Class: Tricyclic Antidepressant
Dosage Forms. Tablet: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg
Common FDA Label Indication, Dosing, and Titration.
1. Depression: Adults, 75 mg po divided into 1-3 daily doses, titrate to max 150 mg/d; Children 12 y and older, 10 mg po tid or 20 mg po daily hs
1. Headache, treatment, and prophylaxis: 25-75 mg po daily hs
2. Irritable bowel syndrome: 10-30 mg po daily hs
3. Pain: 25-100 mg po daily hs
4. Polyneuropathy: 10-25 mg po daily hs; may titrate to max 150-200 mg/d po
5. Postherpetic neuralgia, treatment and prophylaxis: 25-75 mg po daily hs
MOA. Amitriptyline is a heterocyclic antidepressant that blocks presynaptic reuptake of norepinephrine with subsequent downregulation of adrenergic receptors.
Drug Characteristics: Amitriptyline
Medication Safety Issues: Amitriptyline
Drug Interactions: Amitriptyline
Adverse Reactions: Amitriptyline
Efficacy Monitoring Parameters. Improvement in target symptoms of depression. Reduction or improvement in pain or decreased frequency of migraines.
Toxicity Monitoring Parameters. Worsening of depression, suicidality, or unusual changes in behavior, especially at the initiation of therapy or with dosage increases or decreases. Monitor ECGs and LFTs.
Key Patient Counseling Points. Avoid activities requiring mental alertness, alcohol, and other CNS depressants. Symptomatic improvement may not be seen for a few weeks. Avoid sudden discontinuation of drug.
Clinical Pearls. Safety and effectiveness in children below the age of 12 y have not been established. Antidepressants increased the 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.