Amitriptyline and products based on it: indications, instructions, reviews. Amitriptyline - a dangerous medicine Amitriptyline solution instructions for use

Amitriptyline
Buy Amitriptyline in pharmacies

DOSAGE FORMS
solution for intramuscular injection 10 mg/ml

MANUFACTURERS
Zentiva a.s. (Czech Republic)

GROUP
Antidepressants are non-selective inhibitors of neuronal uptake

COMPOUND
The active substance is amitriptyline.

INTERNATIONAL NON-PROPENTED NAME
Amitriptyline

SYNONYMS
Amineurin, Amiptyline, Amitriptyline Grindeks, Amitriptyline Nycomed, Amitriptyline-Akos, Amitriptyline-Ferein, Amitriptyline hydrochloride, Vero-Amitriptyline, Sarotene retard, Elivel

PHARMACHOLOGIC EFFECT
Antidepressant, anxiolytic, sedative. Inhibits the reuptake of neurotransmitters (norepinephrine, serotonin, etc.) by the presynaptic nerve endings of neurons, causes the accumulation of monoamines in the synaptic cleft and enhances postsynaptic impulses. With long-term use, it reduces the functional activity of beta-adrenergic and serotonin receptors in the brain, normalizes adrenergic and serotonergic transmission, and restores the balance of these systems, disturbed during depressive states. Blocks M-cholinergic and histamine receptors of the central nervous system. In anxiety-depressive conditions, it reduces anxiety, agitation and depressive symptoms. If you suddenly stop taking it after long-term treatment, withdrawal syndrome may develop. It is quickly and well absorbed by the gastrointestinal tract. The maximum concentration in the blood after oral administration is achieved after 2.0-7.7 hours. The antidepressant effect develops within 2-3 weeks after the start of treatment. Easily passes through histohematic barriers, including the blood-brain barrier, placental barrier, and penetrates into breast milk. It undergoes biotransformation in the liver. It is excreted by the kidneys within a few days.

INDICATIONS FOR USE
Depression, depressive syndrome, schizophrenic psychoses, anxiety-depressive states of various origins, mixed emotional disorders, behavioral disorders, psychogenic anorexia, nocturnal enuresis (auxiliary treatment), severe pain of a neurogenic nature.

CONTRAINDICATIONS
Hypersensitivity, glaucoma, epilepsy, prostatic hyperplasia, bladder atony, paralytic ileus, history of myocardial infarction, use of MAO inhibitors in the previous 2 weeks, pregnancy, lactation, children (up to 6 years).

SIDE EFFECT
Blockade of peripheral M-cholinergic receptors: dry mouth, urinary retention, constipation, blurred vision, accommodation, increased sweating. From the cardiovascular system: tachycardia, orthostatic hypotension, increased blood pressure, conduction disturbances. From the side of the central nervous system: drowsiness, dizziness, tremor. Allergic reactions: skin rash and others.

INTERACTION
Incompatible with MAO inhibitors. Enhances the effect of compounds that depress the central nervous system, sympathomimetics, antiparkinsonian drugs, weakens the effect of antihypertensive and anticonvulsant drugs. Barbiturates and carbamazepine reduce, and cimetidine increases plasma concentrations.

OVERDOSE
Symptoms: hallucinations, convulsions, coma, cardiac conduction disturbances, extrasystole, gastric arrhythmias, hypothermia. Treatment: gastric lavage, taking an activated carbon suspension, laxatives, maintaining body temperature, monitoring the function of the cardiovascular system for at least 5 days; for severe anticholinergic symptoms (hypotension, arrhythmia, coma) - 0.5-2 g of physostigmine intramuscularly or intravenously.

SPECIAL INSTRUCTIONS
Should not be prescribed to manic patients or patients with suicidal tendencies. Use with caution for ischemic heart disease, arrhythmias, heart failure. During treatment, you should avoid drinking alcohol, as well as avoid activities that require increased attention and speed of reactions.

STORAGE CONDITIONS
In a dry place, protected from light. List B.

In this article you can read the instructions for use of the drug Amitriptyline. Reviews of site visitors - consumers of this medicine, as well as the opinions of specialist doctors on the use of Amitriptyline in their practice are presented. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Amitriptyline analogues in the presence of existing structural analogues. Use for the treatment of depression, psychosis and schizophrenia in adults, children, as well as during pregnancy and lactation. Combination of the drug with alcohol.

Amitriptyline- antidepressant (tricyclic antidepressant). It also has some analgesic (of central origin), antiserotonin effect, helps eliminate bedwetting and reduces appetite.

It has a strong peripheral and central anticholinergic effect due to its high affinity for m-cholinergic receptors; strong sedative effect associated with affinity for H1-histamine receptors and alpha-adrenergic blocking effect.

It has the properties of a class IA antiarrhythmic drug; like quinidine in therapeutic doses, it slows down ventricular conduction (in overdose it can cause severe intraventricular block).

The mechanism of antidepressant action is associated with an increase in the concentration of norepinephrine and/or serotonin in the central nervous system (CNS) (decreasing their reabsorption).

The accumulation of these neurotransmitters occurs as a result of inhibition of their reuptake by the membranes of presynaptic neurons. With long-term use, it reduces the functional activity of beta-adrenergic and serotonin receptors in the brain, normalizes adrenergic and serotonergic transmission, and restores the balance of these systems, disturbed during depressive states. In anxiety-depressive conditions, it reduces anxiety, agitation and depressive symptoms.

The mechanism of antiulcer action is due to the ability to have a sedative and m-anticholinergic effect. Effectiveness for bedwetting appears to be due to anticholinergic activity leading to increased bladder distensibility, direct beta-adrenergic stimulation, alpha-adrenergic agonist activity leading to increased sphincter tone, and central blockade of serotonin uptake. It has a central analgesic effect, which is believed to be associated with changes in the concentration of monoamines in the central nervous system, especially serotonin, and an effect on endogenous opioid systems.

The mechanism of action in bulimia nervosa is unclear (may be similar to that in depression). A clear effect of the drug on bulimia has been shown in patients both without depression and in its presence, while a decrease in bulimia can be observed without a concomitant weakening of depression itself.

During general anesthesia, it reduces blood pressure and body temperature. Does not inhibit monoamine oxidase (MAO).

The antidepressant effect develops within 2-3 weeks after the start of use.

