Amitriptyline instructions for use in tablets. The 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, 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-holino-and histamine receptors CNS.

When taken orally, it is quickly and well absorbed from the gastrointestinal tract. bioavailability of amitriptyline different ways administration is 30-60%, its metabolite - nortriptyline - 46-70%. Cmax in the blood after oral administration is reached after 2.0-7.7 hours. Therapeutic blood concentrations for amitriptyline are 50-250 ng / ml, for nortriptyline - 50-150 ng / ml. Binding to blood proteins is 95%. Easily passes, like nortriptyline, through histohematic barriers, including BBB, placental, penetrates into breast milk. T 1 / 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 a few days.

In anxiety-depressive conditions, it reduces anxiety, agitation and depressive manifestations. Antidepressant action develops within 2-3 weeks after the start of treatment. With a sudden discontinuation after prolonged treatment, withdrawal syndrome may develop.

The use of the substance Amitriptyline

depression various etiologies(especially with severe anxiety and agitation), incl. endogenous, involutional, reactive, neurotic, with organic brain damage, drug-induced; schizophrenic psychoses, mixed emotional disorders, behavioral disorders, bulimia nervosa, children's enuresis(excluding children with hypotension Bladder), chronic pain syndrome(neurogenic character), prevention of migraine.

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, impaired intracardiac conduction, severe arterial hypertension, benign hyperplasia prostate, atony of the bladder, paralytic ileus intestines, pyloric stenosis, peptic ulcer stomach and twelve duodenal ulcer in the stage of exacerbation acute diseases liver and / or kidneys with a pronounced violation of their function, blood diseases, children under 6 years of age (for injection forms - up to 12 years).

Application restrictions

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

Use during pregnancy and lactation

Contraindicated in pregnancy.

Stop during treatment breast-feeding.

Side effects of Amitriptyline

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

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

From the side of cardio-vascular system: tachycardia, orthostatic hypotension, arrhythmia, blood pressure lability, expansion 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 digestive tract: nausea, vomiting, heartburn, anorexia, epigastric discomfort, gastralgia, increased activity of hepatic 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 side genitourinary system: change in libido, potency, testicular edema, glucosuria, pollakiuria.

allergic reactions: skin rash, itch, angioedema, urticaria.

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

Interaction

Incompatible with MAO inhibitors. Enhances the inhibitory effect on the central nervous system of antipsychotics, sedatives and sleeping pills, anticonvulsants, analgesics, drugs for anesthesia, alcohol; shows synergism when interacting with other antidepressants. When combined with neuroleptics and / or anticholinergic drugs, it is possible to develop a febrile temperature reaction, paralytic ileus. Potentiates the hypertensive effects of catecholamines and other adrenostimulants, 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 application with anticoagulants - derivatives of coumarin or indandione - it is possible to increase the anticoagulant activity of the latter. Cimetidine increases the plasma concentration of amitriptyline with possible development toxic effects, inducers of microsomal liver enzymes (barbiturates, carbamazepine) - reduce. Quinidine slows the metabolism of amitriptyline, estrogen-containing oral contraceptives may increase bioavailability. Co-administration with disulfiram and other acetaldehyde dehydrogenase inhibitors may cause delirium. Probucol may exacerbate cardiac arrhythmias. Amitriptyline may exacerbate glucocorticoid-induced depression. When used together with drugs for the treatment of thyrotoxicosis, the risk of developing agranulocytosis increases. With caution combine amitriptyline with digitalis preparations and baclofen.

Overdose

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

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

Routes of administration

Inside, in / m.

Amitriptyline Substance Precautions

Reception of amitriptyline is possible no earlier than 14 days after the abolition of MAO inhibitors. Reduced doses are recommended for elderly patients and children. Should not be given to patients with mania. Due to the possibility of suicidal attempts in patients with depression, regular monitoring of patients is necessary, especially in the first weeks of treatment, as well as the appointment of a minimum 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 tactics of treatment. During treatment, alcohol should be avoided, as well as activities that require heightened attention and speed of reactions.

Interactions with other active substances

Trade names

Name	The value of the Wyshkovsky Index ®

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

After taking Amitriptyline tablets, the maximum concentration of active active substances in blood plasma observed after 4 - 8 hours. Indicators of its bioavailability range from 33% to 62%.

What do amitriptyline tablets help with?

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

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

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

1. violation of the conduction of the heart muscle;
2. atony of the bladder;
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's age up to 6 years;
14. affective insanity;
15. increased intraocular pressure.

If you are subject to at least one of the conditions described above, in order to avoid negative consequences- be sure to inform your doctor about this! medical specialist advise you on another remedy.

Adverse reactions

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

• constipation;
• tinnitus;
• an increase in body temperature;
• heartburn;
• dry mouth;
• allergic manifestations;
• irritability;
• violation of the heart rhythm;
• headaches.

