Drug Data

Generic Name:
AMITRIPTYLINE
Trade/Brand
Name: ApoImipramine, Tofranil,
Impril, Norfranil,
Novopramine,
Tipramine, Tofranil
PM
Minimum Dose:
Depression
Adult: 50 mg daily
Child:
Adolescents(>16yr):
30 mg daily
Elderly: 30 mg daily
Nocturnal enuresis
Child: >11 yr: 25mg
at bedtime; 6-10 yr:
10 mg at bedtime.
*Treatment should
not continue >3
mth.
Neuropathic painAdult: 10 mg at
night
Prophylaxis of
migraine
Adult: 10 mg daily
Maximum Dose:
Depression
Adult: 300 mg daily
Child:
Adolescents(>16yr):
7 5mg daily
Elderly: 75 mg daily
Nocturnal enuresis
Child: >11 yr: 50mg
at bedtime; 6-10 yr:
20 mg at bedtime.
*Treatment should
not continue >3
mth.
Neuropathic painAdult: 25 mg at
night
Prophylaxis of
migraine
Adult: 75 mg daily

Classification
Therapeutic:
Antidepressant

Pharmacologi
c Class:
Tricyclic
Antidepressant

Pregnancy
Risk
Category:
C - Either
studies in
animals have
revealed
adverse effects
on the foetus
(teratogenic or
embryocidal or
other) and
there are no
controlled
studies in
women or
studies in
women and
animals are not
available.

Source: Karch
Am 2011:
Lippincotts
Nursing Drug
Guide;
Lippincott
William and
Wilkins: pp.
117-119

Mechanism of Action

Indication

Contraindications

Adverse Reaction

Amitriptyline is a TCA
that exerts its action by
blocking neuronal reuptake of noradrenaline
and serotonin thus
increasing synaptic
concentration of
serotonin and/or
norepinephrine in the
CNS.

General Indication:

Hypersensitivity, use of MAO

inhibitors within the last 14
days; acute recovery phase
post-MI. Concurrent usage
with cisapride.

CNS: Disturbed
concentration,
sedation and
anticholinergic
(atropine-like) effects;
confusion (especially
in elderly),
hallucinations,
disorientation,
decreased memory,
insomnia, nightmares,
hypomania, mania,
exacerbation of
psychosis, drowsiness,
paresthesias of
extremities,
incoordination, motor
hyperactivity,
akisthisia, ataxia,
tremors, peripheral
neuropathy, EPS,
seizures, speech
blockage, dysarthria,
tinnititus, altered ECG

Absorption: Readily
absorbed from the GI
tract (oral).
Distribution: Widely
distributed; crosses the
placenta; enters breast
milk. Protein-binding:
Extensive.
Metabolism:
Extensively 1st-pass
effect; demethylated
hepatically to
nortriptyline (active
metabolite).
Excretion: Urine (as
metabolites in free or
conjugated form); 9-25
hr (elimination half-life).
Pharmacokinetics
Route Onset
Peak
Duration
PO
Varies 2-4 hr
2-4 wk

Source: Karch Am
2011: Lippincotts
Nursing Drug Guide;
Lippincott William and
Wilkins: pp. 117-119

Relief of symptoms of
depression
(endogenous
depression most
responsive); sedative
effects may help when
depression is
associated with
anxiety and sleep
disturbance
Unlabeled Use:
Control of chronic pain
(e.g. intractable pain
of cancer, central pain
syndromes, peripheral
neuropathies,
postherpetic
neuralgia, tic
douloureux);
prevention of onset of
cluster and migraine
headaches; treatment
of pathologic weeping
and laughing
secondary to forebrain
disease (due to MS);
insomnia,
fibromyalgia

Source: Karch Am
2011: Lippincotts
Nursing Drug Guide;
Lippincott William and
Wilkins: pp. 117-119

