Amitriptyline instructions for use in tablets. Use of the substance Amitriptyline

Gross formula

C 20 H 23 N

Pharmacological group of the substance Amitriptyline

Nosological classification (ICD-10)

CAS code

50-48-6

Characteristics of the substance Amitriptyline

Tricyclic antidepressant. Amitriptyline hydrochloride is a white, odorless, crystalline powder, easily soluble in water, ethanol, and chloroform. Molecular weight 313.87.

Pharmacology

pharmachologic effect- antidepressant, anxiolytic, thymoleptic, sedative.

Inhibits the reuptake of neurotransmitters (norepinephrine, serotonin) by presynaptic nerve endings neurons, causes the accumulation of monoamines in the synaptic cleft and enhances postsynaptic impulses. At long-term use reduces functional activity(desensitization) of beta-adrenergic and serotonin receptors of the brain, normalizes adrenergic and serotonergic transmission, restores the balance of these systems, disturbed by depressive states. Blocks m-cholino- and histamine receptors CNS.

When taken orally, it is quickly and well absorbed from the gastrointestinal tract. Bioavailability of amitriptyline at different ways administration is 30-60%, its metabolite - nortriptyline - 46-70%. Cmax in the blood after oral administration is achieved within 2.0-7.7 hours. Therapeutic concentrations in the blood for amitriptyline are 50-250 ng/ml, for nortriptyline - 50-150 ng/ml. Blood protein binding is 95%. Easily passes, like nortriptyline, through histohematic barriers, including the BBB, placental, penetrates breast milk. T1/2 is 10-26 hours, for nortriptyline - 18-44 hours. In the liver it undergoes biotransformation (demethylation, hydroxylation, N-oxidation) and forms active - nortriptyline, 10-hydroxy-amitriptyline, and inactive metabolites. It is excreted by the kidneys (mainly in the form of metabolites) within several days.

In anxiety-depressive conditions, it reduces anxiety, agitation and depressive symptoms. The antidepressant effect develops within 2-3 weeks after the start of treatment. If you suddenly stop taking it after long-term treatment, withdrawal syndrome may develop.

Use of the substance Amitriptyline

Depression of various etiologies(especially with severe anxiety and agitation), incl. endogenous, involutional, reactive, neurotic, with organic brain damage, medicinal; schizophrenic psychoses, mixed emotional disorders, behavioral disorders, bulimia nervosa, childhood enuresis(except for children with hypotension Bladder), chronic pain syndrome(neurogenic in nature), migraine prevention.

Contraindications

Hypersensitivity, use of MAO inhibitors in the previous 2 weeks, myocardial infarction (acute and recovery period s), heart failure in the stage of decompensation, intracardiac conduction disorders, severe arterial hypertension, benign hyperplasia prostate gland, atony of the bladder, paralytic ileus intestines, pyloric stenosis, peptic ulcer stomach and twelve duodenum in the acute stage, acute diseases liver and/or kidneys with severe impairment of their function, blood diseases, children under 6 years of age (for injection forms - up to 12 years).

Restrictions on use

Epilepsy, ischemic heart disease, arrhythmia, heart failure, angle-closure glaucoma, intraocular hypertension, hyperthyroidism.

Use during pregnancy and breastfeeding

Contraindicated during pregnancy.

Treatment should be stopped during treatment breast-feeding.

Side effects of the substance Amitriptyline

Caused by blockade of peripheral m-cholinergic receptors: dry mouth, urinary retention, constipation, intestinal obstruction, visual impairment, accommodation paresis, increased intraocular pressure, increased sweating.

From the outside nervous system and sense organs: headache, dizziness, ataxia, increased fatigue, weakness, irritability, drowsiness, insomnia, nightmares, motor agitation, tremor, paresthesia, peripheral neuropathy, EEG changes, impaired concentration, dysarthria, confusion, hallucinations, tinnitus.

From the outside of cardio-vascular system: tachycardia, orthostatic hypotension, arrhythmia, blood pressure lability, widening of the QRS complex on the ECG (impaired intraventricular conduction), symptoms of heart failure, fainting, changes in the blood picture, incl. agranulocytosis, leukopenia, eosinophilia, thrombocytopenia, purpura.