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

Treatment rules

Amitriptyline tablets should be taken orally, preferably after a meal. The dosage of the drug is determined by the 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 allowed daily dosage ranges from 150 - 200 mg.

In very severe cases, in particular with prolonged depression, which 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 select another drug that is more suitable for you.

Amitriptyline is a non-selective neurotransmitter uptake inhibitor. 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 an antihistamine and anticholinergic effect, which allows it to be used in spastic conditions of smooth muscles.

Action and indications

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

Amitriptyline also exhibits an adrenoceptor blocking effect, 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 formation by the parietal 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 various origins, including those with an anxious and apathetic component, as well as somatic manifestations of mental disorders.
2. Eating disorders as a manifestation of depression: bulimia (wolf hunger), anorexia.
3. Prevention of migraine attacks.
4. Bedwetting in children and overactive bladder in adults.
5. Neuralgia and chronic pain syndrome in fibromyalgia, irritable bowel syndrome, oncological diseases etc.
6. various phobias.
7. Post-stroke condition, especially in the elderly.
8. Withdrawal syndrome, i.e. abstinence from alcohol, drugs.
9. Psychoses at.

Side effects Amitriptyline:

1. Increased photosensitivity due to paralysis of accommodation (dilated pupil).
2. Intestinal atony, manifested in constipation, sometimes dynamic obstruction.
3. Atony of the stomach, 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 allocation of milk from them, a violation of the menstrual cycle.
10. Changes in blood biochemistry from the liver: increased aminotransferases, direct bilirubin(syndrome of cholestasis - stagnation of bile).
11. Hyperglycemia.

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

When is Amitriptyline contraindicated?

This is a drug with a powerful effect that extends to 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. Hyperplasia of the prostate.
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 convulsive conditions - an antidepressant may increase the frequency of seizures and other movement disorders.
11. Alcohol intake. Amitriptyline may increase 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 at a dosage of 25-50 mg. The next 5 days take from 50 mg three times a day.

The therapeutic effect in the treatment of depressive conditions appears after 2-4 weeks of administration. 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, 25 mg-100 mg daily is used.

Before completely canceling Amitriptyline, doctors gradually reduce the dosage of the drug. It is possible to prescribe adaptogens (rhodiola, ginseng) for the prevention of Amitriptyline withdrawal syndrome, addiction to it is stopped by the correct treatment tactics.

Attention!

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Amitriptyline is one of the most powerful antidepressants active ingredient which is endowed with both anti-bulimic, ...

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. Immediately, we note that in no case should amitriptyline be used in patients with certain malfunctions in the cardiovascular system. In this case we are talking both myocardial infarction and hypertension and decompensated heart failure. Various violations normal working capacity liver or kidney is also considered a contraindication to the use this drug. If the patient has atony of the bladder, individual intolerance any components of this medication, diseases of the hematopoietic system or prostate enlargement, then he should also refuse to take amitriptyline. It is categorically contraindicated in case of exacerbation of gastric ulcer or duodenum.

Using this medication, one should not forget that amitriptyline can be used along with far from all drugs. Often, when using this medication, there are also various violations from the side of the central nervous system, which every patient must know about. If the course of therapy is stopped very suddenly, this may cause the development of a withdrawal syndrome.

If we talk directly about the reviews that relate to this drug, then there are actually a lot of them. About fifty percent of the time people complain about side effects that occur after a day or two of treatment with this medication. Most often they emit 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 of 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 have a single side effect while using amitriptyline. The most common feedback is that this medication is not well tolerated by the body, but it can cause completely different side effects in all people. Even if the body does not perceive it, then this drug can be replaced at any time with another drug.

Using this drug, it is recommended to change the lying position very carefully to a sitting or standing position. All movements should be performed smoothly. We also note the fact that in the event of a sharp withdrawal of this medication, the occurrence of the so-called withdrawal syndrome is quite possible. Using this drug at 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 states, then an attack of epilepsy can occur at any time. Such attacks can also occur in those patients who use certain antipsychotic medications.

Do not forget that in patients suffering from depression, suicide attempts can also be observed. Use of amitriptyline along with electroconvulsive treatment is possible only under the constant supervision of a specialist. In the elderly, as well as citizens who are predisposed to the development of certain disorders, this medication may cause drug psychoses. Most often, such psychosis occurs at night. After the drug is discontinued, they disappear on their own after three to five days.

With special care, all those patients who have chronic constipation should be taken to the use of amitriptyline. The whole point is that given pathological condition taking this medication can provoke the development of paralytic ileus. The same phenomenon can 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, they without fail must report this fact to the anesthesiologist. This drug can be used no earlier than two weeks after a course of therapy with MAO inhibitors. In no case should this drug be used along with norepinephrine, epinephrine, phenylpropanolamine and other sympathomimetics.
When undergoing therapy with amitriptyline, it is very important that the patient leads a truly healthy lifestyle, in which, in the very first place, there should be no place for alcoholic beverages.

