Amitriptyline
583678
223818216
2008-07-05T23:33:39Z
Ratel
672103
/* Unapproved/off-label/investigational use */
{{Drugbox|
|IUPAC_name = 3-(10,11-dihydro-5''H''-dibenzo[[''a'',''d'']] cycloheptene-5-ylidene)-''N'', ''N''-dimethyl-1-propanamine''
| image=Amitriptyline-2D-skeletal.png
| width=200px
| CAS_number=50-48-6
| ATC_prefix=N06
| ATC_suffix=AA09
| ATC_supplemental=
| PubChem=2160
| DrugBank=APRD00227
| C=20 | H=23 | N=1
| molecular_weight = 277.403 g/mol
| bioavailability= 40%
| metabolism = [[Hepatic]]
| elimination_half-life=12-24 hours
| excretion = [[Renal]]
| pregnancy_AU =
| pregnancy_US = D
| pregnancy_category =
| legal_AU = Unscheduled
| legal_UK = POM
| legal_US =
| legal_status =
| routes_of_administration= Oral
}}
'''Amitriptyline''' (or '''Amitryptyline''') '''hydrochloride''' (sold as Elavil, Tryptanol, Endep, Elatrol, Tryptizol, Trepiline, Laroxyl) is a [[tricyclic antidepressant]] [[Medication|drug]]. It is a white, odorless (but tastes like [[licorice]]), [[crystalline]] compound which is freely soluble in water; it is usually dispensed in tablet form. In terms of its [[mechanism of action]], amitriptyline inhibits [[serotonin]] and [[noradrenaline]] reuptake almost equally.
== Uses ==
=== Approved ===
Amitriptyline is approved most commonly for the treatment of depression ([[Clinical depression|clinical/endogenous depression]], also [[involutional melancholia]] 'depression of late life', which is no longer seen as a disease in its own right). Adult typical dosages are 25 to 150 mg daily, with half this initially for elderly or adolescents.
It may also be used to treat [[nocturnal enuresis]] (bed wetting). Children between the ages of 7 to 10 years having a dose of 10 to 20 mg, older children 25 to 50 mg at night. It should be gradually withdrawn at the end of the course, which overall should be of no more than 3 months.<ref name="BNF">[[British National Formulary]] '''45''' (March 2003).</ref>
In some European countries it is also officially approved as a preventive ([[prophylaxis]]) for patients with frequent/[[Chronic (medicine)|chronic]] [[migraine]]s, usually 25 to 75 mg.
=== Unapproved/off-label/investigational use===
Amitriptyline may be prescribed for other conditions such as [[insomnia]], [[PTSD]]<ref>National Institute for Clinical Excellence: [http://www.nice.org.uk/nicemedia/pdf/CG026publicinfo.pdf The Treatment of PTSD in Adults and Children]</ref>, [[migraine]], [[rebound headache]], [[chronic pain]], [[chronic cough]], [[postherpetic neuralgia]] (persistent pain following a [[shingles]] attack), [[carpal tunnel syndrome]], [[fibromyalgia]], [[vulvodynia]], [[interstitial cystitis]], [[UCPPS|male chronic pelvic pain syndrome]], [[irritable bowel syndrome]], [[diabetic neuropathy|diabetic peripheral neuropathy]], [[neurological]] pain, and painful [[paresthesia]]s related to [[multiple sclerosis]] and at low doses as a preventive (prophylaxis) for patients with frequent [[migraine]]s.<ref name="pmid3579659">{{cite journal | author = Ziegler D, Hurwitz A, Hassanein R, Kodanaz H, Preskorn S, Mason J | title = Migraine prophylaxis. A comparison of propranolol and amitriptyline | journal = Arch Neurol | volume = 44 | issue = 5 | pages = 486–9 | year = 1987 | pmid = 3579659}}</ref>
Typically lower dosages are required for pain modification of 10 to 50 mg daily.<ref name="BNF"/>
Amitriptyline in low doses is also sometimes prescribed to help ease the symptoms of [[chronic fatigue syndrome]]. It is thought to help combat symptoms of insomnia primarily, in addition to other selected symptoms of the affliction.
A [[randomized controlled trial]] published in June 2005 found that amitriptyline was effective in [[functional dyspepsia]] that did not respond to a first-line treatment ([[famotidine]] or [[mosapride]]).<ref name="pmid15943846">{{cite journal |author=Otaka M, Jin M, Odashima M, ''et al'' |title=New strategy of therapy for functional dyspepsia using famotidine, mosapride and amitriptyline |journal=Aliment. Pharmacol. Ther. |volume=21 |issue=Suppl 2 |pages=42–6 |year=2005 |month=June |pmid=15943846 |doi=10.1111/j.1365-2036.2005.02473.x |url=http://www.ingentaconnect.com/content/bsc/apt/2005/00000021/A00201s2/art00008}}</ref>
==Side effects==
Common [[adverse drug reaction|side effects]] of using amitriptyline are dry mouth, extreme weight gain, nausea, constipation, nervousness, dizziness, blurred vision and [[insomnia]]. Some rare side effects include [[tinnitus]], [[hypotension]], [[mania]], [[psychosis]], [[anticholinergic]] effects, [[heart block]], [[arrhythmias]], lip and mouth ulcers, [[extrapyramidal symptoms]], [[clinical depression|depression]], and [[hepatotoxicity|hepatic toxicity]].
==Overdose==
The symptoms and the treatment of an overdose are largely the same as for the other tricyclic antidepressants.
{{further|[[Tricyclic antidepressant#Overdose]]}}
== Footnotes ==
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==References==
* [http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?sid=562885 PubChem Substance Summary: Amitriptyline] National Center for Biotechnology Information.
* [http://home.intekom.com/pharm/lennon/trepilin.html TREPILINE®-10 TABLETS; TREPILINE®-25 TABLETS] South African Electronic Package Inserts. 12 May 1978. Revised February 2004.
* [http://home.intekom.com/pharm/lundbeck/saroten.html SAROTEN® RETARD 25 mg Capsules; SAROTEN® RETARD 50 mg Capsules] South African Electronic Package Inserts. December 1987. Updated May 2000.
* [http://www.medsafe.govt.nz/profs/Datasheet/a/Amitriptab.htm AMITRIP® Amitriptyline hydrochloride 10 mg, 25 mg and 50 mg Capsules] Medsafe NZ Physician Data Sheet. November 2004.
* [http://www.betterhealth.vic.gov.au/bhcv2/bhcmed.nsf/pages/afcendep/$File/afcendep.pdf Endep Consumer Medicine Information], Australia. December 2005.
* [http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682388.html MedlinePlus Drug Information: Amitriptyline]. US [[National Institutes of Health]]. January 2008.
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{{Antidepressants}}
[[Category:Tricyclic antidepressants]]
[[Category:Analgesics]]
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