Amitriptyline Hydrochloride

Introduction

Amitriptyline Hydrochloride (HCl) is an antidepressant medication commonly used to treat clinical depression and other psychiatric disorders. It is primarily used to treat symptoms of major depressive disorder, but also has other off-label uses, such as for management of chronic neuropathic pain, fibromyalgia, treatment-resistant migraines, and sleep disturbances. Amitriptyline HCl is an antidepressant that belongs to the class of medications called tricyclic antidepressants (TCAs).

Uses

Treat major depressive disorder
Treat chronic neuropathic pain
Treat fibromyalgia
Treat treatment-resistant migraines
Treat sleep disturbances

Brand Name	Amitriptyline Hydrochloride
Type
Weight
Generic	Amitriptyline Hydrochloride
Manufacturer
Available in	English বাংলা

Mechanism of Action

Amitriptyline HCl works by inhibiting reuptake of serotonin (5-HT) and norepinephrine (NE). That is, it blocks the reuptake of serotonin and norepinephrine from synaptic clefts back into the presynaptic neuron, thus increasing their availability in the synaptic clefts and allowing them to act as neurotransmitters for a longer period of time. In addition, it increases the action of glutamate, which stimulates glutamate receptors and further increases availability of neurotransmitters in the synaptic cleft.

How Long Does it Take to Work?

Amitriptyline HCl usually takes 4 to 6 weeks to produce noticeable effects, although some people may notice a benefit after two weeks. In order for the antidepressant to be effective, it is usually necessary to take it on a consistent and regular basis as prescribed.

Absorption

Amitriptyline HCl is rapidly and nearly completely absorbed following oral administration. Maximum serum concentrations are observed 1–2 hours after dosing.

Route of Elimination

Amitriptyline HCl is eliminated by the kidneys primarily as metabolites, and to a lesser extent as unchanged drug. The metabolites are further metabolized to glucuronide conjugates that are excreted in the urine.

Dosage

Depression: Initially 75 mg (Elderly and Adolescents 30-75 mg) daily in divided doses or as a single dose at bedtime increased gradually as necessary to 150-200 mg; Child under 16 years not recommended for depression.

Nocturnal Enuresis: Child 7-10 years: 10-20 mg, 11-16 years: 25-50 mg at night; max. period of treatment (including gradual withdrawal) 3 months-full physical examination before the further course.

Prophylaxis of Migraine: 100 mg daily.

Tension Headache: 10-25 mg three times daily.

The usual adult dose of Amitriptyline HCl is 75-100 mg per day in divided doses, or 40–60 mg as a single night time dose. The starting dose for elderly or debilitated patients is 10–25 mg per day in divided doses, or 10–20 mg as a single night time dose. Maintenance doses of Amitriptyline HCl have generally ranged from 50 to 150 mg/day, but higher doses may be required for some patients.

Administration

Amitriptyline HCl may be administered orally, orally disintegrating tablet, or rectally in suppository form. The tablet and the orally disintegrating tablet should be taken with food. If a patient vomits within one hour of taking an orally administered dose, the medication should be redosed.

Side Effect

Like other medications, use of Amitriptyline HCl may lead to common side effects, including dry mouth, constipation, blurred vision, dizziness, drowsiness, confusion, headache, and increased heart rate. Other more severe side effects may occur, such as extreme fatigue, weight gain, agitation, restlessness, or suicidal thoughts. It is important to contact a health care provider if any of these more serious side effects develop.

Toxicity

The toxic dose of Amitriptyline HCl is estimated to be greater than 4 grams. Symptoms of toxicity include confusion, slowed breathing, coma, seizures, and potentially death. In case of accidental overdose, seek immediate medical attention.

Precautions

Use with caution in patients with glaucoma, pre-existing seizure disorder, hyperthyroidism, cardiovascular disease, or those taking monoamine oxidase inhibitors or other antidepressants.
Long-term use may increase the risk of liver toxicity and the risk of switching to mania.
Caution should be used when administering to pregnant or breast-feeding women.
Patients should be monitored for weight gain, changes in blood pressure, and changes in appetite.

Interactions

Amitriptyline HCl may interact with many other medications, such as drugs to treat anxiety, pain, or seizures. Therefore, consult your healthcare provider before taking any other medications while taking Amitriptyline HCl.
It may also interact with other medications that increase serotonin levels, such as SNRIs and SSRIs, as well as with MAOIs.
It may also interact with medications that affect the cardiovascular system and alter its effects.

Disease Interactions

Amitriptyline HCl should not be used in patients with uncontrolled angle-closure glaucoma.
It may also worsen the symptoms of narrow-angle glaucoma which includes eye pain, blurred vision, headaches, nausea, and vomiting.
It may also cause or aggravate pre-existing symptoms of Parkinson's disease, such as tremor or rigidity.
It may also worsen seizure disorder, mania, or psychosis.
It should be used with caution in patients with hyperthyroidism or during acute asthmatic attack.

Drug Interactions

Amitriptyline may increase the effects of other medications that are metabolized by the liver enzyme CYP2D6, such as tricyclic antidepressants, certain antipsychotics, or certain antiarrhythmics.
It may also increase or decrease the effects of certain medications used to treat anxiety, such as buspirone and benzodiazepines.
It may reduce the effectiveness of oral contraceptives.
It may also reduce the effects of other medications used to treat depression, such as SSRIs, SNRIs, and MAOIs. For this reason, caution should be taken when mixing these medications.

Food Interactions

Amitriptyline HCl may interact with food or alcohol by altering drug absorption, metabolism, or bioavailability. Therefore, it is important to avoid taking this medication with alcohol or large amounts of food, as this may decrease the effectiveness of the medication.

Pregnancy Use

Amitriptyline hydrochloride should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not recommended for use during the first trimester of pregnancy due to the risk of fetal malformations. If use is deemed necessary, it is important to closely monitor the fetus for any possible adverse reactions.

Lactation Use

Amitriptyline HCl has been detected in human breast milk. The amount detected is low and usually not enough to cause any adverse effects in the nursing infant. However, caution should be taken when taking this medication while breastfeeding, as some of the drug may be passed to the nursing infant.

Acute Overdose

An acute overdose of Amitriptyline HCl can lead to symptoms such as confusion, blurred vision, dizziness, drowsiness, restlessness, agitation, headache, changes in heart rate and blood pressure, nausea, vomiting, and potentially seizures. If you think you have taken too much of this medication, contact your healthcare provider or poison control center immediately.

Contraindications

Do not take if you have taken an MAO inhibitor in the preceding 14 days.
Do not take if you have uncontrolled angle-closure glaucoma.
Do not take if you have mentally disabled persons or manic-depressive patients not responding to other treatments.

Use Direction

Take this medication exactly as prescribed by your healthcare provider. Do not take more or less than your healthcare provider recommends. It is important to take this medication at approximately the same time each

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