Classes
DEA Class; Rx
Common Brand Names; Elavil, Levate
- Antidepressants, TCAs
Description
Tertiary amine tricyclic antidepressant; amitriptyline is metabolized to nortriptyline, an active metabolite
FDA-approved for use in adults for the treatment of depression; used off label for neuropathic pain and other uses
Boxed warning for use in pediatric patients and young adults due to risk for suicidality
Indications
Indicated for the treatment of major depression.
Contraindications
Hypersensitivity
Acute recovery phase following MI
Concurrent use with cisapride
Contraindicated within 14 days of MAOIs; if linezolid or IV methylene blue (MAOIs) must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity; may resume 24 hr after last linezolid or methylene blue dose, or after 2 weeks of monitoring, whichever comes first
Adverse Effects
- Extrapyramidal symptoms (EPS)
- Fatigue
- Hallucination
- Headache
- Hypertension
- Increased LFTs
- Insomnia
- Lethargy
- Leukopenia
- MI
- Nausea
- Ocular pressure increased
- Orthostatic hypotension
- Palpitation
- Paresthesia
- Photosensitivity
- Rash
- Restlessness
Warnings
Bone marrow suppression reported
Avoid use in narrow-angle glaucoma
May cause sedation and impair mental and physical abilities
Avoid use with any drugs or conditions that prolong QT interval
May cause orthostatic hypotension
Use caution in patients with cardiovascular disease, diabetes, mania, hepatic and renal impairment, thyroid dysfunction, and seizure disorder
May worsen mania symptoms or precipitate mania in patients with bipolar disorder
Clinical worsening and suicidal ideation may occur despite medication in adolescents and young adults (18-24 years)
Risk of anticholinergic side effects; may cause constipation, urinary retention, blurred vision, and xerostomia
Use caution in patients with urinary retention, open-angle glaucoma, BPH, decreased gastrointestinal motility, or paralytic ileus
Possibility of EPS and neuroleptic malignant syndrome
Abrupt discontinuation of therapy not recommended in patients receiving high doses for prolonged periods
Fractures reported with therapy
Pregnancy and Lactation
Pregnancy category: C
Lactation: Distributed in breast milk; do not nurse (AAP states effect on nursing infants is unknown but may be of concern)
Maximum Dosage
150 mg/day PO in outpatients; 300 mg/day PO for hospitalized patients.
150 mg/day PO in outpatients.
150 mg/day PO in outpatients.
< 12 years: Safety and efficacy have not been established.
How supplied
Amitriptyline hydrochloride
tablet
- 10mg
- 25mg
- 50mg
- 75mg
- 100mg
- 150mg
