Amitriptyline

Brand names

• Amitid
• Amitril
• Apo-Amitriptyline
• Elatrol
• Elavil
• Elavil Plus [CD]
• Emitrip
• Endep
• Enovil
• Etrafon [CD]
• Etrafon-A [CD]
• Etrafon-D [CD]
• Etrafon-Forte [CD]
• Levate
• Novo-Triptyn
• PMS-Amitriptyline
• PMS-Levazine [CD]
• SK-Amitriptyline
• Triavil [CD]

Usage

To relieve symptoms of major depression.

How it works

Amitriptyline affects levels of specific brain chemicals (serotonin, norepinephrine, and acetylcholine) that are thought to be linked to mood, emotions, and mental state.

Side effects

Serious

Confusion, heartbeat irregularities, hallucinations, seizures, extreme fatigue or drowsiness, blurred or altered vision, breathing difficulty, constipation, impaired concentration, difficult urination, fever, extreme and persistent restlessness, loss of coordination and balance, difficulty swallowing or speaking, dilated pupils, eye pain, fainting. Also trembling, shaking, weakness, and stiffness in the extremities; shuffling gait.

Common

Drowsiness, dizziness, or lightheadedness, headache, dry mouth or unpleasant taste, fatigue, heightened sensitivity to light, unusual weight gain, increased appetite, nausea.

Less common

Heartburn, insomnia or restlessness, diarrhea, increased sweating, vomiting.

Possible interactions

Other medicaments:

Amitriptyline may increase the effects of:

• albuterol or other direct sympathomimetic medicaments (amphetamines, epinephrine).
• antihistamines (such as diphenhydramine-Benadryl, others), which can increase the risk of urinary retention, chronic glaucoma and bowel obstruction (ileus). This is especially problematic in the elderly.
• atropinelike medicaments.
• cimetidine (Tagamet).
• disulfiram (Antabuse), which can worsen the disulfiram effect if alcohol is consumed.

Amitriptyline may decrease the effects of:

• clonidine (Catapres).
• guanethidine (Ismelin).
• guanfacine (Hytrin).
• methyldopa, which can result in reduced amitriptyline and/or methyldopa benefits.

Amitriptyline taken concurrently with:

• amphetamines can cause excessive amitriptyline responses.
• amprenavir (Agenerase), ritonavir (Norvir) and perhaps other protease inhibitors can lead to amitriptyline toxicity.
• anticoagulants such as warfarin (Coumadin) may cause an increased risk of bleeding.
• baclofen (Lioresal) may lead to muscle weakness and memory loss.
• bepridil (Vascor) can lead to heart rhythm problems. Do not combine.
• carbamazepine (Tegretol) may decrease the blood level of amitriptyline.
• cisapride (Propulsid) can lead to heart rhythm problems.
• diazepam (Valium) and perhaps other benzodiazepines can result in additive loss of psychomotor skills.
• dofetilide (Tikosyn) can lead to heart rhythm problems.
• enfIurane (various) may increase seizure risk.
• epinephrine may cause an increased risk of rapid heart rate and high blood pressure.
• estrogens may increase amitriptyline medicament levels.
• ethanol (alcohol) may give additive central nervous system toxicity.
• fluconazole (Diflucan) can result in very high levels of amitriptyline.
• fluoxetine(Prozac) can result in very high levels of amitriptyline.
• fluvoxamine (Luvox) can result in very high levels of amitriptyline.
• gatifloxacin (Tequin), grepafloxacin (Raxar) , moxifloxacin (Avelox) or sparfloxacin (Zagam) may result in heart toxicity.
• meperidine (Demerol) worsens breathing (respiratory) depression risk.
• monoamine oxidase (MAO) type A inhibitor medicaments may cause high fever, delirium and convulsions.
• phenytoin (Dilantin) or fosphenytoin (Cerebyx) can lead to amitriptyline toxicity.
• potassium (various) may lead to ulceration from potassium as amitriptyline may slow the intestine.
• quinidine (Quinaglute, etc.) can result in increased antidepressant blood levels.
• sertraline (Zoloft) can lead to heart rhythm problems. Do not combine.
• thyroid preparations may impair heart rhythm and function. Ask your doctor for help with adjustment of thyroid dose.
• tramadol (Ultram) may increase risk of seizures. This combination is not advised.
• venlafaxine (Effexor) can result in very high levels of amitriptyline.
• verapamil (Calando, others) can result in very high levels of amitriptyline.

Foods:

Excessive vitamin C can blunt therapeutic benefit of this medicament. May also increase appetite and cause excessive weight gain.

Herbal medicines or minerals:

Since amitriptyline and St. John's wort may act to increase serotonin, the combination is not advised. St. John's wort also increases sun sensitivity. Since part of the way ginseng works may be as a MAO inhibitor, do not combine with amitriptyline. Indian snakeroot, kava kava and yohimbe are also best avoided while taking this medicine.

Alcohol:

Avoid completely. Can markedly increase the intoxicating effects of alcohol and brain function depression.

Tobacco smoking:

May hasten the removal of this medicament from your body.

Exposure to sun:

This medicament may cause photosensitivity.

Exposure to heat:

May inhibit sweating and impair the body's adaptation to hot environments, increasing risk of heatstroke. Avoid saunas.

Exposure to cold:

Older patients should avoid prolonged cold exposure.

Discontinuation:

It is best to stop this medicament gradually. Abrupt withdrawal after long-term use can cause headache, malaise and nausea.

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