Pharmacokinetics

Absorption is high. Passes (including nortriptyline, a metabolite of amitriptyline) through histohematic barriers, including the blood-brain barrier, placental barrier, and penetrates into breast milk. Excreted by the kidneys (mainly in the form of metabolites) - 80% in 2 weeks, partially with bile.

Indications

• depression (especially with anxiety, agitation and sleep disorders, including in childhood, endogenous, involutional, reactive, neurotic, medicinal, with organic brain damage);
• as part of complex therapy it is used for mixed emotional disorders, psychoses in schizophrenia, alcohol withdrawal, behavioral disorders (activity and attention), nocturnal enuresis (except for patients with bladder hypotension), bulimia nervosa, chronic pain syndrome (chronic pain in cancer patients, migraine, rheumatic diseases, atypical pain in the face, postherpetic neuralgia, post-traumatic neuropathy, diabetic or other peripheral neuropathy), headaches, migraines (prevention), gastric and duodenal ulcers.

Release forms

Tablets 10 mg and 25 mg.

Dragee 25 mg.

Solution for intravenous and intramuscular administration (injections in injection ampoules).

Instructions for use and dosage

Administered orally, without chewing, immediately after meals (to reduce irritation of the gastric mucosa).

Adults

For adults with depression, the initial dose is 25-50 mg at night, then the dose can be gradually increased, taking into account the effectiveness and tolerability of the drug, to a maximum of 300 mg per day in 3 divided doses (the largest part of the dose is taken at night). When a therapeutic effect is achieved, the dose can be gradually reduced to the minimum effective, depending on the patient's condition. The duration of the course of treatment is determined by the patient’s condition, the effectiveness and tolerability of the therapy and can range from several months to 1 year, and if necessary, more. In old age with mild disorders, as well as with bulimia nervosa, as part of complex therapy for mixed emotional disorders and behavioral disorders, psychoses in schizophrenia and alcohol withdrawal, a dose of 25-100 mg per day (at night) is prescribed, after achieving a therapeutic effect, switch for the minimum effective dose - 10-50 mg per day.

For the prevention of migraine, with chronic pain syndrome of a neurogenic nature (including prolonged headaches), as well as in the complex therapy of gastric and duodenal ulcers - from 10-12.5-25 to 100 mg per day (maximum part of the dose taken at night).

Children

For children as an antidepressant: from 6 to 12 years old - 10-30 mg per day or 1-5 mg/kg per day in fractions, in adolescence - up to 100 mg per day.

For nocturnal enuresis in children 6-10 years old - 10-20 mg per day at night, 11-16 years old - up to 50 mg per day.

Side effect

• blurred vision;
• mydriasis;
• increased intraocular pressure (only in persons with a local anatomical predisposition - a narrow angle of the anterior chamber);
• drowsiness;
• fainting states;
• fatigue;
• irritability;
• anxiety;
• disorientation;
• hallucinations (especially in elderly patients and patients with Parkinson's disease);
• anxiety;
• mania;
• memory impairment;
• decreased ability to concentrate;
• insomnia;
• "nightmare" dreams;
• asthenia;
• headache;
• ataxia;
• increased frequency and intensification of epileptic seizures;
• changes in the electroencephalogram (EEG);
• tachycardia;
• feeling of heartbeat;
• dizziness;
• orthostatic hypotension;
• arrhythmia;
• lability of blood pressure (decrease or increase in blood pressure);
• dry mouth;
• constipation;
• nausea, vomiting;
• heartburn;
• gastralgia;
• increased appetite and body weight or decreased appetite and body weight;
• stomatitis;
• change in taste;
• diarrhea;
• darkening of the tongue;
• increase in size (swelling) of the testicles;
• gynecomastia;
• increase in the size of the mammary glands;
• galactorrhea;
• decreased or increased libido;
• decreased potency;
• skin rash;
• photosensitivity;
• angioedema;
• hives;
• hair loss;
• noise in ears;
• swelling;
• hyperpyrexia;
• swollen lymph nodes;
• urinary retention.

Contraindications

• hypersensitivity;
• use together with MAO inhibitors and 2 weeks before starting treatment;
• myocardial infarction (acute and subacute periods);
• acute alcohol intoxication;
• acute intoxication with sleeping pills, analgesics and psychoactive drugs;
• angle-closure glaucoma;
• severe disturbances of AV and intraventricular conduction (bundle branch block, AV block 2 degrees);
• lactation period;
• children under 6 years of age;
• galactose intolerance;
• lactase deficiency;
• glucose-galactose malabsorption.

Use during pregnancy and breastfeeding

In pregnant women, the drug should be used only if the expected benefit to the mother outweighs the potential risk to the fetus.

Use in children

Contraindicated in children under 6 years of age.

In children, adolescents and young adults (under 24 years of age) with depression and other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and behavior. Therefore, when prescribing amitriptyline or any other antidepressants in this category of patients, the risk of suicide should be weighed against the benefits of their use

special instructions

Before starting treatment, blood pressure monitoring is necessary (in patients with low or labile blood pressure, it may decrease even more); during the treatment period - control of peripheral blood (in some cases, agranulocytosis may develop, and therefore it is recommended to monitor the blood picture, especially with an increase in body temperature, development of flu-like symptoms and sore throat), during long-term therapy - control of the functions of the cardiovascular system and liver. In the elderly and patients with cardiovascular diseases, monitoring of heart rate, blood pressure, and ECG is indicated. Clinically insignificant changes may appear on the ECG (smoothing of the T wave, depression of the S-T segment, widening of the QRS complex).

Caution is required when suddenly moving to a vertical position from a lying or sitting position.

During the treatment period, the use of ethanol should be avoided.

Prescribed no earlier than 14 days after discontinuation of MAO inhibitors, starting with small doses.

If you suddenly stop taking it after long-term treatment, withdrawal syndrome may develop.

Amitriptyline in doses above 150 mg per day reduces the threshold of convulsive activity (the risk of epileptic seizures in predisposed patients should be taken into account, as well as in the presence of other factors predisposing to the occurrence of convulsive syndrome, for example, brain damage of any etiology, simultaneous use of antipsychotic drugs (neuroleptics) ), during the period of withdrawal from ethanol or withdrawal of drugs with anticonvulsant properties, for example, benzodiazepines). Severe depression is characterized by a risk of suicidal actions, which can persist until significant remission is achieved. In this regard, at the beginning of treatment, a combination with drugs from the group of benzodiazepines or antipsychotic drugs and constant medical supervision (entrust trusted persons with the storage and dispensing of drugs) may be indicated. In children, adolescents and young adults (under 24 years of age) with depression and other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and behavior. Therefore, when prescribing amitriptyline or any other antidepressants in this category of patients, the risk of suicide should be weighed against the benefits of their use. In short-term studies, the risk of suicide did not increase in people over 24 years of age, but it decreased slightly in people over 65 years of age. During treatment with antidepressants, all patients should be monitored for early detection of suicidal tendencies.