From the gastrointestinal tract: nausea, vomiting, heartburn, anorexia, discomfort in the epigastrium, gastralgia, increased activity of liver transaminases, stomatitis, taste disturbance, darkening of the tongue.

From the side of metabolism: galactorrhea, changes in ADH secretion; rarely - hypo- or hyperglycemia, impaired glucose tolerance.

From the outside genitourinary system: changes in libido, potency, testicular swelling, glucosuria, pollakiuria.

Allergic reactions: skin rash, itching, angioedema, urticaria.

Others: increase in the size of the mammary glands in women and men, hair loss, enlargement lymph nodes, photosensitivity, weight gain (with long-term use), withdrawal syndrome: headache, nausea, vomiting, diarrhea, irritability, sleep disturbance with vivid, unusual dreams, increased excitability (after long-term treatment, especially in high doses, if you abruptly stop taking the drug).

Interaction

Incompatible with MAO inhibitors. Strengthens the inhibitory effect on the central nervous system of neuroleptics, sedatives and sleeping pills, anticonvulsants, analgesics, anesthetics, alcohol; exhibits synergism when interacting with other antidepressants. When used together with neuroleptics and/or anticholinergic drugs, the development of a febrile temperature reaction and paralytic intestinal obstruction is possible. Potentiates the hypertensive effects of catecholamines and other adrenergic stimulants, which increases the risk of developing disorders heart rate, tachycardia, severe arterial hypertension. May reduce the antihypertensive effect of guanethidine and drugs with a similar mechanism of action, as well as weaken the effect anticonvulsants. At simultaneous use with anticoagulants - derivatives of coumarin or indanedione - it is possible to increase the anticoagulant activity of the latter. Cimetidine increases plasma concentrations of amitriptyline with possible development toxic effects, inducers of microsomal liver enzymes (barbiturates, carbamazepine) - reduce. Quinidine slows down the metabolism of amitriptyline, estrogen-containing oral contraception may increase bioavailability. Concomitant use with disulfiram and other acetaldehyde dehydrogenase inhibitors may provoke delirium. Probucol may increase cardiac arrhythmias. Amitriptyline may enhance glucocorticoid-induced depression. When used together with drugs for the treatment of thyrotoxicosis, the risk of developing agranulocytosis increases. Use caution when combining amitriptyline with digitalis and baclofen.

Overdose

Symptoms: hallucinations, convulsions, delirium, coma, cardiac conduction disturbances, extrasystole, ventricular arrhythmia, hypothermia.

Treatment: gastric lavage, taking the suspension activated carbon, laxatives, fluid infusion, symptomatic therapy, maintaining body temperature, monitoring the function of the cardiovascular system for at least 5 days, because relapse of disorders may occur after 48 hours or later. Hemodialysis and forced diuresis are ineffective.

Routes of administration

Inside, intramuscularly.

Precautions for the substance Amitriptyline

Amitriptyline can be taken no earlier than 14 days after stopping MAO inhibitors. Reduced doses are recommended for elderly patients and children. Should not be prescribed to patients with mania. Due to the possibility of suicide attempts in patients with depression, it is necessary to regularly monitor patients, especially in the first weeks of treatment, as well as prescribe as little required doses to reduce the risk of overdose. If there is no improvement in the patient's condition within 3-4 weeks, it is necessary to reconsider the treatment tactics. During treatment, you should avoid drinking alcohol, and also refrain from activities that require increased attention and speed of reactions.

Interactions with other active ingredients

Trade names

Name	The value of the Vyshkowski Index ®

One of the most powerful antidepressant drugs is Amitriptyline. It is an analgesic, antiulcer and sedative medical product, the effectiveness of which is due to the ingredients present in its composition. This tricyclic antidepressant belongs to the group of neuronal monoamine uptake inhibitors. The mechanism of its action is associated with inhibition of the uptake of serotonin and catecholamines in the central nervous system. The positive effect of its use develops gradually, over 2–4 weeks.

