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Dr Rahul Seewal

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?;72@)42A;! Amitriptyline is a tricyclic antidepressant that is licensed to treat depression. However, in much lower doses, it has been found to be quite effective in treating pain due to dysfunction of the nervous system for example post herpetic neuralgia and diabetic neuropathic pain. It is also useful in posttraumatic stress disorder, eating disorder, posttraumatic stress disorder, generalised anxiety disorder and insomnia. &A5.!-@*.7+,.! The usual dose is between 10 and 50 mg taken an hour before sleep (in night). It is advisable to start on a small dose and allow your body to get used to the medicine and gradually increase the dose every 2-3 days by 10 mg.

Day of treatment
1 4 8 14 18

Bedtime dose 10mg 20mg 30mg 40mg 50mg

The table for dose adjustment is for guidance only. The dose increment can be done over a longer period of time or more gradually. Please contact us if you have any doubts or are experiencing side effects. Potential side effects Dizziness and drowsiness. Sometimes this can be related to position (postural hypotension and tends to happen while standing or sitting. It is more common in people taking antihypertensive medications. Blurred vision Dryness of skin and mouth - patients might feel quite thirsty!! Weight gain Urinary retention - this is especially common in elderly males with prostrate enlargement. Increased PR interval (slowing of electrical activity n the heart) To be avoided during pregnancy and lactation. Reduced libido and sexual dysfunction in both men and women Treatment duration Guided by standard outcome parameters, if effective, Amitriptyline can be safely taken for several years. If ineffective, the treatment should be discontinued after 3 months of adequate dose therapy.

! Dr Rahul Seewal 2013. All rights reserved

Medical Stuff Mechanism of action - Amitriptyline works by inhibiting the uptake of stimulatory neurotransmitters noradrenalin and serotonin in the nervous system. This increases their concentration and reverses the imbalance which probably is the cause of altered nervous system function. The significant drug interactions with Amitriptyline are as follows Drug Selective serotonin reuptake inhibitors (SSRI) Carbamezapine Warfarin Clonidine Quinidine Anticholinergics (antiallergics/ cough suppressants like Cholpheneramine and glaucoma medicines) Mono amine oxidase (MAO) inhibitors Interaction Adverse toxic reaction due to elevated levels of SSRI Reduce the levels of Amitriptyline and increase carbamezapine levels (possibility of toxicity) Increase warfarin levels with potential for bleeding Enhanced antihypertensive effect Increase chances of arrhythmias Increase anticholinergic side effects (Blurred vision Dryness of skin and mouth) Toxic crisis involving raised body temperature and blood pressure, dryness of mucosa, agitation, confusion

Pregnancy It should be avoided in pregnancy as it crosses placenta and can result in foetal anticholinergic syndrome.

! Dr Rahul Seewal 2013. All rights reserved