In patients with cyclic affective disorders during the depressive phase, manic or hypomanic states may develop during therapy (reducing the dose or discontinuing the drug and prescribing an antipsychotic drug is necessary). After relief of these conditions, if indicated, treatment in low doses can be resumed.

Due to possible cardiotoxic effects, caution is required when treating patients with thyrotoxicosis or patients receiving thyroid hormone preparations.

In combination with electroconvulsive therapy, it is prescribed only under the condition of careful medical supervision.

In predisposed patients and elderly patients, it can provoke the development of drug-induced psychoses, mainly at night (after discontinuation of the drug, they disappear within a few days).

May cause paralytic ileus, primarily in patients with chronic constipation, the elderly, or those forced to bed rest.

Before performing general or local anesthesia, the anesthesiologist should be warned that the patient is taking amitriptyline.

Due to the anticholinergic effect, there may be a decrease in tear production and a relative increase in the amount of mucus in the tear fluid, which can lead to damage to the corneal epithelium in patients using contact lenses.

With long-term use, an increase in the incidence of dental caries is observed. The need for riboflavin may be increased.

Animal reproduction studies have shown adverse effects on the fetus, and there are no adequate and well-controlled studies in pregnant women. In pregnant women, the drug should be used only if the expected benefit to the mother outweighs the potential risk to the fetus.

Passes into breast milk and may cause drowsiness in nursing infants. To avoid the development of withdrawal syndrome in newborns (manifested by shortness of breath, drowsiness, intestinal colic, increased nervous excitability, increased or decreased blood pressure, tremors or spastic phenomena), amitriptyline is gradually discontinued at least 7 weeks before the expected birth.

Children are more sensitive to acute overdose, which should be considered dangerous and potentially fatal to them.

During the treatment period, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Drug interactions

When ethanol (alcohol) is used together with drugs that depress the central nervous system (including other antidepressants, barbiturates, benzadiazepines and general anesthetics), a significant increase in the depressant effect on the central nervous system, respiratory depression and hypotensive effect is possible. Increases sensitivity to drinks containing ethanol (alcohol).

Increases the anticholinergic effect of drugs with anticholinergic activity (for example, phenothiazine derivatives, antiparkinsonian drugs, amantadine, atropine, biperiden, antihistamines), which increases the risk of side effects (from the central nervous system, vision, intestines and bladder). When used together with anticholinergic blockers, phenothiazine derivatives and benzodiazepines, there is a mutual enhancement of the sedative and central anticholinergic effects and an increased risk of epileptic seizures (lowering the threshold of convulsive activity); Phenothiazine derivatives may also increase the risk of neuroleptic malignant syndrome.

When used together with anticonvulsants, it is possible to enhance the inhibitory effect on the central nervous system, reduce the threshold of convulsive activity (when used in high doses) and reduce the effectiveness of the latter.

When used together with antihistamines, clonidine - increased inhibitory effect on the central nervous system; with atropine - increases the risk of paralytic intestinal obstruction; with drugs that cause extrapyramidal reactions - an increase in the severity and frequency of extrapyramidal effects.

With the simultaneous use of amitriptyline and indirect anticoagulants (coumarin or indadione derivatives), the anticoagulant activity of the latter may increase. Amitriptyline may enhance depression caused by glucocorticosteroids (GCS). Medicines used to treat thyrotoxicosis increase the risk of developing agranulocytosis. Reduces the effectiveness of phenytoin and alpha-blockers.

Inhibitors of microsomal oxidation (cimetidine) prolong T1/2, increase the risk of developing toxic effects of amitriptyline (a dose reduction of 20-30% may be required), inducers of microsomal liver enzymes (barbiturates, carbamazepine, phenytoin, nicotine and oral contraceptives) reduce plasma concentrations and reduce the effectiveness of amitriptyline.

Combined use with disulfiram and other acetaldehydrogenase inhibitors provokes delirium.

Fluoxetine and fluvoxamine increase plasma concentrations of amitriptyline (a 50% reduction in amitriptyline dose may be required).

With the simultaneous use of amitriptyline with clonidine, guanethidine, betanidine, reserpine and methyldopa - a decrease in the hypotensive effect of the latter; with cocaine - the risk of developing cardiac arrhythmias.

Antiarrhythmic drugs (such as quinidine) increase the risk of developing rhythm disturbances (possibly slowing down the metabolism of amitriptyline).

Pimozide and probucol may increase cardiac arrhythmias, which is manifested by prolongation of the QT interval on the ECG.

It enhances the effect of epinephrine, norepinephrine, isoprenaline, ephedrine and phenylephrine on the cardiovascular system (including when these drugs are part of local anesthetics) and increases the risk of developing heart rhythm disturbances, tachycardia, and severe arterial hypertension.

When co-administered with alpha-adrenergic agonists for intranasal administration or for use in ophthalmology (with significant systemic absorption), the vasoconstrictor effect of the latter may be enhanced.

When taken together with thyroid hormones, there is a mutual enhancement of the therapeutic effect and toxic effects (including cardiac arrhythmias and a stimulating effect on the central nervous system).

M-anticholinergic drugs and antipsychotic drugs (neuroleptics) increase the risk of developing hyperpyrexia (especially in hot weather).

When co-administered with other hematotoxic drugs, increased hematotoxicity is possible.

Incompatible with MAO inhibitors (increased frequency of periods of hyperpyrexia, severe convulsions, hypertensive crises and patient death are possible).

Analogues of the drug Amitriptyline

Structural analogues of the active substance:

• Amizol;
• Amirol;
• Amitriptyline Lechiva;
• Amitriptyline Nycomed;
• Amitriptyline-AKOS;
• Amitriptyline-Grindeks;
• Amitriptyline-LENS;
• Amitriptyline-Ferein;
• Amitriptyline hydrochloride;
• Apo-Amitriptyline;
• Vero-Amitriptyline;
• Saroten retard;
• Tryptisol;
• Elivel.

If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and look at the available analogues for the therapeutic effect.

Compound

Amitriptyline dragees and tablets contain 10 or 25 mg of the active substance in the form amitriptyline hydrochloride.