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

Let us immediately draw the attention of readers to the fact that against the background of the use of apo-amitriptyline, very diverse side effects can make themselves known. This can be both blurred vision and dry mouth, constipation, excessive sweating, urinary retention, dizziness, excessive drowsiness, ventricular arrhythmia, tremor, impaired cardiac conduction, and so on. Often they make themselves known and various kinds allergic reactions, accompanied by the occurrence 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 reuptake. 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 in the central nervous system. Amitriptyline is an antagonist of muscarinic cholinergic receptors in the CNS and in the periphery, has peripheral antihistamine (H1) and antiadrenergic properties. It also causes anti-neuralgic (central analgesic), anti-ulcer and anti-bulemic effects, and is effective for nighttime urinary incontinence. Antidepressant action develops within 2-4 weeks. After the start of application.

Pharmacokinetics

bioavailability of amitriptyline different ways administration - 30-60%, its active metabolite nortriptyline - 46-70%. The time to reach the maximum concentration (Tmax) after oral administration is 2.0-.7.7 hours. The 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. The maximum concentration in blood plasma (Cmax) is 0.04-0.16 μg / 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 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 is 10 to 28 hours for amitriptyline and 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 in breast milk at concentrations similar to those in plasma.

Indications for use:

Use strictly as directed by your doctor.

Depression of any etiology. Especially effective in anxiety - depressive conditions, due to the severity sedative effect. It does not exacerbate productive symptoms (delusions, hallucinations), unlike antidepressants with a stimulating effect.

Mixed emotional and behavioral disorders, phobic disorders.

Children's enuresis (with the exception of children with hypotonic bladder).

Psychogenic anorexia, bulimic neurosis.

Neurogenic pain chronic nature for migraine prevention.

Application method:

Assign inside (during or after a meal).

The initial daily dose for oral administration 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 therapeutic dose is 150-200 mg (the maximum part of the dose is taken at night). At severe depression resistant to therapy, the dose is increased to 300 mg or more, up to the maximum tolerated dose. In these cases, it is advisable to start treatment with intramuscular or intravenous administration the drug, while using higher initial doses, accelerating the increase in dosages under the control of the somatic condition.

After obtaining a stable antidepressant effect after 2-4 weeks, the doses are gradually and slowly reduced. In the event of signs of depression with a decrease in doses, it is necessary to return to the previous dose.

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

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 nature (including prolonged headaches) from 12.5-25 mg to 100 mg / day. Interaction with others medicines Amitriptyline potentiates CNS depression with the following drugs: neuroleptics, sedatives and hypnotics, anticonvulsants, central and narcotic painkillers, anesthetics, alcohol.

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

With the combined use of amitriptyline with neuroleptics, and / or anticholinergic drugs, febrile temperature response, paralytic ileus. Amitriptyline potentiates the hypertensive effects of catecholamines but inhibits the effects of drugs that affect the release of norepinephrine.

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

With the simultaneous administration of amitriptyline and cimetidine, an increase in the plasma concentration of amitriptyline is possible.

Simultaneous administration of amitriptyline with MAO inhibitors can lead to lethal outcome. A break in treatment between taking MAO inhibitors and tricyclic antidepressants should be at least 14 days!

Undesirable phenomena:

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

From the side of the central nervous system: headache, ataxia, fatigue, weakness, irritability, dizziness, tinnitus, drowsiness or insomnia, impaired concentration, nightmares, dysarthria, confusion, hallucinations, motor agitation, disorientation, tremor, paresthesia, peripheral neuropathy, EEG changes. Rare extrapyramidal disorders, convulsions, anxiety. From the side of the cardiovascular system: tachycardia, arrhythmia, conduction disturbance, lability blood pressure, expansion of the QRS complex on the ECG (impaired intraventricular conduction), symptoms of heart failure, fainting. From the digestive tract: nausea, vomiting, heartburn, anorexia, stomatitis, taste disturbances, darkening of the tongue, epigastric discomfort, gastralgia, increased activity of "liver" transaminases, rarely cholestatic jaundice, diarrhea. From the side endocrine system: an increase in the size of the mammary glands in men and women, galactorrhea, a change in the secretion of antidiuretic hormone (ADH), a change in libido, potency. Rarely, hypo- or hyperglycemia, glucosuria, impaired glucose tolerance, testicular edema. 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 prolonged use, sweating, pollakiuria. At long-term treatment, especially at high doses, with a sharp cessation of treatment, withdrawal syndrome may develop: headache, nausea, vomiting, diarrhea, as well as irritability, sleep disturbance with vivid, unusual dreams, irritability.

