Amitriptyline

Overview

What is Amitriptyline? 

Amitriptyline is a tricyclic antidepressant that is used to treat a variety of mental conditions, primarily depression (major depressive disorder (MDD). Its ingredients include the active compound amitriptyline hydrochloride and various inactive ingredients that may differ by manufacturer. The drug functions by increasing serotonin and/or norepinephrine levels in the brain that helps maintain mental balance. 

Amitriptyline has a three-ring central structured molecule with side chains (Tricyclic), hence its classification. It is produced through a multi-step chemical synthesis that involves the creation of a dibenzocycloheptene backbone, which is then modified to include additional chemical groups that confer the drug's pharmacological properties. 

Global Name

Generic Name and Brand Names 

• Generic name: Amitriptyline 
  
• Brand names: Elavil, Endep, Vanatrip

Usage

What is Amitriptyline used for?

Amitriptyline is primarily used to treat symptoms of depression. It can also be prescribed for other conditions, including: 

• Anxiety disorders 
• Post-traumatic stress disorder (PTSD) 
• Chronic pain 
• Migraine prophylaxis 
• Insomnia 

How do you use Amitriptyline?

Availability:

Amitriptyline is available in tablet form, as well as an oral solution. 

Dosage information: 

• Adults: 75 mg per day in divided doses; may be increased to 150 mg daily. 
• Adolescents: 10-50 mg daily in divided doses or before bedtime. 
• Elderly: Lower initial dose, increased cautiously. 

Suitability: 

• Children: Not recommended for use in children under 12 years of age. 
• Adults: Suitable with the appropriate prescription. 
• Elderlies: Suitable with a lower initial dose.

Who can’t take Amitriptyline? 

• Children under 12 years 
• Adults with certain medical conditions 
• Elderlies with increased susceptibility to side effects 
• Pregnancy and Lactation: Not recommended without medical advice. 
• Recent history of acute myocardial infarction (heart attack) or serious cardiovascular events (e.g. arrhythmias, heart blocks, thrombosis) 

Allergies: 
People with known hypersensitivity to amitriptyline or its ingredients should avoid the drug. 

Warnings and Precautions: 

• Caution in patients with a history of cardiovascular disease. 
• Monitor for worsening depression or the emergence of suicidal thoughts. 
• It may cause drowsiness; avoid driving or operating heavy machinery. 

Amitriptyline should ideally be taken after meals to reduce gastrointestinal side effects. 

Interactions and contraindications of Amitriptyline: 
Amitriptyline can interact with MAO inhibitors, SSRIs, anticholinergic drugs, and alcohol. It is contraindicated in patients who have recently had a myocardial infarction. 

Side Effects

Common side effects include drowsiness, dry mouth, and dizziness. Severe side effects may include arrhythmias, seizures, and severe hypotension. 

Pharmacist Tips

For those taking Amitriptyline, here are some essential tips to ensure safe and effective use: 

• Store at room temperature away from moisture and light. 
• Keep medication in a secure place, out of children's reach. 
• Swallow tablets whole; do not crush or chew. 

• Take missed doses as soon as possible, but skip if it's near the next scheduled dose. 
• Gradually taper off under a doctor's guidance to avoid withdrawal symptoms. 

Always consult your pharmacist or healthcare provider for personalized advice and instructions tailored to your treatment plan. 

Availability

Where is Amitriptyline available in Hong Kong?

Amitriptyline is a prescription medication that can be prescribed by healthcare providers.

FAQs

What should I do if I experience severe side effects?

Contact your healthcare provider immediately if severe side effects occur. 

Can I stop taking Amitriptyline abruptly?

No, discontinuation should be done gradually under medical supervision to avoid withdrawal symptoms. 

How long does Amitriptyline make you sleepy? 

The sedative effects of amitriptyline typically set in within a few hours of taking the medication, and the sleepiness can last for several hours after administration. However, the duration and intensity of drowsiness can vary among individuals and may decrease over time as the body adjusts to the medication. 

How to avoid weight gain on Amitriptyline?

To avoid weight gain on amitriptyline, maintain a balanced diet with controlled portion sizes, and engage in regular physical activity. It's also important to consult with your healthcare provider, as they may suggest adjustments to your medication or additional strategies tailored to your situation.  Nutritionist/dietitian suggestions may also be sought.