Amitriptyline (Elavil)

Category:

  • Miscellaneous

Description:

  • Tricyclic antidepressant, anxiolytic, antineurolgic

Indications:

  • Depression

  • Chronic pain (chronic tension headache, migraine, diabetic neuropathy, cancer pain, postherpetic neuralgia)

Contraindications:

  • Acute recovery phase of myocardial infarction

  • Concurrent use of monoamine oxidase inhibitors

Precautions:

  • Pregnancy category D; excreted into breast milk; effect on nursing infant unknown

  • Suicidal patients, convulsive disorders, prostatic hypertrophy, psychiatric disease, sever depression, increased intra-ocular pressure, narrow-angle glaucoma, urinary retention, hepatic/renal disease, hyperthyroidism, elderly, abrupt discontinuation

Adverse Reactions (Side Effects):

  • CNS: anxiety, confusion, dizziness, drowsiness, exra-pyridimal symptoms, insomnia, memory impairment, nervousness, nightmares, panic, stimulation, tremors, weakness

  • CV: dysrhythmias, hypertension, orthostatic hypotension, palpitations, syncope, tachycardia

  • EENT: blurred vision, mydriasis, nasal congestion, ophthalmoplegia, tinnitis

  • GI: constipation, cramps, diarrhea, dry mouth, epigastric distress, hepatitis, increased appetite, jaundice, nausea, paralytic ileus, stomatitis, vomiting, weight gain

  • HEME: agranulocytosis, eosinophilia, leukopenia, thrombocytopenia

  • GU: urinary retention

  • SKIN: photosensitivity, pruritis, rash, sweating, urticaria  

Dosage:

Administered orally (tablet) and intramuscularly (NEVER intravenously!)

  • Adult dose: 

    • PO 50-100mg at bedtime, 

    • may increase to 200mg daily, not to exceed 300mg daily (chronic pain doses usually at lower end of range)

    • IM (do not administer IV) 20-30mg four times daily, or 80-120mg at bedtime

  • Adolescent/geriatric: 

    • PO 30mg daily in divided doses

    • may be increase to 150mg daily

  • Child dose:   

    • chronic pain management: 

      • PO 0.1 mg/kg/day in 3 divided doses initially

      • advance as tolerated over 2-3 weeks to 0.5-2 mg/kg at bedtime

    • depression: 

      • PO 1 mg/kg/day in 3 divided doses initially

      • increases to 1.5 mg/kg/day

Drug interactions: 

Numerous, most significantly:

  • MAOIís: (Monamine oxidase inhibitors)

    • excessive sympathetic response

    • mania

    • hyperpyrexia

  • Epinephrine, norepinephrine

    • enhanced pressor response

  • Guanethidine, guanadrel: 

    • inhibited antihypertensive response

  • Ethanol: 

    • additive impairment of motor skills

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