Additional substances in the tablets are: microcrystalline cellulose, talc, lactose monohydrate, silicon dioxide, magnesium stearate, pregelatinized starch.

Additional substances in the dragees are: magnesium stearate, potato starch, talc, polyvinylpyrrolidone, lactose monohydrate.

1 ml of solution contains 10 mg of active substance. Additional substances are: hydrochloric acid (sodium hydroxide), dextrose monohydrate, water for infusion, sodium chloride, benzethonium chloride.

Release form

The drug is available in the form of tablets, dragees and solution.

pharmachologic effect

Tricyclic antidepressant . Has a sedative, thymoleptic effect. It has an additional analgesic effect of central origin.

Pharmacodynamics and pharmacokinetics

MNN: Amitriptyline.

The drug reduces appetite, eliminates nighttime urinary incontinence, and has antiserotonin action. The drug has a strong central and peripheral anticholinergic effect. Antidepressant effect is achieved by increasing the concentration of serotonin in the nervous system and norepinephrine in synapses. Long-term therapy leads to a decrease in the functional activity of serotonin and beta-adrenergic receptors in the brain. Amitriptyline reduces the severity of depressive symptoms, agitation , anxiety during anxiety and depression . By blocking H2-histamine receptors in the stomach wall (parietal cells), an antiulcer effect is provided. The medication is able to reduce body temperature, the level during general anesthesia. The drug does not inhibit monoamine oxidases. The antidepressant effect appears after 3 weeks of therapy.

The maximum concentration of the substance in the blood occurs after a few hours, usually after 2-12. Excreted as metabolites in urine. Binds well to proteins.

Indications for use of Amitriptyline

What are tablets and solution usually prescribed for?

The drug is indicated for depression (agitation, anxiety, sleep disorders, alcohol withdrawal, with organic brain lesions, neurotic withdrawal), with behavioral disorders, mixed emotional disorders, nocturnal enuresis , chronic pain syndrome (with cancer, with postherpetic neuralgia ), for bulimia nervosa, for migraine (for prevention), for. Indications for the use of Amitriptyline in tablets and in other forms of release are the same.

Contraindications

According to the annotation, the medicine is not used if the main component is intolerant, if angle-closure glaucoma , acute intoxication with psychoactive, analgesic, hypnotics, and acute alcohol intoxication. The medication is contraindicated in breastfeeding, severe intraventricular conduction disorders, and antioventricular conduction disorders. With pathology of the cardiovascular system, with suppression of bone marrow hematopoiesis, manic-depressive psychoses , chronic alcoholism, decreased motor function of the digestive system, stroke, liver and kidney pathology, intraocular hypertension , urinary retention, prostatic hyperplasia, bladder hypotension, thyrotoxicosis, pregnancy, epilepsy Amitriptyline is prescribed with caution.

Side effects of Amitriptyline

Nervous system: agitation, hallucinations, fainting, asthenia, drowsiness, anxiety, hypomanic state, increased depression, depersonalization, motor restlessness, increased epileptic seizures, extrapyramidal syndrome , ataxia, myoclonus, paresthesia in the form of peripheral neuropathy, tremor of small muscles, headaches.

Anticholinergic effects: increased, blurred vision, mydriasis, dry mouth, tachycardia , difficulty urinating, paralytic ileus, delirium, confusion, decreased sweating.

The cardiovascular system: instability of blood pressure, intraventricular conduction disorders , arrhythmia, orthostatic hypotension , dizziness, palpitations, tachycardia.

Digestive tract: darkening of the tongue, diarrhea, changes in taste perception, vomiting, gastralgia, hepatitis, cholestatic jaundice.

Endocrine system: galactorrhea, hyperglycemia, decreased potency or increased libido, increased size of the mammary glands, gynecomastia, testicular swelling, syndrome of inappropriate ADH secretion, hyponatremia. Also noted hypoproteinemia , pollakiuria, urinary retention, enlarged lymph nodes, hyperpyrexia, swelling, tinnitus, hair loss.

When discontinuing the drug, unusual agitation, sleep disturbances, malaise, headache, diarrhea, nausea, unusual dreams, restlessness, irritability . When administered intravenously, a burning sensation, lymphangitis, thrombophlebitis, etc. are noted.

Reviews of the side effects of Amitriptyline are quite frequent. When using the drug, addiction may also occur.

Amitriptyline, instructions for use (Method and dosage)

The medicine is taken orally immediately after eating, without chewing, which ensures the least irritation of the stomach walls. The initial dosage is 25-50 mg at night for adults. Within 5 days, the amount of the drug is increased to 200 mg per day in 3 doses. If there is no effect within 2 weeks, the dose is increased to 300 mg.

Solutions are administered slowly intravenously and intramuscularly, 20-40 mg 4 times a day with a gradual transition to oral administration. The course of therapy is no more than 8 months. For prolonged headaches, for migraines, chronic pain syndrome of neurogenic origin, for migraines, 12.5-100 mg per day is prescribed.

Instructions for use of Amitriptyline Nycomed are similar. Before use, be sure to familiarize yourself with the contraindications for the drug.

Overdose

Manifestations from the outside nervous system: coma, stupor, increased drowsiness, anxiety, hallucinations, ataxia, epileptic syndrome, choreoathetosis , hyperreflexia, muscle tissue rigidity, confusion, disorientation, impaired concentration, psychomotor agitation.

Manifestations of an overdose of Amitriptyline from the side of cardio-vascular system: intracardiac conduction disturbance, arrhythmia, tachycardia, drop in blood pressure, shock, heart failure , rarely - cardiac arrest.

Also noted are oliguria, increased sweating, hyperthermia , vomiting, shortness of breath, depression of the respiratory system, cyanosis. Possible drug poisoning.

To avoid the negative consequences of an overdose, emergency gastric lavage and administration of cholinesterase inhibitors are required in case of severe anticholinergic manifestations. It is also required to maintain water and electrolyte balance, blood pressure levels, control over the functioning of the cardiovascular system, and carry out resuscitation and anticonvulsant measures if necessary. Forced diuresis , as well as hemodialysis have not proven effective in treating an overdose of Amitriptyline.

