRIPTYLINE STORAGE: Keep out of the reach of children in a container that small children cannot open.
Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.
More Information:
APO-AMITRIPTYLINE Apotex
Amitriptyline HCl
Use:
Tricyclic antidepressant. Depressive illness of psychotic or
endogenous nature and in selected patient with neurotic depression.
May help alleviate anxiety component of depression. Outpatient
adults: Initially, 25 mg 3 times/day. Depending on tolerance and
response, increase to a total of 150 mg/day with increases made
preferably in late afternoon and/or bedtime doses. Hospitalized
patients may require 100 mg/day initially, increased gradually to
200 mg/day if necessary. A small number may need up to 300 mg/day.
Adolescent and elderly patients: Lower dosages are recommended for
these patients and 50 mg/day given in divided doses or in a single
evening or bedtime dose may be satisfactory. For maintenance, reduce
dosage to the lowest amount that maintains relief of symptoms-
usually 50-100 mg/day in divided doses, or in suitable patients, in
a single dose, preferably at bedtime.
Contraindications:
Not to be given concomitantly with MAOIs; discontinue MAOI therapy
at least 14 days before starting amitriptyline. Acute recovery phase
following MI, acute CHF.
Precautions:
History of seizures, impaired liver function, hepatic damage, blood
dyscrasias, urinary retention, constipation, narrow-angle glaucoma
or increased intraocular pressure, cardiovascular disorders,
hyperthyroidism. Pregnancy, lactation. Not recommended for depressed
patients < 12 years of age. Psychoses, patient with suicidal
tendencies, concurrent electroshock therapy. Discontinue
amitriptyline several days before elective surgery.
Side effects:
Anticholinergic effects (e.g. dry mouth, blurred vision, urinary
retention, constipation, palpitations, tachycardia, associated
sublingual adenitis or gingivitis). Weight loss or gain. Tinnitus,
drowsiness, nervousness, insomnia, Hypotension, dizziness, rash
sweating, confusion, mania, psychosis, heart block, arrhythmias,
extrapyramidal symptoms. Gastric upset. Endocrine effects (e.g.
changes in libido, impotence, gynecomastia, galactorrhea). Rarely,
bone marrow depression, hepatic toxicity, seizures, peripheral
neuropathy, severe cardiovascular effects in patients with cardiac
disease, photosensitivity, Dysarthria, stuttering, renal failure.
Withdrawal symptoms.
Interactions:
Possible hyperpyretic crisis if given with or within 14 days of MAOI
therapy. May enhance the response to alcohol, other CNS depressants
and anticholinergics (paralytic ileus). Use cautiously with
sympathomimetics. May block the antihypertensive effect of
guanethidine or similar agents. Delirium with ethchlorvynol and also
with disulfiram. Cimetidine may reduce the hepatic metabolism of
some tricyclic antidepressants.
Patient tips:
Caution re drowsiness, blurred vision (NB driving). Restrict alcohol
intake. Antidepressant activity may take up to 30 days to develop
adequately. Photosensitivity.
Supplied:
10 mg, 25 mg, 50 mg, 75 mg tablets.
Antidepressant
In the drug management of depressive illness.
Amitriptyline may be used in depressive illness of psychotic or
endogenous nature and in selected patients with neurotic depression.
Endogenous depression is more likely to be alleviated than are other
depressive states. Amitriptyline, because of its sedative action, is
also of value in alleviating the anxiety component of depression.
As with other tricyclic antidepressants, amitriptyline may
precipitate hypomanic episodes in patients with bipolar depression.
These drugs are not indicated in mild depressive states and
depressive reactions.
In patients who have shown prior hypersensitivity to it. It
should not be given concomitantly with a MAO inhibiting compound.
Hyperpyretic crises, severe convulsions, and deaths have occurred in
patients receiving tricyclic antidepressant and MAO inhibiting drugs
simultaneously. When it is desired to substitute amitriptyline for a
MAO inhibitor, a minimum of 14 days should be allowed to elapse
after the latter is discontinued. Amitriptyline should then be
initiated cautiously with gradual increase in dosage until optimum
response is achieved.
This drug is not recommended for use during the acute recovery
phase following myocardial infarction and in the presence of acute
congestive heart failure.
See Pregnancy under Warnings.
Amitriptyline should be used with caution in patients with a
history of seizures, impaired liver function, a history of hepatic
damage or blood dyscrasias and, because of its atropine-like action,
in patients with a history of urinary retention, or with
narrow-angle glaucoma or increased intraocular pressure. In patients
with narrow-angle glaucoma, even average doses may precipitate an
attack.
There has been a report of fatal dysrhythmia occurring as late as
56 hours after amitriptyline overdose.
Patients with cardiovascular disorders should be watched closely.
Tricyclic antidepressant drugs, including amitriptyline,
particularly when given in high doses, have been reported to produce
arrhythmias, sinus tachycardia, and prolongation of the conduction
time.
A few instances of unexpected deaths have been reported in
patients with cardiovascular disorders. Myocardial infarction and
stroke have also been reported with drugs of this class. Therefore,
these drugs should be used with caution in patients with a history
of cardiovascular disease, such as myocardial infarction and
congestive heart failure.
Concurrent administration of amitriptyline and electroshock
therapy may increase the hazards of therapy. Such treatment should
be limited to patients for whom it is essential.
Close supervision is required when amitriptyline is given to
hyperthyroid patients or those receiving thyroid medication.
Occupational Hazards:
May impair mental and/or physical abilities required for performance
of hazardous tasks, such as operating machinery or driving a motor
vehicle.
Pregnancy:
There are no well-controlled studies in pregnant women; therefore,
in administering the drug to pregnant patients or women who may
become pregnant, the potential benefits must be weighed against the
possible hazards to mother and child.
Lactation:
Amitriptyline is detectable in breast milk. Because of the potential
for serious adverse reactions in infants from amitriptyline, a
decision should be made whether to discontinue nursing or
discontinue the drug.
Children:
In view of the lack of experience with the use of this drug in the
treatment of depression in children, amitriptyline is not
recommended for depressed patients under 12 years of age.
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