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Amitriptyline is a tricyclic inhibitor drug. Though SSRI are more commonly prescribed today for the indication of moderate to severe depression, migraine prophylaxis; tension, headache, enuresis, amitriptyline is still used for those indications. Amitriptyline inhibits the membrane pump mechanism responsible for uptake of norepinephrine and serotonin in adrenergic and serotonergic neurons.(1)

For the relief of symptoms of depression. Endogenous depression is more likely to be alleviated than are other depressive states.(2) Migraine prophylaxis; tension, headache, enuresis.(3)

It is contraindicated in patients who have shown prior hypersensitivity to it.(2) Do not use it during the acute recovery phase following myocardial infarction Arrhythmias (especially heart block); manic phase in bipo-lar disorders; severe liver disease; children; porphyria; glaucoma, prostatic hypertrophy.(3)

Paralytic ileus; hyperpyrexia; urinary retention; dilatation of the urinary tract; constipation; blurred vision, disturbance of accommodation, increased ocular pressure, mydriasis; dry mouth. Coma; seizures; hallucinations; delusions; confusional states; disorientation; incoordination; ataxia; tremors; peripheral neuropathy; numbness, tingling, and paresthesias of the extremities Skin rash; urticaria; photosensitization; edema of face and tongue. Rarely hepatitis (including altered liver function and jaundice); nausea; epigastric distress; vomiting; anorexia; stomatitis; peculiar taste; diarrhea; parotid swelling; black tongue. Testicular swelling and gynecomastia in the male; breast enlargement and galactorrhea in the female; increased or decreased libido; impotence; elevation and lowering of blood sugar levels Alopecia; edema; weight gain or loss; urinary frequency; increased perspiration. Myocardial infarction; stroke; nonspecific ECG changes and changes in AV conduction; heart block; arrhythmias; hypotension, particularly orthostatic hypotension; syncope; hypertension; tachycardia; palpitation.(2,3)

It should not be given concomitantly with monoamine oxidase inhibitors. Hyperpyretic crises, severe convulsions, and deaths can occur. It should not be given concurrently with Cisapride due to the potential for increased QT interval and increased risk for arrhythmia. It may may block the antihypertensive action of guanethidine or similarly acting compounds.(2)

Used with caution in patients with a history of seizures. Because of its atropine-like action, its use in patients with a history of urinary retention, angle-closure glaucoma or increased intraocular pressure is avoided. In patients of cardiovascular disorders, its use should be restricted as it is, particularly when given in high doses, have been reported to produce arrhythmias, sinus tachycardia, and prolongation of the conduction time. Because of the potential for serious adverse reactions in nursing infants from amitriptyline, a decision should be made whether to discontinue nursing or to discontinue the drug. It is not recommended at the present time for patients under 12 years of age.(2)

Available as tablets 10, 25, 50 and 75 mg; injection 10 ml ampoule (10 mg/ml). Initial Dosage for Adults: For outpatients 75 mg of amitriptyline HCl a day in divided doses is usually satisfactory. An alternate method of initiating therapy in outpatients is to begin with 50 to 100 mg amitriptyline HCl at bedtime. This may be increased by 25 or 50 mg as necessary in the bedtime dose to a total of 150 mg per day. Hospitalized patients may require 100 mg a day initially. This can be increased gradually to 200 mg a day if necessary. A small number of hospitalized patients may need as much as 300 mg a day. Intramuscular Dosage: Initially, 20 to 30 mg (2 to 3 mL) four times a day.(2)

1. O’Donnel JM, Shelton RC. Drug Therapy of Depression and Anxiety Disorders. In: Brunton L, Chabner B, Knollmann B eds. Goodman & Gilman’s The Pharmacological basis of Therapeutics. 12th ed. China: McGraw Hill; 2011. P. 397-415. 2. ELAVIL [Internet]. [cited 2013 Sept 15]. Available from: 3. National Formulary of India. 4 th ed. Government of India, Ministry of Health and Family Welfare. India: Indian Pharmacopoeia Commission; 2011