Interaction

Hypotensive effect respiratory depression , a depressant effect on the nervous system is observed with the joint prescription of medications that depress the functioning of the central nervous system: general anesthetics, benzodiazepines, barbiturates, antidepressants and others. The drug increases the severity of the anticholinergic effect when taken , antihistamines , biperiden, atropine, antiparkinsonian drugs, phenothiazine. The drug enhances the anticoagulant activity of indadione, coumarin derivatives, and indirect anticoagulants. There is a decrease in efficiency alpha blockers , phenytoin. , increase the concentration of the drug in the blood. The risk of developing epileptic seizures increases, and the central anticholinergic and sedative effects also increase when combined with benzodiazepines, phenothiazines, and anticholinergics. Simultaneous use methyldopa , betanidine, guanethidine, reduces the severity of their hypotensive effect. When taking cocaine, arrhythmia develops. Delirium develops when taking acetaldehydrogenase inhibitors. Amitriptyline enhances the effects on the cardiovascular system , norepinephrine, , isoprenaline. The risk of hyperpyrexia increases when taking antipsychotics and m-anticholinergics.

Terms of sale

Prescription or not? The medicine is not sold without a prescription.

Storage conditions

In a dry, dark place, out of reach of children, at a temperature of no more than 25 degrees Celsius.

Best before date

No more than 3 years.

special instructions

Before carrying out therapy, monitoring blood pressure levels is mandatory. Parenteral Amitriptyline is administered exclusively under the supervision of a physician in a hospital setting. In the first days of treatment it is necessary to observe bed rest. A complete abstinence from ethanol intake is required. Abrupt refusal of therapy can cause withdrawal syndrome . The drug at a dose of more than 150 mg per day leads to a decrease in the threshold of convulsive activity, which is important to consider when developing epileptic seizures in patients with a predisposition. Possible development of hypomanic or manic states in persons with cyclical, affective disorders during the depressive phase. If necessary, treatment is resumed with small doses after relief of these conditions. Caution should be exercised when treating individuals taking thyroid hormone medications due to the possible risk of cardiotoxic effects. The medication can provoke the development of paralytic intestinal obstruction in elderly people, as well as those prone to chronic constipation. It is imperative to warn anesthesiologists about taking amitriptyline before performing local or general anesthesia. Long-term therapy provokes development. The need for riboflavin may increase. Amitriptyline passes into breast milk and causes increased drowsiness in infants. The medication affects driving.

The medicine is described in Wikipedia.

Amitriptyline and alcohol

Amitriptyline analogues

Level 4 ATX code matches:

Analogues of the drug are: Saroten And Amitriptyline Hydrochloride .

microcrystalline cellulose - 40 mg, lactose monohydrate (milk sugar) - 40 mg, pregelatinized starch - 25.88 mg, colloidal silicon dioxide (aerosil) - 400 mcg, talc - 1.2 mg, magnesium stearate - 1.2 mg.
microcrystalline cellulose - 100 mg, lactose monohydrate (milk sugar) - 100 mg, pregelatinized starch - 64.7 mg, colloidal silicon dioxide (aerosil) - 1 mg, talc - 3 mg, magnesium stearate - 3 mg.

pharmachologic effect

Antidepressant (tricyclic antidepressant). It also has some analgesic (of central origin), antiserotonin effect, helps eliminate bedwetting and reduces appetite.
It has a strong peripheral and central anticholinergic effect due to its high affinity for m-cholinergic receptors; strong sedative effect associated with affinity for H1-histamine receptors and alpha-adrenergic blocking effect.
It has the properties of a class IA antiarrhythmic drug; like quinidine in therapeutic doses, it slows down ventricular conduction (in overdose it can cause severe intraventricular block).
The mechanism of antidepressant action is associated with an increase in the concentration of norepinephrine and/or serotonin in the central nervous system (CNS) (decreasing their reabsorption).
The accumulation of these neurotransmitters occurs as a result of inhibition of their reuptake by the membranes of presynaptic neurons. With long-term use, it reduces the functional activity of beta-adrenergic and serotonin receptors in the brain, normalizes adrenergic and serotonergic transmission, and restores the balance of these systems, disturbed during depressive states. In anxiety-depressive conditions, it reduces anxiety, agitation and depressive symptoms.
The mechanism of antiulcer action is due to the ability to have a sedative and m-anticholinergic effect. Effectiveness for bedwetting appears to be due to anticholinergic activity leading to increased bladder distensibility, direct beta-adrenergic stimulation, alpha-adrenergic agonist activity leading to increased sphincter tone, and central blockade of serotonin uptake. It has a central analgesic effect, which is believed to be associated with changes in the concentration of monoamines in the central nervous system, especially serotonin, and an effect on endogenous opioid systems.
The mechanism of action in bulimia nervosa is unclear (may be similar to that in depression). A clear effect of the drug on bulimia has been shown in patients both without depression and in its presence, while a decrease in bulimia can be observed without a concomitant weakening of depression itself.
During general anesthesia, it reduces blood pressure and body temperature. Does not inhibit monoamine oxidase (MAO).
The antidepressant effect develops within 2-3 weeks after the start of use.

Indications for use

Depression (especially with anxiety, agitation and sleep disorders, including in childhood, endogenous, involutional, reactive, neurotic, drug-induced, with organic brain damage).
As part of complex therapy, it is used for mixed emotional disorders, psychoses in schizophrenia, alcohol withdrawal, behavioral disorders (activity and attention), nocturnal enuresis (except for patients with bladder hypotension), bulimia nervosa, chronic pain syndrome (chronic pain in cancer patients, migraine, rheumatic diseases, atypical pain in the face, postherpetic neuralgia, post-traumatic neuropathy, diabetic or other peripheral neuropathy), headaches, migraines (prevention), gastric and duodenal ulcers.

Mode of application

Administered orally, without chewing, immediately after meals (to reduce irritation of the gastric mucosa).
Adults
For adults with depression, the initial dose is 25-50 mg at night, then gradually the dose can be increased taking into account the effectiveness and tolerability of the drug to a maximum of 300 mg/day. in 3 doses (the largest part of the dose is taken at night). When a therapeutic effect is achieved, the dose can be gradually reduced to the minimum effective, depending on the patient's condition. The duration of the course of treatment is determined by the patient’s condition, the effectiveness and tolerability of the therapy and can range from several months to 1 year, and if necessary, more. In old age with mild disorders, as well as with bulimia nervosa, as part of complex therapy for mixed emotional disorders and behavioral disorders, psychosis with schizophrenia and alcohol withdrawal, a dose of 25-100 mg/day is prescribed. (at night), after achieving a therapeutic effect, switch to the minimum effective doses - 10-50 mg/day.
For the prevention of migraines, with chronic pain syndrome of a neurogenic nature (including prolonged headaches), as well as in the complex therapy of gastric and duodenal ulcers - from 10-12.5-25 to 100 mg/day. (the maximum dose is taken at night).
Children
For children as an antidepressant: from 6 to 12 years old - 10-30 mg/day. or 1-5 mg/kg/day. fractionally, in adolescence - up to 100 mg/day.
For nocturnal enuresis in children 6-10 years old - 10-20 mg/day. at night, 11-16 years - up to 50 mg/day.
In pregnant women, the drug should be used only if the expected benefit to the mother outweighs the potential risk to the fetus.