After taking Amitriptyline tablets, the maximum concentration of active active ingredients in blood plasma is observed after 4 – 8 hours. Its bioavailability indicators range from 33% to 62%.

What do Amitriptyline tablets help with?

This medicine can only be taken as prescribed by a doctor. As a rule, it is recommended by medical specialists for depression of any etiology, when a person is unable to cope on his own. emotional problems. It is especially effective against the following pathologies:

• depressive states;
• behavioral disorders;
• psychogenic anorexia;
• schizophrenic psychoses;
• phobic disorders;
• bulimic neurosis;
• childhood enuresis;
• chronic neurogenic pain;
• migraines.

Do not take this medicine under any circumstances if you have the following contraindications:

1. disruption of cardiac muscle conduction;
2. bladder atony;
3. heart failure;
4. pregnancy and breastfeeding;
5. high blood pressure;
6. paralytic ileus;
7. myocardial infarction;
8. violation normal functioning kidneys, liver and other internal organs;
9. prostatic hypertrophy;
10. hypersensitivity to the ingredients of this medication;
11. alcohol addiction;
12. epileptic seizures;
13. children under 6 years of age;
14. affective insanity;
15. increased intraocular pressure.

If you are susceptible to at least one of the conditions described above, avoid negative consequences– be sure to tell your doctor about this! Medical specialist will recommend you another medicine.

Adverse reactions

In some cases, taking this medicine is accompanied by various adverse reactions:

• constipation;
• tinnitus;
• increased body temperature;
• heartburn;
• dry mouth;
• allergic manifestations;
• irritability;
• heart rhythm disturbances;
• headaches.

At the beginning of treatment, your doctor will definitely warn you about them. possible emergence. Do not be alarmed, as they may indicate the process of adaptation of your body to this medication. And yet, if during treatment with Amitriptyline you notice one or more of the above-described phenomena, tell your doctor about it.

Treatment rules

Amitriptyline tablets should be taken orally, preferably after meals. The dosage of the drug is determined by your doctor depending on your disease, age, drug tolerance and other factors. Standard initial daily dose This medication is 50–75 mg, divided into 2–3 doses. The maximum permitted daily dosage ranges from 150 to 200 mg.

In very severe cases, in particular when protracted depressions that are difficult to treat, an increase is allowed daily dosage up to 300 mg. Absence positive effect 30 days after the start of treatment with this medication indicates the ineffectiveness of such therapy. In this case, the doctor will choose another drug that is more suitable for you.

Amitriptyline is from the group of non-selective neurotransmitter uptake inhibitors. By chemical structure refers to tricyclic compounds. It is used in the treatment of many types of depression and their somatic manifestations. Why is Amitriptyline prescribed? The drug has antihistamine and anticholinergic effects, which allows it to be used for spastic conditions of smooth muscles.

Action and indications

The effect of the antidepressant Amitriptyline is that the drug prevents the reuptake of neurotransmitters such as serotonin, dopamine, and norepinephrine from the synaptic cleft. This tricyclic compound promotes the accumulation of nervous system mediators, prolonging and enhancing their action, which relieves symptoms of depression. The administration of Amitriptyline after compensates for the lack of dopamine due to death nerve cells that produce it.

Amitriptyline also exhibits an adrenergic blocking effect and has an analgesic effect. Suppression of acetylcholine receptors allows the drug to be used for abdominal pain, bedwetting and overactive bladder. An antidepressant is also used in the treatment of ulcers by suppressing the formation of hydrochloric acid in the stomach. Suppression of acid production by the lining cells of the stomach also leads to a decrease in appetite, which is used in the treatment of bulimia.

List of pathologies that Amitriptyline helps with:

1. Depression of various origins, including with an anxious and apathetic component, as well as somatic manifestations of mental disorders.
2. Eating disorders as a manifestation of depression: bulimia (ravenous hunger), anorexia.
3. Prevention of migraine attacks.
4. Bedwetting in children and overactive bladder in adults.
5. Neuralgia and chronic pain syndrome with fibromyalgia, irritable bowel syndrome, oncological diseases etc.
6. Various phobias.
7. Post-stroke condition, especially in older people.
8. Withdrawal syndrome, i.e. abstinence from alcohol and drugs.
9. Psychoses with.