Precautions
Bipolar illness, pregnancy,
lactation
elderly,
CVS
disease,
renal
or
liver
impairment, epilepsy, thyroid
dysfunction,
DM.
Avoid
abrupt withdrawal; urinary
retention,
prostatic
hyperplasia;
chronic
constipation;
angle-closure
glaucoma;
phaeochromocytoma.
Monitor for signs of clinical
worsening,
suicidality
or
behavioural changes. May
increase risks associated with
electro-convulsive
therapy.
May affect ability to drive or
operate machinery.
Drug-drug Interaction
Reduced
effect
of
antihypertensives.
Potentiates
hypertensive
effects of sympathomimetics.
Concurrent
use
with
altretamine
may
cause
orthostatic hypotension. May
increase adverse CV effects
when
used
with
amphetamines. May increase
serum
levels
of
carbamazepine.
Increased
risk of cardiac arrhythmias
when used with -agonists.
Absorption may be reduced
when
used
with
cholestyramine, colestipol or
sucralfate. Additive sedative
effects when used with CNS
depressants. Concurrent use
with CYP2D6 inhibtors (e.g.
chlorpromazine, delavirdine,
fluoxetine,
miconazole,
paroxetine) may increase
serum levels of amitriptyline.
May increase antidiabetic
effect
of
tolazamide,
chlorpropamide or insulin.
May reduce absorption of
levodopa. Increased risk of

CV: Orthostatic
hypotension,
hypertension,
syncope, palpitayions,
MI, arythmias, heart
block, precipitation of
Heart Failure, CVA
Endocrine: Elevated
or depressed blood
sugar, elevated
prolactin levels,
inappropriate ADH
Secretion
GI: Dry mouth,
constipation, paralytic
ileus, nausea,
vomiting, epigastric
distress
GU: Urinary retention,
delayed micturition,
dilation of the urinary
tract, gynecomastia,
testicular swelling,
breast enlargement,
menstrual irregularity
and galctorrhea;
increased or
decreased libido,
impotence

Nursing
Responsibilities
Before:
1.) Verify order on
Patients Chart
2.) Know Reason for
giving drug
3.) Obtain baseline
Vital Signs
4.) Check for
Hypersensitivity
to the drug
5.) Check for
Pregnancy/
Lactation
During:
1.) Verify clients
identity
2.) Inform Client
about purpose of
the drug
3.) Administer major
portion of dose
at bedtime if
drowsiness,
severe
anticholinergic
effects occur
4.) Reduce dosage
as ordered if
minor side
effects develop;
discontinue if
serious side
effects occur
5.) Check Vital Signs
After:
1.) Document
appropriately
2.) Dispose of used
materials
3.) Restrict drug
access for
depressed and
potentially
suicidal patients
4.) Arrange for CBC
if patient
develops fever,
sore throat or
other sign of
infection
5.) Note that drugs
sedative effects
may take place
before
antidepressant

Availability:
Tablets, Capsules
Route(s) of
Administration:
Oral
Source: Karch
Am 2011:
Lippincotts
Nursing Drug
Guide;
Lippincott
William and
Wilkins: pp.
117-119

neurotoxicity when used with

lithium. Increased risk of
seizures when used with
tramadol.
May
increase
anticoagulant
effect
of
warfarin. May cause QT
prolongation
and
fatal
arrhythmias when used with
drugs
that
prolong
QT
interval.
Drug-Food Interaction
Alcohol
may
enhance
adverse effects.
Source: Karch Am 2011:
Lippincotts Nursing Drug
Guide; Lippincott William and
Wilkins: pp. 117-119

Hematologic: Bone
marrow depression,
purpura, lekopenia

Source: Karch
Am 2011:
Lippincotts Nursing
Drug Guide;
Lippincott William
and Wilkins: pp. 117119

effects
6.) Instruct to avoid
prolonged
exposure to
sunlight or
sunlamps; use
sunscreen or
protective
garments
7.) Instruct not to
consume
considerable
amounts of
alcohol while on
this drug
8.) Instruct to call
nurse/physician if
adverse effects
occur
9.) Arrange to taper
drug when
discontinuing
10.) Check Vital Signs

Source: Karch Am 2011:

Lippincotts Nursing Drug
Guide; Lippincott William
and Wilkins: pp. 117-119
Source:

Deglin, J. et. Al. 2009. Daviss Drug Guide for Nurses. 12 th ed. F.A. Davis. pp 349-351