Amitriptylin

Drug name: Amitriptylin

Other names used:

• Amitril®
• Elatrol®
• Elavil®
• Endep®
• l Amitid®
• Laroxy®
• Trepiline®
• Tryptanol®
• Tryptizol®

Active Ingredients: Amitriptyline

Therapeutic actions: Amitriptyline belongs to a class of medications called tricyclic antidepressants. It is not entirely clear how amitriptyline works. Amitriptyline does affect several chemicals in the brain, including serotonin and norepinephrine. It is thought that maybe amitriptyline allows these chemicals to stay in the brain longer, which can help with depression symptoms.

Indications:

• Depressive illness
• Bedwetting (nocturnal enuresis) in children aged seven years and over
• Nerve pain (unlicensed use)
• Preventing migraine (unlicensed use).

Contraindications and cautions:
You should not take amitriptyline if you:

• Are allergic to amitriptyline or any inactive ingredient used to make amitriptyline. Your healthcare provider or pharmacist has a list of the inactive ingredients used to make amitriptyline.
• Have recently had a heart attack (known medically as a myocardial infarction).
• Have used a monoamine oxidase inhibitor (MAOI) within the last 14 days. MAOIs include:
  • Isocarboxazid (Marplan®)
  • Phenelzine (Nardil®)
  • Rasagiline (Azilect®)
  • Selegiline (Eldepryl®, Emsam®, Zelapar®)
  • Tranylcypromine (Parnate®).
• Are taking cisapride (Propulsid®) due to an increased risk of a dangerous change in heart rhythm.

You should talk with your healthcare provider prior to taking amitriptyline hydrochloride if you have:

• Bipolar disorder or a family history of bipolar disorder
• Schizophrenia
• A history of suicide attempts or suicidal thoughts
• Severe anxiety or agitation
• A recent history of heart attack
• Heart problems, including heart disease
• Hyperthyroidism (overactive thyroid)
• Seizures
• Glaucoma
• Bladder problems
• Diabetes
• Difficulty passing urine
• An enlarged prostate (also known as benign prostatic hyperplasia or BPH)
• Liver problems
• Any allergies, including allergies to foods, dyes, or preservatives.

Also let your healthcare provider know if you:

• Are pregnant or thinking of becoming pregnant
• Are breastfeeding
• Drink alcohol regularly
• Will be undergoing surgery.

Adverse effects: Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Dry mouth
• Drowsiness
• Blurred vision
• Constipation
• Nausea
• Difficulty in passing urine
• Drop in blood pressure when going from lying or sitting to sitting or standing, causing dizziness and lightheadedness (postural hypotension)
• Sweating
• Involuntary muscle movements such as tremors or twitching
• Rashes
• Confusion or delirium
• Headache
• Sexual problems
• Changes in behaviour
• Increased appetite and weight gain
• Taste disturbances
• Low blood pressure (hypotension)
• Disturbances in the normal numbers of blood cells in the blood
• Abnormal heart beats
• Faster than normal heart beat (tachycardia)
• Convulsions (fits)
• A decreased sex drive (libido).
• Impotence. Impotence is usually defined as a total inability to achieve an erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. Ultimately, impotence is the repeated inability to get or keep an erection firm enough for sexual intercourse. Impotence is also known as erectile dysfunction (or ED for short).

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

Interactions: It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.
Amitriptyline should not be taken in combination with a monoamine oxidase inhibitor Antidepressant (MAOI), eg phenelzine, tranylcypromine, isocarboxazid, or moclobemide. Treatment with amitriptyline should not be started until at least two weeks after stopping an MAOI. Conversely, an MAOI should not be started until two weeks after stopping amitriptyline. Moclobemide should not be started until at least a week after stopping amitriptyline.

If amitriptyline is taken with other medicines that enhance serotonin activity in the brain, there may be an increased risk of side effects such as agitation, tremor, shivering, increased heart rate and diarrhoea, known collectively as the 'serotonin syndrome'. Other medicines that increase serotonin activity include the following:

• lithium
• rasagiline
• selegiline
• sibutramine
• SSRI antidepressants, eg fluoxetine, paroxetine
• SNRI antidepressants, eg duloxetine, venlafaxine
• other tricyclic antidepressants.

There may be an increased risk of drowsiness if other medicines that can cause drowsiness, such as the following, are taken in combination with amitriptyline:

• sedating antihistamines, eg chlorphenamine, promethazine
• benzodiazepines, eg diazepam, temazepam
• sleeping tablets, eg zopiclone
• strong opioid painkillers, such as morphine, codeine.

There may be an increased risk of side effects such as dry mouth, constipation, difficulty passing urine and blurred vision if amitriptyline is taken with other medicines that have anticholinergic effects, such as the following:

• anticholinergics for urinary incontinence, eg tolterodine, oxybutynin
• anticholinergics for Parkinson's disease, eg procyclidine, trihexyphenidyl
• antihistamines, eg promethazine, chlorphenamine
• antispasmodics, eg hyoscine, atropine
• antipsychotics, eg chlorpromazine, clozapine (some antipsychotics may also increase the blood level of amitriptyline)
• antiarrhythmics, eg disopyramide, propafenone
• certain other antidepressants
• muscle relaxants, eg baclofen
• antisickness medicines, eg meclozine, cyclizine.

There may be an increased risk of side effects on the heart if amitriptyline is taken in combination with the following medicines; these medicines should be avoided in people taking amitriptyline:

• atomoxetine
• medicines to treat abnormal heart rhythms (antiarrhythmics), eg amiodarone, procainamide, quinidine, disopyramide, sotalol
• the antihistamines astemizole, terfenadine or mizolastine
• the antimalarials halofantrine, chloroquine or quinine
• certain antipsychotics, eg thioridazine, haloperidol, pimozide
• moxifloxacin
• pentamidine.

Amitriptyline may alter the anti-blood-clotting effect of anticoagulant medicines such as warfarin. Your blood clotting time (INR) should be carefully monitored if you are taking these two medicines together. Amitriptyline may oppose the blood pressure lowering effects of clonidine and guanethidine.
There may be a sudden and marked increase in blood pressure and heart rate if adrenaline, noradrenaline or phenylephrine are given by injection to people taking amitriptyline. These medicines should be avoided in people taking amitriptyline.

The following medicines may increase the blood level of amitriptyline and could increase the risk of its side effects:

• calcium channel blockers such as diltiazem or verapamil
• cimetidine
• methylphenidate
• oestrogen-containing contraceptives (these may also decrease the antidepressant effect of amitriptyline)
• ritonavir
• SSRI Antidepressants such as fluvoxamine and fluoxetine.

The level of amitriptyline in the blood may be decreased by the following medicines, and these could make it less effective:

• barbiturates such as phenobarbital
• rifampicin
• the herbal remedy St John's wort (Hypericum perforatum).

If you experience a dry mouth as a side effect of this medicine you may find that medicines that are designed to dissolve and be absorbed from under the tongue, eg sublingual glyceryl trinitrate (GTN) tablets for angina, become less effective. This is because the tablets do not dissolve properly in a dry mouth. To resolve this, drink a mouthful of water before taking sublingual tablets.

Additional Information: DO NOT SHARE THIS MEDICINE with others. DO NOT USE THIS MEDICINE for other health conditions. KEEP THIS PRODUCT, as well as syringes and needles, if needed during treatment, out of the reach of children. Do not reuse needles, syringes, or other materials.