Side effects Amitriptyline:

1. Increased sensitivity to light due to paralysis of accommodation (dilated pupil).
2. Intestinal atony, manifested in constipation, sometimes dynamic obstruction.
3. Stomach atony, heartburn, belching, nausea.
4. Decreased bladder tone and urinary retention.
5. Hypertension.
6. Dry mouth and bad smell from the oral cavity.
7. Irritability.
8. Drowsiness.
9. Violations in hormonal system: increased prolactin hormone and swelling mammary glands, sometimes the release of milk from them, menstrual irregularities.
10. Changes in blood biochemistry from the liver: increased aminotransferases, direct bilirubin(cholestasis syndrome - bile stagnation).
11. Hyperglycemia.

Important! Amitriptyline withdrawal syndrome may be accompanied by cholinergic effects - drooling, gastrointestinal cramps and diarrhea.

When is Amitriptyline contraindicated?

This is a drug with a powerful effect that affects the cardiovascular and nervous system. Contraindications to the use of Amitriptyline:

1. Exacerbation of ulcerative processes in the stomach and duodenum.
2. Tachycardia (rapid heartbeat).
3. Hypertonic disease.
4. Atony of the stomach and intestines, stenosis of the pyloric part of the stomach.
5. Decreased bladder tone.
6. Prostatic hyperplasia.
7. Decompensated heart failure.
8. Angle-closure glaucoma.
9. The use of other drugs from the group of antidepressants - serotonin syndrome is possible.
10. Chronic seizure conditions - an antidepressant may increase the frequency of seizures and other movement disorders.
11. Drinking alcohol. Amitriptyline may enhance the depression of the nervous system by ethyl alcohol.
12. Thyrotoxicosis.

Mode of application

How to take Amitriptyline for depression? Take the drug for the first time at night after meals in a dosage of 25-50 mg. For the next 5 days, take 50 mg three times a day.

The therapeutic effect in the treatment of depressive conditions appears after 2-4 weeks of use. If the symptoms of depression disappear, then the dose is reduced to 50 mg per day. This maintenance dose is taken for three months to prevent relapses.

To prevent migraine pain, use 25 mg-100 mg daily.

Before completely stopping Amitriptyline, doctors gradually reduce the dosage of the drug. It is possible to prescribe adaptogens (rhodiola, ginseng) to prevent Amitriptyline withdrawal syndrome; addiction to it can be controlled by correct treatment tactics.

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This drug is produced in the form of tablets and solution for injection. In its instructions for use, the reader will be able to find all the necessary information regarding its dosages, side effects, contraindications, and so on. Let us immediately note that amitriptyline should under no circumstances be used by patients with certain malfunctions in the cardiovascular system. In this case we're talking about both about myocardial infarction and hypertension, as well as decompensated heart failure. Various violations normal performance liver or kidneys are also considered a contraindication for use this drug. If the patient has bladder atony, individual intolerance any components of this medication, a disease of the hematopoietic system or enlargement of the prostate gland, then he should also stop taking amitriptyline. It is strictly contraindicated in case of exacerbation of a stomach ulcer or duodenum.

When using this medication, we must not forget that amitriptyline cannot be used along with all drugs. Often when using this medication there are also various disorders from the central nervous system, which every patient must know about. If the course of therapy is stopped very suddenly, this may cause withdrawal syndrome.

If we talk directly about the reviews that relate to this drug, then there are actually a lot of them. In about fifty percent of cases, people complain about side effects symptoms that occur within a day or two of treatment with this medication. Most often they express apathy and excessive drowsiness. Given the occurrence of such side effects, patients are forced to take this drug mainly before going to bed. There are also cases when patients complain about the same signs, while pointing to the fact that they continue to haunt them for more than two to three months. In such cases, the drug is most often replaced by another pharmaceutical agent. There are also reviews in which people confidently say that they did not experience a single side effect while using amitriptyline. The most common review is that this medication is not very well tolerated by the body, but it can cause completely different side effects in all people. Even if the body does not accept it, then this medicine can be replaced with another drug at any time.