Contraindicated for children under 6 years of age.
In children, adolescents and young adults (under 24 years of age) with depression and other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and behavior. Therefore, when prescribing amitriptyline or any other antidepressants in this category of patients, the risk of suicide should be weighed against the benefits of their use

Interaction

When ethanol is used together with drugs that depress the central nervous system (including other antidepressants, barbiturates, benzadiazepines and general anesthetics), a significant increase in the depressant effect on the central nervous system, respiratory depression and hypotensive effect is possible. Increases sensitivity to drinks containing ethanol.
Increases the anticholinergic effect of drugs with anticholinergic activity (for example, phenothiazine derivatives, antiparkinsonian drugs, amantadine, atropine, biperiden, antihistamines), which increases the risk of side effects (from the central nervous system, vision, intestines and bladder). When used together with anticholinergic blockers, phenothiazine derivatives and benzodiazepines, there is a mutual enhancement of the sedative and central anticholinergic effects and an increased risk of epileptic seizures (lowering the threshold of convulsive activity); Phenothiazine derivatives may also increase the risk of neuroleptic malignant syndrome.
When used together with anticonvulsants, it is possible to enhance the inhibitory effect on the central nervous system, reduce the threshold of convulsive activity (when used in high doses) and reduce the effectiveness of the latter.
When used together with antihistamines, clonidine - increased inhibitory effect on the central nervous system; with atropine - increases the risk of paralytic intestinal obstruction; with drugs that cause extrapyramidal reactions - an increase in the severity and frequency of extrapyramidal effects.
With the simultaneous use of amitriptyline and indirect anticoagulants (coumarin or indadione derivatives), the anticoagulant activity of the latter may increase. Amitriptyline may enhance depression caused by glucocorticosteroids (GCS). Medicines used to treat thyrotoxicosis increase the risk of developing agranulocytosis. Reduces the effectiveness of phenytoin and alpha-blockers.
Inhibitors of microsomal oxidation (cimetidine) prolong T1/2, increase the risk of developing toxic effects of amitriptyline (a dose reduction of 20-30% may be required), inducers of microsomal liver enzymes (barbiturates, carbamazepine, phenytoin, nicotine and oral contraceptives) reduce plasma concentrations and reduce the effectiveness of amitriptyline.
Combined use with disulfiram and other acetaldehydrogenase inhibitors provokes delirium.
Fluoxetine and fluvoxamine increase plasma concentrations of amitriptyline (a 50% reduction in amitriptyline dose may be required).
Estrogen-containing oral contraceptives and estrogens may increase the bioavailability of amitriptyline.
With the simultaneous use of amitriptyline with clonidine, guanethidine, betanidine, reserpine and methyldopa - a decrease in the hypotensive effect of the latter; with cocaine - the risk of developing cardiac arrhythmias.
Antiarrhythmic drugs (such as quinidine) increase the risk of developing rhythm disturbances (possibly slowing down the metabolism of amitriptyline).
Pimozide and probucol may increase cardiac arrhythmias, which is manifested by prolongation of the QT interval on the ECG.
It enhances the effect of epinephrine, norepinephrine, isoprenaline, ephedrine and phenylephrine on the cardiovascular system (including when these drugs are part of local anesthetics) and increases the risk of developing heart rhythm disturbances, tachycardia, and severe arterial hypertension.
When co-administered with alpha-adrenergic agonists for intranasal administration or for use in ophthalmology (with significant systemic absorption), the vasoconstrictor effect of the latter may be enhanced.
When taken together with thyroid hormones, there is a mutual enhancement of the therapeutic effect and toxic effects (including cardiac arrhythmias and a stimulating effect on the central nervous system).
M-anticholinergic drugs and antipsychotic drugs (neuroleptics) increase the risk of developing hyperpyrexia (especially in hot weather).
When co-administered with other hematotoxic drugs, increased hematotoxicity is possible.
Incompatible with MAO inhibitors (increased frequency of periods of hyperpyrexia, severe convulsions, hypertensive crises and patient death are possible).

Side effect

Associated with the anticholinergic effect of the drug: blurred vision, accommodation paralysis, mydriasis, increased intraocular pressure (only in persons with a local anatomical predisposition - a narrow anterior chamber angle), tachycardia, dry mouth, confusion (delirium or hallucinations), constipation, paralytic intestinal tract obstruction, difficulty urinating.
From the central nervous system: drowsiness, fainting, fatigue, irritability, anxiety, disorientation, hallucinations (especially in elderly patients and patients with Parkinson's disease), anxiety, psychomotor agitation, mania, hypomania, memory impairment, decreased ability to concentrate, insomnia, nightmares, asthenia; headache; dysarthria, tremor of small muscles, especially the arms, hands, head and tongue, peripheral neuropathy (paresthesia), myasthenia gravis, myoclonus; ataxia, extrapyramidal syndrome, increased frequency and intensification of epileptic seizures; changes in the electroencephalogram (EEG).
From the cardiovascular system: tachycardia, palpitations, dizziness, orthostatic hypotension, nonspecific changes in the electrocardiogram (ECG) (S-T interval or T wave) in patients without heart disease; arrhythmia, blood pressure lability (decrease or increase in blood pressure), intraventricular conduction disturbances (widening of the QRS complex, changes in the P-Q interval, bundle branch block).
From the gastrointestinal tract: nausea, heartburn, gastralgia, hepatitis (including impaired liver function and cholestatic jaundice), vomiting, increased appetite and body weight or decreased appetite and body weight, stomatitis, changes in taste, diarrhea, darkening of the tongue.
From the endocrine system: increase in size (swelling) of the testicles, gynecomastia; increase in the size of the mammary glands, galactorrhea; decreased or increased libido, decreased potency, hypo- or hyperglycemia, hyponatremia (decreased vasopressin production), syndrome of inappropriate secretion of antidiuretic hormone (ADH). Allergic reactions: skin rash, itching, photosensitivity, angioedema, urticaria.
Other: hair loss, tinnitus, edema, hyperpyrexia, swollen lymph nodes, urinary retention, pollakiuria.
With long-term treatment, especially in high doses, if it is abruptly stopped, withdrawal syndrome may develop: nausea, vomiting, diarrhea, headache, malaise, sleep disturbances, unusual dreams, unusual agitation; with gradual withdrawal after long-term treatment - irritability, motor restlessness, sleep disturbances, unusual dreams.
The connection with taking the drug has not been established: lupus-like syndrome (migratory arthritis, the appearance of antinuclear antibodies and positive rheumatoid factor), impaired liver function, ageusia.

