Composition
Tab 10 mg/25 mg: Amitriptyline HCI 10 mg/25 mg. Cap 25 mg/50 mg: Amitriptyline HCI 25 mg/50 mg.
Indications & Dosage
Depressive illness: Adult & Children above 16 yrs: Initially 75 mg daily in divided doses, alternatively initially 75 mg once daily at bedtime, increased if necessary to 150-200 mg daily, increased gradually. Elderly: Initially 30-75 mg daily in divided doses, alternatively initially 30-75 mg once daily at bedtime, increased if necessary to 150-200 mg daily, increased gradually. Neuropathic pain: Adult & Children above 16 yrs: Initially 10 mg once daily, increased if necessary to 75 mg once daily, dose to be taken at night, increased gradually. Migraine prophylaxis: Adult: Initially 10 mg once daily, then increased if necessary to 50-75 mg once daily at night (max. per dose 150 mg).
Contraindications
Arrhythmias, acute porphyrias, during manic phase of bipolar disorder, heart block, immediate recovery period after myocardial infarction, severe liver disorder
Precautions
Cardiovascular disease (risk of sudden death), hepatic impairment (avoid if severe), diabetes, epilepsy, history of bipolar disorder, history of psychosis or mania, chronic constipation, hyperthyroidism, increased intra-ocular pressure, patients with risk of suicide, phaeochromocytoma, prostatic hypertrophy, susceptibility to angle-closure glaucoma, urinary retention, withdraw gradually.
Interactions
With or within 14 days of MAOIs. Other antide-pressants, St. Johns Wort, tramadol, drugs that prolong the QT interval (e.g. antiarrhythmics), moxifloxacin, anticonvulsants, diltiazem, verapamil, clonidine, other antihypertenelves, antipsychotics, sotaiol, dopaminergics, artemether/ lumefantrine, sibutramine, anticholinergics, sympathomimetics, oral anticoagulants, cimetidine.
Pregnancy
Avoid unless potential benefit outweighs risk
Lactation
Contraindicated, avoid
Side Effects
Agitation, anorexia, fatigue, hypertension, mydriasis, oedema, palpitation, restlessness, stomatitis, blurred vision, confusion, constipation, convulsions, delusions, dizziness, drowsiness, dry mouth, ECG changes, gynaecomastia, haematological reactions, hallucinations, headache, heart block, hepatic reactions, hypomania, hyponatraemia, increased intra-ocular pressure, irritability, mania, movement disorders, myalgia, paraesthesia, photosensitivity, postural hypotension, pruritus, rash, sexual dysfunction, sleep disturbances, suicidal behavior, sweating, tachycardia, tinnitus, urinary retention, urticaria, vomiting, weight changes. Rare: Alopecia, arrhythmia, dysarthria, extrapyramidal symptoms, paralytic ileus, tremor