When using this medication, it is recommended to be extremely careful when changing a lying position to a sitting or standing position. All movements should be performed smoothly. We also note the fact that in case of abrupt withdrawal of this medication, the occurrence of the so-called withdrawal syndrome is quite possible. Using this drug in a dosage of more than one hundred and fifty milligrams per day, there is a decrease in the threshold for convulsive readiness. It must be remembered that if a person is predisposed to convulsive conditions, then an epileptic attack may occur at any time. Such attacks can also occur in those patients who use certain antipsychotic medications.

We should not forget that patients suffering from depression may also experience suicide attempts. Amitriptyline can be used along with electroconvulsive treatment only under the constant supervision of a specialist. In older people, as well as citizens who are predisposed to the development of certain disorders, this medication may cause drug psychoses. Most often, such psychoses occur at night. After stopping the medication, they disappear on their own within three to five days.

All those patients who have chronic constipation should be especially careful when using amitriptyline. The whole point is that, given this pathological condition Taking this medication may cause the development of paralytic ileus. The same phenomenon can also be observed in those patients who, for one reason or another, are bedridden. If a person is taking this medication and needs general or local anesthesia, he or she mandatory must report this fact to the anesthesiologist. This medicine can be used no earlier than two weeks after a course of therapy with MAO inhibitors. Under no circumstances should this drug be used along with norepinephrine, epinephrine, phenylpropanolamine and other sympathomimetics.
When undergoing a course of amitriptyline therapy, it is very important that the patient leads a truly healthy lifestyle, in which, first of all, there should be no place for alcoholic beverages.

Contraindications to the use of this drug
Given pharmaceutical Not everyone can use it, and this is because it has numerous contraindications for use. So, for example, it should never be prescribed to patients who are undergoing therapy with inhibitors
monoamine oxidases. From using this medicinal product You should also refuse if you have prostatic hypertrophy, bladder atony, paralytic ileus, or pyloric stenosis. It is also not recommended for use in cases of glaucoma and myocardial infarction. It is very important not to use this medication during pregnancy or lactation. IN childhood it should only be used on the advice of a specialist. Extreme caution should be taken when this medicine and all those patients who have arrhythmia, heart failure, ischemic disease heart or various heart rhythm disorders.

Let us immediately draw the readers' attention to the fact that against the background of the use of apo-amitriptyline, very diverse side effects can make themselves known. This may include blurred vision, dry mouth, constipation, excessive sweating, urinary retention, dizziness, excessive drowsiness, ventricular arrhythmia, tremor, cardiac conduction disturbances, and so on. Often they make themselves known and various kinds allergic reactions, accompanied by the appearance of not only a skin rash, but also itching. When using this pharmaceutical, it is very important to pay close attention to the available precautions for its use along with other drugs.

Name:

Amitriptyline (Amitriptylinum)

Pharmachologic effect:

Amitriptyline is a tricyclic antidepressant from the group of non-selective inhibitors of neuronal monoamine uptake. It has a pronounced thymoanaleptic and sedative effect.

Pharmacodynamics

The mechanism of the antidepressant action of amitriptyline is associated with inhibition of the reverse neuronal uptake of catecholamines (norepinephrine, dopamine) and serotonin into the central nervous system. Amitriptyline is an antagonist of muscarinic cholinergic receptors in the central nervous system and in the periphery, and has peripheral antihistamine (H1) and antiadrenergic properties. It also causes antineuralgic (central analgesic), antiulcer and antibulemic effects, and is effective for bedwetting. The antidepressant effect develops within 2-4 weeks. After starting use.