Contraindications:

Heart failure in the stage of decompensation

Acute and recovery period of myocardial infarction

Violation of the conduction of the heart muscle

Severe arterial hypertension

Acute liver and kidney diseases with severe dysfunction

Peptic ulcer of the stomach and 12 duodenal ulcer in the acute stage

prostatic hypertrophy

Bladder atony

Pyloric stenosis, paralytic ileus

Simultaneous treatment with MAO inhibitors (see Interactions)

Pregnancy, breastfeeding period

Children's age up to 6 years

Hypersensitivity to amitriptyline

Amitriptyline should be used with caution in alcoholics bronchial asthma, manic-depressive psychosis (MDP), and epilepsy (see special instructions), with oppression of bone marrow hematopoiesis, hyperthyroidism, angina pectoris and heart failure, angle-closure glaucoma, intraocular hypertension, schizophrenia (although when it is taken, productive symptoms usually do not exacerbate).

Overdose

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

Assistance measures: discontinuation of amitriptyline therapy, gastric lavage, fluid infusion, symptomatic therapy, maintenance of blood pressure and water and electrolyte balance. Showing monitoring of cardiovascular activity (ECG) for 5 days, tk. relapse can occur after 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: neuroleptics, sedatives and hypnotics, anticonvulsants, painkillers, anesthetics, alcohol, shows synergism when interacting with other antidepressants. With the combined use of amitriptyline with neuroleptics, and / or anticholinergic drugs, a febrile temperature reaction, paralytic ileus may occur. Amitriptyline potentiates the hypertensive effects of catecholamines and other adrenostimulants, which increases the risk of developing cardiac arrhythmias, tachycardia, severe arterial hypertension, but inhibits the effects of drugs that affect 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 - coumarin or indandione derivatives, an increase in the anticoagulant activity of the latter is possible. With the simultaneous administration of amitriptyline and cimetidine, an increase in the plasma concentration of amitriptyline is possible with the possible development of toxic effects. Inducers of microsomal liver enzymes (barbiturates, carbamazepine) reduces 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. Co-administration of amitriptyline with disulfiram and other acetaldehyde dehydrogenase inhibitors may cause delirium. Estrogen-containing oral contraceptives may increase the bioavailability of amitriptyline, pimozide and probucol may increase cardiac arrhythmias. Amitriptyline may exacerbate depression caused by glucocorticosteroids, joint application with drugs for the treatment of thyrotoxicosis, the risk of developing agranulocytosis increases. Simultaneous reception 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 at doses above 150 mg/day lowers the threshold for seizure activity, so the possibility of seizures in patients with such a history, and in the category of patients who are predisposed to this due to age or injury. Treatment with amitriptyline in the elderly should be carefully monitored and, with minimum doses the drug, increasing them gradually, in order to avoid the development of delirious disorders, hypomania and other complications. Patients with depressive phase TIR, can go into a manic stage. While taking amitriptyline, it is forbidden to drive vehicles, maintain mechanisms and other types of work that require increased concentration of attention, as well as drinking alcohol.

Release form of the drug:

The following forms of release are possible:

Packing - 50 tablets, each of which contains 25 mg of the active substance.

Packs of 20, 50 and 100 coated tablets.

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

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

Solution Description:

Transparent colorless, not containing mechanical inclusions, may be slightly colored.

Storage conditions:

At temperatures between 10 °C and 25 °C, in a dry, dark place out of the reach of children.

Shelf life - 2-3 years (depending on the form of release and manufacturer). Do not take after the expiry date stated on the packaging!

Conditions for dispensing from pharmacies - by prescription.

Synonyms:

Teperin, Tryptisol, Adepril, Adepress, Atriptal, Damilen, Daprimen, Elatral, Lantron, Laroxal, Novotriptin, Redomex, Saroten, Sarotex, Triptil, Triptanol, Elavil, Amiprin, Laroxil, Lentizol, Proheptadiene, Tryptopol, Amitriptyline Hydrochloride, Amitriptyline-Slovakofarm , Amitriptyline Lechiva, Amitriptyline-Akos

Amitriptylin-Slovakopharma

Compound:

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 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. SLOVAKOPHARMA.

3. ZENTIVA a.s., Czech Republic

Similar drugs:

Doxepin Fluorocizin (Phtoracizinum) Imipramine Azaphen (Azaphenum) Coaxil (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 have been prescribed this medicine and have been on therapy, tell us if it was effective (helped), if there were any side effects, what you liked / did not like. Thousands of people search the Internet for reviews of various medicines. But only a few leave them. If you personally do not leave a review on this topic, the rest will have nothing to read.

Thank you very much!