AMITRYP AMITRYP AMITRYP TRYPTANOL AMOTRIP AMYLINE READY READY NORTENSIL NORTENSIL AMITIN TRIPTYLIN TRIPTYLIN

Dose: 0.285 to 0.429 mg/ kg
Single Dose: 0.36 (0.357)
Frequency: 6 hourly
Route: IM
Instructions: Initial

Dose:
Single Dose:
Frequency:
Route:
Instructions: Not recommended in this age group

Dose: 0.4 to 0.8 mg/kg
Single Dose: 0.6 (0.6)
Frequency: 24 hourly
Route: Oral
Instructions: Recommended for 5-12 yrs Children

Amitriptyline is the derivative of Amitriptyline (HCl). It is of Synthetic origin and belongs to Dibenzo cyclohepten propylamine. It belongs to Adenosine uptake inhibitor pharmacological group on the basis of mechanism of action and also classified in Psychotherapeutic Drugs and Antidepressant pharmacological group.The Molecular Weight of Amitriptyline (HCl) is 313.90. Its pKa is 9.4.

Amitriptyline (HCl) is contraindicated in conditions like Glucoma,Myocardial infarction,Prostatic hypertrophy.

The severe or irreversible adverse effects of Amitriptyline (HCl), which give rise to further complications include Postural hypotension, Tachycardia, Cardiac arrhythmias, Conduction disturbances, Congestive heart failure.Amitriptyline (HCl) produces potentially life-threatening effects which include Agranulocytosis, Thrombocytopenia. which are responsible for the discontinuation of Amitriptyline (HCl) therapy.The signs and symptoms that are produced after the acute overdosage of Amitriptyline (HCl) include Hypotension, Cardiac arrhythmias, Coma, Seizures, Blurred vision, Dry mouth, Urinary retention, Hypothermia, Metabolic acidosis, Mydriasis, Sinus tachycardia, Hypoxia, QT interval lengthening, P-R interval lengthening.The symptomatic adverse reactions produced by Amitriptyline (HCl) are more or less tolerable and if they become severe, they can be treated symptomatically, these include Weakness, Dizziness, Headache, Fatigue, Constipation, Dry mouth, Blurred vision, Urinary retensionX, Tremor.

Amitriptyline (HCl) is primarily indicated in conditions like Chronic pain, Depression, Enuresis, Migraine prophylaxis, Tension headache.

Amitriptyline (HCl) is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAcrosoxacinAdrenalineAlcoholAntazolineIncreased antimuscarinic and sedative effects when antihistamines (e.g Antazoline) given with tricyclic antidepressants (e.g Amitriptyline)Apraclonidine (HCl)Avoid concomitant use.AstemizoleBethanidine (Sulphate)Bretylium (Tosylate)CarbamazepineCarbamazepine accelerates metabolism of tricyclics (e.g Amitriptyline); reduced plasma concentration by induction of CYP450 enzymes and reduced effects. ModerateTolerance,patient response,seizure control and monitoring of serum concentration should be done.Cimetidine (HCl)CisaprideCisapride can cause ventricular arrhythmia due to prolong QT interval when given with Amitriptyline.MajorThis combination is contraindicated.Clonidine (HCl)Debrisoquine (Sulphate)DisopyramideDisulfiramEnfluraneEnfluraneErgotamine (Tartrate)reports of serotonin syndrome in patients recieving ergotamine with amitriptyline , imipramine, paroxetine, or sertralineFenfluramine (HCl)FluconazoleFluconazole inhibit CYP450 3A4 isoenzyme which decrease Amitriptyline clearance leads to CNS toxicity and prolong QT interval. ModerateAdjust amitriptyline dose and monitor its serum levels.Fluvoxamine (Maleate)Amitriptyline metabolism is decrease while plasma concentration is increased by flovoxamine which inhibit multiple hepatic microsomal enzymes.MajorCoadministration of these two drugs are avoided.FurazolidoneGuanethidineHuman InsulinIndacaterol prolong the QTc interval should be monitored closely.Insulin LisproIproniazid PhosphateInfrequent reports of AMITRIPTYLINE increasing the SEROTONERGIC effect of IPRONIAZID. Potential risk. IsoproterenolLevodopaLevodopa serum concentration is reduced by amitriptyline due to slow gastric emptying and increase gastric degradation.Patient monitor for altered safety and efficacy.LoprazolamTheoretical potential for LOPRAZOLAM increasing the SEDATIVE effect of AMITRIPTYLINE. ModerateMazindolNabiloneConcurrent use may increase the efficacy of nabilone.Concurrent use should be avoided, or you may need dosage adjustments or special tests during treatment.Nitroglycerinsimultaneous use may cause orthostatic hypotension Noradrenaline (Acid Tartrate)OxymorphoneCentral nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.ModerateDuring concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be made aware of the possibility of additive CNS effects (e.g., drowsiness, dizziness, lightheadedness, confusion) and counseled to avoid activities requiring mental alertness until they know how these agents affect them. Patients should also be advised to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.PericyazineThese drugs shouldnot be taken concurrently without doctors prescription.PhentermineConcurrent use may result in high blood pressure.Phenytoin (Na)Procainamide (HCl)ProcarbazineAdministration of Amitriptyline and procarbazine can cause nausea,vomitiing,flushing,dizziness,tremor,hyperthermia and hypertensive crises,seizures,coma and death may also occur.MajorThis combination should not be used or a gap of atleast 14 days should be given after discontinuing any of these drugs to start the other.QuinidineBy inhibting CYP450 3A4 2D6 metabolism quinidine increase serum levels of amitriptyline and both these drugs can prolong QT interval.ModerateThis combination should be avoided and monitor patient for drowsiness,confusion,weakness and seizures.Riboflavin (Vitamin B2)Tricyclic antidepressants may reduce levels of riboflavin in the body. In addition to raising levels of the vitamin in the body, taking riboflavin may also improve the effects of these antidepressantsRiluzoleAmitriptyline (HCl) could decrease the rate of riluzole elimination.Sotalol (HCl)St.Johns Wort ExtractSignificant reduction in amitriptyline concentrations were reported with concurrent ingestion of St. Johns wort.SulpirideTerfenadineThioridazine (HCl)coadministration of these two drugs can cause increase in plasma concentration of both drugs that result in central nervous system depression,hypotension and prolong QT interval.ModerateCombine use of these drugs should be avoided.VORICONAZOLEadditive QTc prolongation may occurconsider alternate therapyWarfarin (Na)Amitriptyline may enhance the anticoagulant effect of Warfarin. ModerateMonitor for increased prothrombin times (PT)/toxic effects of Warfarin if Amitriptyline is initiated/dose increased, or decreased effects if Amitriptyline is discontinued/dose decreased. These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.

Fringes TLC method of measuring Urinary Alkaloids

Drug should not be given to Pregnant Mothers, patients suffering from Liver Malfunction, Geriatrics, and Neonates.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.

Tab Store in a well closed container, Below 40°C. Protect from Sunlight and Moisture.

Amitriptyline (HCl) should be used with caution in patients with cardiac disease and pre-existing hematological disorders. It is classified as a pregnancy category C drug. No complete or well-controlled studies have been done. Use during pregnancy should be avoided unless the potential benefits outweigh the possible risks to the fetus. Abrupt discontinuation should be avoided because it could precipitate sympotoms of cholinergic rebound such as nausea, vomiting or diarrhoea. It should be used with caution in patients with history of alcoholism or who may use sedative medicines because the depressant effect on CNS can be potentiated.