Pharmacokinetics

Bioavailability of amitriptyline at in different ways administration - 30-60%, its active metabolite nortriptyline - 46-70%. Time to reach maximum concentration (Tmax) after oral administration is 2.0-7.7 hours. Volume of distribution is 5-10 l/kg. Effective therapeutic concentrations in the blood of amitriptyline are 50-250 ng/ml, for nortriptyline (its active metabolite) 50-150 ng/ml. Maximum concentration in blood plasma (Cmax) -0.04-0.16 mcg/ml. Passes through histohematic barriers, including the blood-brain barrier (including nortriptyline). Amitriptyline concentrations in tissues are higher than in plasma. Communication with plasma proteins is 92-96%. Metabolized in the liver (by demethylation, hydroxylation) with the formation of active metabolites - nortriptyline, 10-hydroxy-amitriptyline, and inactive metabolites. The plasma half-life ranges from 10 to 28 hours for amitriptyline and from 16 to 80 hours for nortriptyline. Excreted by the kidneys - 80%, partly with bile. Complete elimination within 7-14 days. Amitriptyline crosses the placental barrier and is excreted into breast milk in concentrations similar to plasma concentrations.

Indications for use:

Use strictly as prescribed by your doctor.

Depression of any etiology. Particularly effective for anxiety and depression, due to the severity sedative effect. Does not cause exacerbation of productive symptoms (delusions, hallucinations), unlike antidepressants with a stimulating effect.

Mixed emotional and behavioral disorders, phobic disorders.

Pediatric enuresis (except for children with a hypotonic bladder).

Psychogenic anorexia, bulimic neurosis.

Neurogenic pain chronic, for the prevention of migraine.

Method of application:

Prescribed orally (during or after meals).

The initial daily dose when taken orally is 50-75 mg (25 mg in 2-3 doses), then the dose is gradually increased by 25-50 mg until the desired antidepressant effect is obtained. Optimal daily allowance therapeutic dose is 150-200 mg (the maximum dose is taken at night). At severe depression resistant to therapy, the dose is increased to 300 mg or more, to the maximum tolerated dose. In these cases, it is advisable to start treatment with intramuscular or intravenous administration the drug, using higher initial doses, accelerating the increase in dosage under the control of the somatic condition.

After obtaining a stable antidepressant effect after 2-4 weeks, the dose is gradually and slowly reduced. If signs of depression appear when reducing doses, you should return to the previous dose.

If the patient's condition does not improve within 3-4 weeks of treatment, then further therapy is not advisable.

In elderly patients with mild disorders, in outpatient practice, doses are 25-50-100 mg (max) in divided doses or 1 time per day at night. For migraine prevention, chronic pain neurogenic in nature (including prolonged headaches) from 12.5-25 mg to 100 mg/day. Interaction with others medicines Amitriptyline potentiates the inhibition of the central nervous system by the following drugs: antipsychotics, sedatives and hypnotics, anticonvulsants, central and narcotic painkillers, anesthetics, alcohol.

Prescribed intramuscularly or intravenously. For severe depression resistant to therapy: intramuscularly or intravenously (administer slowly!) at a dose of 10-20-30 mg up to 4 times a day, the dose should be increased gradually, the maximum daily dose is 150 mg, after 1-2 weeks switch to taking the drug orally. Children over 12 years of age and the elderly are given lower doses and increased more slowly.

When amitriptyline is used concomitantly with neuroleptics and/or anticholinergic drugs, febrile symptoms may occur. temperature reaction, paralytic intestinal obstruction. Amitriptyline potentiates the hypertensive effects of catecholamines, but inhibits the effects of drugs affecting the release of norepinephrine.

Amitriptyline may reduce the antihypertensive effect of sympatholytics (octadine, guanethidine and drugs with a similar mechanism of action).

When taking amitriptyline and cimetidine simultaneously, it is possible to increase the plasma concentration of amitriptyline.

Concomitant use of amitriptyline with MAO inhibitors can lead to fatal outcome. The break in treatment between taking MAO inhibitors and tricyclic antidepressants should be at least 14 days!

Adverse events:

Mainly associated with the anticholinergic effect of the drug: accommodation paresis. Blurred vision, increased intraocular pressure, dry mouth, constipation, intestinal obstruction, urinary retention, increased body temperature. All these phenomena usually disappear after adaptation to the drug or dose reduction.