Contraindications

Hypersensitivity, use in conjunction with MAO inhibitors and 2 weeks before treatment, myocardial infarction (acute and subacute periods), acute alcohol intoxication, acute intoxication with hypnotics, analgesics and psychoactive drugs, angle-closure glaucoma, severe AV and intraventricular conduction disorders (branch block His bundle, AV block II stage), lactation period, children under 6 years of age.
Due to the content of lactose monohydrate (milk sugar) in the tablets, the drug should not be taken by patients with rare hereditary diseases such as galactose intolerance, lactase deficiency or glucose-galactose malabsorption.
Carefully. Amitriptyline should be used with caution in persons with alcoholism, bronchial asthma, schizophrenia (possible activation of psychosis), bipolar disorder, epilepsy, suppression of bone marrow hematopoiesis, diseases of the cardiovascular system (CVS) (angina pectoris, arrhythmia, heart block, chronic heart failure, myocardial infarction, arterial hypertension), intraocular hypertension, stroke, decreased motor function of the gastrointestinal tract (GIT) (risk of paralytic ileus), liver and/or renal failure, thyrotoxicosis, prostatic hyperplasia, urinary retention, hypotension bladder, during pregnancy (especially the first trimester), in old age.

Overdose

Symptoms
From the central nervous system: drowsiness, stupor, coma, ataxia, hallucinations, anxiety, psychomotor agitation, decreased ability to concentrate, disorientation, confusion, dysarthria, hyperreflexia, muscle rigidity, choreoathetosis, epileptic syndrome.
From the cardiovascular system: decreased blood pressure, tachycardia, arrhythmia, impaired intracardiac conduction, ECG changes (especially QRS) characteristic of intoxication with tricyclic antidepressants, shock, heart failure; in very rare cases - cardiac arrest.
Other: respiratory depression, shortness of breath, cyanosis, vomiting, hyperthermia, mydriasis, increased sweating, oliguria or anuria.
Symptoms develop 4 hours after an overdose, reach a maximum after 24 hours and last 4-6 days. If an overdose is suspected, especially in children, the patient should be hospitalized.
Treatment: for oral administration: gastric lavage, intake of activated charcoal; symptomatic and supportive therapy; for severe anticholinergic effects (lowering blood pressure, arrhythmia, coma, myoclonic epileptic seizures) - administration of cholinesterase inhibitors (the use of physostigmine is not recommended due to the increased risk of seizures); maintaining blood pressure and water-electrolyte balance. Monitoring of cardiovascular functions (including ECG) for 5 days (relapse may occur after 48 hours or later), anticonvulsant therapy, artificial pulmonary ventilation (ALV) and other resuscitation measures are indicated. Hemodialysis and forced diuresis are ineffective.

special instructions

Before starting treatment, blood pressure monitoring is necessary (in patients with low or labile blood pressure, it may decrease even more); during the treatment period - control of peripheral blood (in some cases, agranulocytosis may develop, and therefore it is recommended to monitor the blood picture, especially with an increase in body temperature, development of flu-like symptoms and sore throat), during long-term therapy - control of the functions of the cardiovascular system and liver. In the elderly and patients with cardiovascular diseases, monitoring of heart rate, blood pressure, and ECG is indicated. Clinically insignificant changes may appear on the ECG (smoothing of the T wave, depression of the S-T segment, widening of the QRS complex).
Caution is required when suddenly moving to a vertical position from a lying or sitting position.
During the treatment period, the use of ethanol should be avoided.
Prescribed no earlier than 14 days after discontinuation of MAO inhibitors, starting with small doses.
If you suddenly stop taking it after long-term treatment, withdrawal syndrome may develop.
Amitriptyline in doses above 150 mg/day. reduces the threshold of convulsive activity (the risk of epileptic seizures in predisposed patients should be taken into account, as well as in the presence of other factors predisposing to the occurrence of convulsive syndrome, for example, brain damage of any etiology, simultaneous use of antipsychotic drugs (neuroleptics), during the period of abstinence from ethanol or withdrawal of medications with anticonvulsant properties, such as benzodiazepines). Severe depression is characterized by a risk of suicidal actions, which can persist until significant remission is achieved. In this regard, at the beginning of treatment, a combination with drugs from the group of benzodiazepines or antipsychotic drugs and constant medical supervision (entrust trusted persons with the storage and dispensing of drugs) may be indicated. In children, adolescents and young adults (under 24 years of age) with depression and other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and behavior. Therefore, when prescribing amitriptyline or any other antidepressants in this category of patients, the risk of suicide should be weighed against the benefits of their use. In short-term studies, the risk of suicide did not increase in people over 24 years of age, but it decreased slightly in people over 65 years of age. During treatment with antidepressants, all patients should be monitored for early detection of suicidal tendencies.
In patients with cyclic affective disorders during the depressive phase, manic or hypomanic states may develop during therapy (reducing the dose or discontinuing the drug and prescribing an antipsychotic drug is necessary). After relief of these conditions, if indicated, treatment in low doses can be resumed.
Due to possible cardiotoxic effects, caution is required when treating patients with thyrotoxicosis or patients receiving thyroid hormone preparations.
In combination with electroconvulsive therapy, it is prescribed only under the condition of careful medical supervision.
In predisposed patients and elderly patients, it can provoke the development of drug-induced psychoses, mainly at night (after discontinuation of the drug, they disappear within a few days).
May cause paralytic ileus, primarily in patients with chronic constipation, the elderly, or those forced to bed rest.
Before performing general or local anesthesia, the anesthesiologist should be warned that the patient is taking amitriptyline.
Due to the anticholinergic effect, there may be a decrease in tear production and a relative increase in the amount of mucus in the tear fluid, which can lead to damage to the corneal epithelium in patients using contact lenses.
With long-term use, an increase in the incidence of dental caries is observed. The need for riboflavin may be increased.
Animal reproduction studies have shown adverse effects on the fetus, and there are no adequate and well-controlled studies in pregnant women. In pregnant women, the drug should be used only if the expected benefit to the mother outweighs the potential risk to the fetus.
Passes into breast milk and may cause drowsiness in nursing infants. To avoid the development of withdrawal syndrome in newborns (manifested by shortness of breath, drowsiness, intestinal colic, increased nervous excitability, increased or decreased blood pressure, tremors or spastic phenomena), amitriptyline is gradually discontinued at least 7 weeks before the expected birth.
Children are more sensitive to acute overdose, which should be considered dangerous and potentially fatal to them.
During the treatment period, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Amitriptyline instructions for use are classified as tricyclic antidepressants. These are some of the strongest drugs at a fairly reasonable price. But today, experts are divided on the possibility of recommending this drug in the first line of therapy.

