Amitriptyline

Description overdue on 22.09.2012

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Tricyclic antidepressants . It has an additional analgesic effect of central origin. The drug reduces appetite and eliminates bedwetting urinating, has antiserotoninovoe action.   The drug has a pronounced central and peripheral anticholinergic effects. Antidepresivny effect   It is achieved by increasing the concentration of serotonin in the nervous system and norepinephrine in synapses. Long-term therapy is to decrease the functional activity of serotonin and beta-adrenergic receptors in the brain. Amitriptyline reduces the severity of depressive symptoms, agitation , When anxiety anxiety-depressive states . By blocking H2 histamine receptors in the stomach wall (parietal cells) provided antiulcer effects. The drug is able to reduce body temperature, blood pressure during general anesthesia. The drug does not inhibit monoamine oxidase. The antidepressant effect is manifested after 3 weeks of therapy. Amitriptyline is released in a tablet dosage form, capsules, solution, dragee.

Indications:

Amitriptyline prescribed for depression   (agitation, anxiety, sleep disorders, alcohol withdrawal, with organic brain lesions, neurotic abstinence), in violation of the behavior of mixed emotional disorders, nocturnal enuresis , Chronic pain (for cancer pathology at postherpetic neuralgia ), Bulimia nervosa, migraine (for prevention), ulcerative lesions of the digestive system.

Contraindications:

Amitriptyline does not apply in myocardial infarction, hypersensitive to the main component, with angle-closure glaucoma Acute intoxication psychoactive, analgesic, hypnotic in acute alcohol intoxication. The drug is contraindicated in breast-feeding, severe intraventricular conduction disorders, antioventrikulyarnoy conductivity. In the pathology of the cardiovascular system, with inhibition of bone marrow hematopoiesis, affective insanity , Asthma, chronic alcoholism, reducing motor function of the digestive system, stroke, liver disease and kidney failure, ocular hypertension , Urinary retention, prostatic hyperplasia, bladder hypotension, thyrotoxicosis, pregnancy, epilepsy   Amitriptyline is used with caution.

Side effect:

Nervous system:   agitation, hallucinations, disorientation , Fainting, fatigue, drowsiness, restlessness, hypomania, increased depression, depersonalization, restlessness, increased seizures, extrapyramidal syndrome , Ataxia, myoclonus, paresthesia in the form peripheral neuropathy, tremor of the petty musculature, headaches. Anticholinergic effects:   increased intraocular pressure, blurred vision, mydriasis, dry mouth, tachycardia , Difficulty urinating, paralytic ileus, delirium, sputannosti of consciousness, decreased sweating. Cardiovascular system:   unstable blood pressure, intraventricular conduction disorders , Arrhythmia, orthostatic hypotension , Dizziness, palpitations, tachycardia. The digestive tract:   darkening of the tongue, diarrhea, change in taste perception, vomiting, heartburn , Gastralgia, hepatitis, cholestatic jaundice.   Endocrine system:   galactorrhea, hyperglycemia, reduced potency or increased libido, increase the size of breasts, gynecomastia, testicular swelling, syndrome of inappropriate secretion of antidiuretic hormone, hyponatremia. It is also noted hypoproteinemia , Pollakiuria, urinary retention, swollen lymph nodes, hyperpyrexia, swelling, tinnitus, hair loss. In case of cancellation of the drug observed unusual excitement, insomnia, malaise, headache, diarrhea, nausea, abnormal dreams, restlessness, irritability . When administered intravenously, it noted a burning sensation, lymphangitis, thrombophlebitis, allergic response.

Overdose:

Manifestations from Nervous System : Coma, stupor, excessive sleepiness, anxiety, hallucinations, ataxia, epileptic syndrome, choreoathetosis , Hyperreflexia, ataxophemia , Rigidity muscle tissue, sputannosti of consciousness, disorientation, violations of of concentration of attention, psychomotor agitation. Manifestations of overdose drug Amitriptyline from Cardiovascular : Violation of intracardiac conduction, arrhythmia, tachycardia, drop in blood pressure, shock, heart failure Rarely - cardiac arrest. It is also noted anuria , Oliguria, increased sweating, hyperthermia , Vomiting, shortness of breath, oppression work of of the respiratory system, cyanosis. It requires emergency gastric lavage, administration of cholinesterase inhibitors at the expressed anticholinergic manifestations. It also requires the maintenance of water and electrolyte balance, blood pressure, control over the work of the cardiovascular system, resuscitation and anticonvulsant activities, if necessary. Forced diuresis And hemodialysis has not proven effective in overdose Amitriptyline.

Mode of application:

The drug is taken orally immediately after meals, not liquid, which provides the least irritation of the stomach wall. The initial dose - 25-50 mg at night for adults. During 5- days amount of formulation Amitriptyline increased until 200mg in day in 3 admission. If no effect within two weeks the dose was increased to 300 mg. The solutions were administered slowly intravenously and intramuscularly, 20-40 mg 4 times a day with a gradual transition to oral. The course of treatment - no more than 8 months. When prolonged headaches, migraines, chronic pain of neurogenic origin, migraine appoint 12 5-100mg day.

Special instructions:

Before the therapy required level control blood pressure. Amitriptyline parenterally administered only under medical supervision in a hospital. In the first days of treatment must be bed rest. It requires complete rejection of reception of ethanol. Sharp rejection of the therapy may cause syndrome "cancel" . The medicament in a dose of 150mg per day lower the threshold for seizure activity that is important to consider in the development of epileptic seizures in patients with predisposition. Perhaps the development of hypomanic or mania   at persons of with cyclic, affective disorders during a depressive phase of. If necessary, treatment renew with small doses after cupping of specified states. Care must be taken in the treatment of persons taking drugs thyroid hormones in patients with hyperthyroidism because of possible risk of cardiotoxicity. The drug can trigger the development of paralytic ileus in the elderly, as well as prone to chronic constipation. It is mandatory to alert anesthesiologists for admission amitriptyline before the local or general anesthesia. Prolonged therapy provokes caries . May increase the need for riboflavin. Amitriptyline passes into breast milk in infants causes increased drowsiness. The drug affects the control of motor vehicles.

Drug Interactions:

The hypotensive effect, respiratory depression , A depressing effect on the nervous system is observed with a joint appointment of drugs that inhibit the work of the central nervous system: General anesthetics, benzodiazepines, barbiturates, antidepressants and others. The drug increases the severity of the effect of anticholinergic while taking amantadine, antihistamines , Biperiden, atropine, antiparkinsonian, phenothiazines. The drug increases the anticoagulant activity indadiona, coumarin derivatives, indirect anticoagulants. There is a decrease of efficiency alpha-blockers , Phenytoin. Fluvoxamine, fluoxetine   increase the concentration of drug in the blood. The risk of seizures increases, as well as enhanced central anticholinergic and sedative action in co-therapy with benzodiazepines, phenothiazines, holinoblokatorami. Simultaneous reception   methyldopa , Of reserpine, betanidina, guanetidina, of clonidine reduces the severity of of their the hypotensive of influence. When cocaine is developing an arrhythmia. Delirium develops when receiving atsetaldegidrogenazy inhibitors, disulfiram. Amitriptyline increases the impact on the cardiovascular system phenylephrine, norepinephrine, epinephrine, isoprenaline. The risk increases with hyperpyrexia receiving antipsychotics, Mr. holinoblokatorov.