From the central nervous system: headache, ataxia, increased fatigue, weakness, irritability, dizziness, tinnitus, drowsiness or insomnia, impaired concentration, nightmares, dysarthria, confusion, hallucinations, motor agitation, disorientation, tremor, paresthesia, peripheral neuropathy, EEG changes. Rarely, extrapyramidal disorders, seizures, anxiety. From the cardiovascular system: tachycardia, arrhythmia, conduction disturbances, lability blood pressure, widening of the QRS complex on the ECG (impaired intraventricular conduction), symptoms of heart failure, fainting. From the gastrointestinal tract: nausea, vomiting, heartburn, anorexia, stomatitis, taste disturbances, darkening of the tongue, discomfort in the epigastrium, gastralgia, increased activity of liver transaminases, rarely cholestatic jaundice, diarrhea. From the outside endocrine system: an increase in the size of the mammary glands in men and women, galactorrhea, changes in the secretion of antidiuretic hormone (ADH), changes in libido, potency. Rarely: hypo- or hyperglycemia, glucosuria, impaired glucose tolerance, testicular swelling. Allergic reactions: skin rash, itching, photosensitivity, angioedema, urticaria. Other: agranulocytosis, leukopenia, eosinophilia, thrombocytopenia, purpura and other blood changes, hair loss, swollen lymph nodes, weight gain with long-term use, sweating, pollakiuria. At long-term treatment, especially in high doses, with abrupt cessation of treatment, withdrawal syndrome may develop: headache, nausea, vomiting, diarrhea, as well as irritability, sleep disturbance with vivid, unusual dreams, increased excitability.

Contraindications:

Heart failure in the stage of decompensation

Acute and recovery period of myocardial infarction

Conduction disorders of the heart muscle

Severe arterial hypertension

Acute liver and kidney diseases with severe dysfunction

Peptic ulcer of the stomach and duodenum in the acute stage

Prostatic hypertrophy

Bladder atony

Pyloric stenosis, paralytic ileus

Concomitant treatment with MAO inhibitors (see Interactions)

Pregnancy, breastfeeding period

Children under 6 years old

Hypersensitivity to amitriptyline

Amitriptyline should be used with caution in persons suffering from alcoholism, bronchial asthma, manic-depressive psychosis (MDP) and epilepsy (see. special instructions), with suppression of bone marrow hematopoiesis, hyperthyroidism, angina pectoris and heart failure, angle-closure glaucoma, intraocular hypertension, schizophrenia (although when taking it, there is usually no exacerbation of productive symptoms).

Overdose

Drowsiness, disorientation, confusion, dilated pupils, increased body temperature, shortness of breath, dysarthria, agitation, hallucinations, seizures, muscle rigidity, suppuration, coma, vomiting, arrhythmia, arterial hypotension, heart failure, respiratory depression.

Help: discontinuation of amitriptyline therapy, gastric lavage, fluid infusion, symptomatic therapy, maintaining blood pressure and water-electrolyte balance. Monitoring of cardiovascular activity (ECG) is indicated for 5 days, because relapse may occur within 48 hours or later. Hemodialysis and forced diuresis are not very effective.

Interaction with other drugs

Amitriptyline enhances the inhibitory effect on the central nervous system the following drugs: antipsychotics, sedatives and hypnotics, anticonvulsants, painkillers, anesthetics, alcohol, exhibits synergism when interacting with other antidepressants. When amitriptyline is used together with neuroleptics and/or anticholinergic drugs, a febrile temperature reaction and paralytic intestinal obstruction may occur. Amitriptyline potentiates the hypertensive effects of catecholamines and other adrenergic stimulants, which increases the risk of developing heart rhythm disturbances, tachycardia, severe arterial hypertension, but inhibits the effects of drugs affecting the release of norepinephrine. Amitriptyline may reduce the antihypertensive effect of guanethidine and drugs with a similar mechanism of action, as well as weaken the effect of anticonvulsants. With the simultaneous use of amitriptyline and anticoagulants - derivatives of coumarin or indanedione, an increase in the anticoagulant activity of the latter is possible. When taking amitriptyline and cimetidine simultaneously, it is possible to increase the plasma concentration of amitriptyline with the possible development of toxic effects. Inducers of microsomal liver enzymes (barbiturates, carbamazepine) reduce plasma concentrations of amitriptyline. Amitriptyline enhances the effect of antiparkinsonian drugs and other drugs that cause extrapyramidal reactions. Quinidine slows down the metabolism of amitriptyline. Concomitant use of amitriptyline with disulfiram and other acetaldehyde dehydrogenase inhibitors may precipitate delirium. Estrogen-containing oral contraceptives may increase the bioavailability of amitriptyline; pimozide and probucol may increase cardiac arrhythmias. Amitriptyline may enhance depression caused by glucocorticosteroids, joint use with medications for the treatment of thyrotoxicosis, the risk of developing agranulocytosis increases. Simultaneous use amitriptyline with MAO inhibitors can be fatal. The break in treatment between taking MAO inhibitors and tricyclic antidepressants should be at least 14 days!

