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&nbsp;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&nbsp;mg, older children 25 to 50&nbsp;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 It should be gradually withdrawn at the end of the course, which overall should be of no more than 3 months.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&nbsp;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&nbsp;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 == <!--This article uses the Cite.php citation mechanism. If you would like more information on how to add references to this article, please see http://meta.wikimedia.org/wiki/Cite/Cite.php --> <div class="references-small"> <references /> </div> ==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&nbsp;mg Capsules; SAROTEN® RETARD 50&nbsp;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&nbsp;mg, 25&nbsp;mg and 50&nbsp;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. <br/> {{Antidepressants}} [[Category:Tricyclic antidepressants]] [[Category:Analgesics]] [[ar:أميتربيتيلين]] [[de:Amitriptylin]] [[es:Amitriptilina]] [[fr:Amitriptyline]] [[it:Amitriptilina]] [[nl:Amitriptyline]] [[ja:塩酸アミトリプチリン]] [[nn:Amitriptylin]] [[pl:Amitryptylina]] [[pt:Amitriptilina]] [[ru:Амитриптилин]] [[sv:Amitriptylin]]