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Back to Psychiatry Drug Index
Name: Amitriptyline hydrochloride
Pregnancy Category C
Drug classes
- Tricyclic antidepressant (TCA; tertiary amine)
Mechanism of actions
Mechanism of action unknown; TCAs act to inhibit the reuptake of the
neurotransmitters norepinephrine and serotonin, leading to an increase
in
their effects; anticholinergic at CNS and peripheral receptors;
sedative.
Indications
Relief of symptoms of depression (endogenous depression most
responsive);
sedative effects may be helpful in patients whose depression is
associated with anxiety and sleep disturbance.
Unlabeled uses: control of chronic pain (eg, intractable pain of
cancer,
peripheral neuropathies, postherpetic neuralgia, tic douloureux,
central
pain syndromes); prevention of onset of cluster and migraine
headaches;
treatment of pathologic weeping and laughing secondary to forebrain disease (due to multiple sclerosis)
Contraindications/cautions
Contraindicated in the presence of hypersensitivity to any tricyclic
drug; concomitant therapy with an MAO inhibitor; recent MI;
myelography
within previous 24 h or scheduled within 48 h; lactation.
Use caution in the presence of electroshock therapy; preexisting
cardiovascular disorders (severe coronary heart disease, progressive
heart failure, angina pectoris, paroxysmal tachycardia); angle-closure
glaucoma, increased intraocular pressure, urinary retention, ureteral
or
urethral spasm; seizure disorders; hyperthyroidism; impaired hepatic,
renal function; psychiatric patients (schizophrenic or paranoid
patients
may exhibit a worsening of psychosis with TCA therapy);
manic-depressive
patients; elective surgery (TCAs should be discontinued as long as
possible before surgery).
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Adverse effects
- CNS: Sedation and anticholinergic (atropine-like) effects; confusion
(especially in elderly), disturbed concentration, hallucinations,
disorientation, decreased memory, feelings of unreality, delusions,
anxiety, nervousness, restlessness, agitation, panic, insomnia, nightmares, hypomania, mania, exacerbation of psychosis, drowsiness,
weakness, fatigue, headache, numbness, tingling, paresthesias of
extremities, incoordination, motor hyperactivity, akathisia, ataxia,
tremors, peripheral neuropathy, extrapyramidal symptoms, seizures,
speech
blockage, dysarthria, tinnitus, altered EEG
- GI: Dry mouth, constipation, paralytic ileus, nausea, vomiting,
anorexia, epigastric distress, diarrhea, flatulence, dysphagia,
peculiar
taste, increased salivation, stomatitis, glossitis, parotid swelling,
abdominal cramps, black tongue, hepatitis, jaundice (rare), elevated
transaminase, altered alkaline phosphatase
- CV: Orthostatic hypotension, hypertension, syncope, tachycardia,
palpitations, MI, arrhythmias, heart block, precipitation of CHF,
stroke
- Hematologic: Bone marrow depression, including agranulocytosis;
eosinophila, purpura, thrombocytopenia, leukopenia
- GU: Urinary retention, delayed micturition, dilation of the urinary
tract, gynecomastia, testicular swelling in men; breast enlargement,
menstrual irregularity and galactorrhea in women; increased or
decreased
libido; impotence
- Endocrine: Elevated or depressed blood sugar, elevated prolactin
levels,
inappropriate ADH secretion
- Hypersensitivity: Skin rash, pruritus, vasculitis, petechiae,
photosensitization, edema (generalized or of face and tongue), drug
fever
- Withdrawal: Symptoms on abrupt discontinuation of prolonged therapy:
nausea, headache, vertigo, nightmares, malaise
- Other: Nasal congestion, excessive appetite, weight gain or loss;
sweating, alopecia, lacrimation, hyperthermia, flushing, chills
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