Due to the presence of a large number of side effects of tricyclic antidepressants, their poor tolerability profile, and violation of the rules for taking medications by patients, which leads to an increase in morbidity and sometimes death, many experts, including international ones, pay more attention to the drugs new generation. They are comparable in effect to Amitriptyline, but have fewer side effects. Nevertheless, Amitriptyline is used quite successfully in psychiatric practice.

What is Amitriptyline?

Amitriptyline is an antidepressant, one of the most common. In addition to depression, it fights anxiety and has a pronounced hypnotic and calming (sedative) effect. In certain doses it can act as a psychoenergetic and stimulant. For each patient, the interval in which the drug has such an effect is individual.

When it is exceeded, the calming properties of the drug come to the fore, and the stimulating and depression-reducing properties recede into the background. Of its group of drugs, Amitriptyline is considered the most reliable, effective and cheapest. You can find Amitriptyline tablets starting at 26 rubles for 10 tablets.

Very often, for depressive disorders, treatment begins not with this group of drugs, but, for example, with monoamine oxidase inhibitors. If you are taking any thymoanaleptics (antidepressants) or anxiolytics (drugs that reduce anxiety), you need to warn your doctor.

Because some drugs are very dangerous to use together. For example, MAO inhibitors should never be taken together with tricyclic antidepressants. This threatens death. If you need to change one drug to another, there should be a pause of at least 2 weeks between taking MAO inhibitors and tricyclic antidepressants.

Before taking the drug Amitriptyline, the instructions for use must be read carefully and strictly follow the indicated dosages. This product is produced both in ampoules and tablets. For outpatient use, Amitriptyline tablets are usually prescribed.

Amitriptyline: instructions for use (official)

Range of application of the drug

What can amitriptyline help with? Amitriptyline - therefore, its main purpose is to fight depression. It is applicable for any type of depression, but most often Amitriptyline tablets are indicated for use in depressive states of an endogenous nature (that is, arising for internal reasons).

What does Amitriptyline help with, besides depression? Amitriptyline tablets are indicated for use in migraines and are prescribed as a preventative measure. It is given to children with enuresis, if the cause of the pathology does not lie in the bladder with weak tone. Amitriptyline is a medicine that works well:

• with anxiety;
• various pathological fears (phobias);
• eating disorders (bulimia and anorexia) of a neurogenic nature.

Unlike many other drugs of its group, it does not cause hallucinations, at least in most cases. In some cases, this antidepressant is also used by somatic medicine in very small dosages to reduce the manifestations of neurotic conditions.

Rules for taking Amitriptyline

How is the drug taken? Strictly as prescribed by a doctor, as it interacts when taken orally with drugs for the treatment of other serious pathologies. The instructions for use recommend taking amitriptyline after meals and according to the schedule, starting with minimal doses and increasing the dosage by 25 mg every day until the working dose is reached.

The minimum dose is considered to be 50 mg per day per dose; 150 mg/day, 200/250/300 mg per day can be prescribed as a working dose. The size of this dose is determined by the severity of the pathological process. The daily dose is recommended to be divided into several doses (2-4). The last dose should be taken before bedtime. The instructions for the antidepressant Amitriptyline also prescribe slowly stopping taking it, gradually reducing the dose.

Consequences of abrupt refusal

If you abruptly stop taking the drug, the patient may experience the so-called “withdrawal syndrome”:

1. discomfort;
2. headache;
3. nervousness;
4. sleep disorders.

These are not signs of dependence on the drug, but the consequences of its sudden withdrawal. For children and elderly people, the medicine is prescribed in reduced doses. In the case of severe forms of depression, complicated by suicidal thoughts or actions, treatment of the patient with Amitriptyline in large doses is possible only in a hospital. Since in some cases there is a suicidal effect of the drug, including a delayed one.

Side effects and contraindications

Usually this drug is well tolerated, but, nevertheless, it can cause effects on the active substance or auxiliary chemicals in the composition. Visual symptoms (accommodation disorder), intestinal dysfunction (constipation, diarrhea, and paresis) are noted.

Impaired urinary function (urinary retention, atony of the bladder), vestibulopathy, lethargy, apathy, increased drowsiness (especially with too intense dose increases), decreased libido. When used in large doses or too quickly administered intravenously, convulsive epileptiform seizures may occur. In some cases, there are disturbances in sensitivity (temperature, pain, etc.), spontaneous and pathological leakage of milk from the mammary glands, gynecomastia, weight gain, liver dysfunction, changes in the blood count.

This remedy is not prescribed to children under 12 years of age, women during pregnancy, especially in the first and last trimester (except in extreme cases) and nursing mothers. During the experiments, the teratogenic effect of the drug was revealed. If the medicine could not be discontinued while the child is pregnant, then at least a week before giving birth, you need to reduce the dosage and stop taking it before delivery so that the child does not develop withdrawal syndrome.

While taking this medication, you should not engage in activities that require attention and quick reaction, including driving a car.

Drugs with similar effects

Amitriptyline – INN (that is, international nonproprietary name). Patented products containing Amitriptyline as an active ingredient include:

• Saroten Retard,
• Elivel,
• Damile Maleinat,
• Amitriptyline-Grindeks,
• Vero-Amitriptyline,
• Amitriptyline Nycomend.

The latter is quite common. For Amitriptyline Nycomed 25 mg, the instructions for use are similar to those for regular domestic Amitriptyline; it costs approximately 53 rubles per package. Prescription drug. Prescriptions for such drugs are written using Latin. For Amitriptyline, the recipe in Latin will look like this:

Amitriptyline

Rp.: Tab. Amitriptylini 0.025 No. 20

D.S. 2 tablets each 4 times a day after meals for depression.

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