special instructions

Amitriptyline in doses above 150 mg/day reduces the threshold for seizure activity, so the possibility of seizures in patients with a history of such, and in those categories of patients who are predisposed to this due to age or injury. Treatment with amitriptyline in old age should be carefully monitored and, with the use of minimum doses of the drug, increasing them gradually, in order to avoid the development of delirious disorders, hypomania and other complications. Patients with depressive phase MDP, can go into a manic stage. While taking amitriptyline, driving vehicles, servicing machinery and other types of work that require increased concentration, as well as drinking alcohol, is prohibited.

Release form of the drug:

The following forms of release are possible:

Packaging - 50 tablets, each containing 25 mg of active substance.

Packages of 20, 50 and 100 film-coated tablets.

2 ml in colorless glass ampoules. 5 ampoules are packed in a molded PVC container. 2 molded containers (10 ampoules) along with instructions for use are placed in a cardboard box.

Solution for injection 10 mg/ml in ampoules of 2 ml, 5 or 10 ampoules per cardboard pack, 5 ampoules per blister pack, 1 or 2 blister packs per cardboard pack along with instructions for use.

Description of the solution:

Transparent, colorless, free of mechanical inclusions, may be slightly colored.

Storage conditions:

At a temperature of 10 °C to 25 °C in a dry, dark place out of reach of children.

Shelf life - 2-3 years (depending on the form of release and manufacturer). Do not take after the expiration date indicated on the package!

Conditions for dispensing from pharmacies - according to a doctor's prescription.

Synonyms:

Teperin, Triptisol, Adepril, Adepress, Atriptal, Damilene, Daprimen, Elatral, Lantron, Laroxal, Novotriptin, Redomex, Saroten, Sarotex, Triptyl, Triptanol, Elavil, Amiprin, Laroxil, Lentisol, Proheptadiene, Triptopol, Amitriptyline Hydrochloride, Amitriptyline-Slovakopharma , Amitriptyline Lechiva, Amitriptyline-Akos

Amitriptylin-Slovakopharma

Compound:

Film-coated tablets contain 0.0283 g (28.3 mg) of amitriptyline hydrochloride, which corresponds to 0.025 g (25 mg) of amitriptyline.

Per 1 ml of solution for injection Amitriptyline hydrochloride 10 mg (in terms of amitriptyline)

Excipients: glucose, sodium chloride, benzethonium chloride, water for injection.

International name: 5-(3-dimethylaminopropylidene)-10,11-dihydrodibenzocycloheptene.

Additionally:

Manufacturers:

1. Pharmaceutical company "MAGIC" Serta-Belgium.

2. SLOVACOPHARMA.

3. ZENTIVA a.s., Czech Republic

Drugs with similar effects:

Doxepin Phtoracizinum Imipramine Azaphenum Coaxil

Dear doctors!

If you have experience in prescribing this drug to your patients, share the result (leave a comment)! Did this medicine help the patient, did any side effects occur during treatment? Your experience will be of interest to both your colleagues and patients.

Dear patients!

If you were prescribed this medicine and completed a course of therapy, tell us whether it was effective (helped), whether there were any side effects, what you liked/disliked. Thousands of people search the Internet for reviews of various medications. But only a few leave them. If you personally do not leave a review on this topic, others will have nothing to read.

Thank you very much!