Amitriptyline T300 26-27

Amitriptyline

Elavil

Amitriptyline Drug Class

Tricyclic Antidepressant

Amitriptyline Dosage Forms

Oral Tablet: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg

Amitriptyline Dosing By Indication

1. Depression: Adults, 25–50 mg po daily divided into 1–2 daily doses, titrate to max 300 mg/d; Children ≥12 y of age, 10 mg po tid or 20 mg po daily HS, titrate to max 200 mg/d

Amitriptyline Off Label Uses

1. Migraine or headache, chronic tension, prevention: 10–25 mg po daily HS; titrate to max 125 mg/d (headache) or 150 mg/d (migraine)
2. Chronic fatigue syndrome-related sleep disorders and pain: 10 mg po daily HS; titrate to max 50 mg/d (sleep disorders) or 100 mg/d (pain disorders)
3. Neuropathic pain or postherpetic neuralgia: 10–25 mg po daily HS; titrate to max 150 mg/d
4. Fibromyalgia: 10 mg po daily 1–3 h before bedtime, titrate by 5–10 mg to max 75 mg/d
5. Sialorrhea: 10–25 mg po daily HS, may titrate to 100 mg/d
6. Functional dyspepsia: 10–25 mg po daily HS, titrate by 10–25 mg to max 50 mg/d
7. Cyclic vomiting syndrome prevention: 10–25 mg po daily HS, titrate by 10–25 mg to max 100 mg/d; Children ≥5 y of age, 0.2–0.5 mg/kg po daily HS, titrate to max 1–1.5 mg/kg/d
8. Interstitial cystitis: 10 mg po daily HS, max 100 mg/d

Amitriptyline MOA

This drug is a tricyclic antidepressant that blocks presynaptic reuptake of serotonin and norepinephrine with subsequent downregulation of adrenergic receptors.

Amitriptyline Common Adverse Effects

Sedation

Amitriptyline Efficacy Monitoring Parameters

Improvement in target symptoms of depression. Reduction or improvement in pain or decreased frequency of migraines.

Amitriptyline Safety Monitoring Parameters

Worsening of depression, suicidality, or unusual changes in behavior, especially at initiation or with dosage changes. Altered mentation, seizures, autonomic dysregulation, muscle spasms, gastrointestinal symptoms. Monitor ECGs, LFTs, blood glucose, BP, and HR.

Amitriptyline Key Counseling Points

Avoid activities requiring mental alertness, alcohol, and other CNS depressants. Symptomatic improvement may take a few weeks. Avoid sudden discontinuation of drug.

Amitriptyline Clinical Pearls

Antidepressants increase risk of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies with major depressive disorder (MDD) and other psychiatric disorders. Can cause anticholinergic side effects. May cause syndrome of inappropriate antidiuretic hormone secretion (SIADH)