Home Pain in the tooth Action of amitriptyline. Taking Amitriptyline

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Action of amitriptyline. Taking Amitriptyline

Amitriptyline is a drug from the group of antidepressants that is used during the treatment depressive states, mixed emotional and phobic disorders.

The drug is presented in the form of tablets for oral administration and a solution for intramuscular injection. Active substance- amitriptyline.

Amitriptyline is a tricyclic antidepressant that works by inhibiting the reuptake of dopamine, norepinephrine, and serotonin. Against the background of long-term use of the drug, it restores the balance of systems disturbed by depressive states. The drug has a pronounced sedative effect, as well as antihistamine and antibulimic effects.

The use of the drug Amitriptyline during the treatment of depressive-anxiety disorders helps to reduce agitation, anxiety and depressive manifestations. The use of the drug also contributes to the provision of a moderate analgesic effect due to the effect on the receptors of the central nervous system.

Amitriptyline has antiulcer, sedative and m-anticholinergic effects, which contributes to the provision of analgesic effects and accelerates the healing process of ulcers. Amitriptyline increases the ability of the bladder to stretch, increases the tone of the sphincter. This makes it possible to use drugs during the treatment of bedwetting. Against the backdrop of the general anesthesia Amitriptyline may lower body temperature and blood pressure.

The antidepressant effect of the drug develops within 14-21 days after the start of use.

The excretion of the active component is carried out by the kidneys. The period of complete elimination takes 1-2 weeks. The substance can cross the placenta and be excreted in breast milk.

Indications and contraindications

Indications for the use of Amitriptyline are:

Amitriptyline can also be used to prevent migraine attacks.

Contraindications

Amitriptyline is contraindicated for use in the event of the development of such conditions:

heart failure (in the stage of decompensation);
acute infarction and the recovery period after a similar condition;
with violations of the conduction of the heart muscles;
individual intolerance to the active substance;
with a pronounced increase in blood pressure;
at severe violations functioning of the liver and urinary system;
exacerbations of peptic ulcer of the stomach and duodenum;
the drug is not used in the treatment of pregnant and lactating women, as well as patients under 6 years of age.

Simultaneous use with MAO inhibitors is strictly contraindicated in patients with atony of the bladder, intestinal obstruction and prostatic hypertrophy.

The drug is used with extreme caution in the treatment of people with a history of alcoholism, bronchial asthma, a tendency to manic-depressive psychosis, epilepsy, hyperthyroidism, angina pectoris, heart failure, angle-closure glaucoma, intraocular hypertension, schizophrenia.

Adverse reactions

Against the background of the use of Amitriptyline, the likelihood of developing disorders of the digestive, endocrine and cardiovascular systems, as well as the central nervous system increases: headache, fatigue, heart rhythm disturbances, nausea, vomiting. It is also possible to develop allergic manifestations, with long-term treatment, hair can fall out and body weight increases.

If the patient took the drug for a long time and abruptly canceled its use, then a withdrawal syndrome may develop in the form of vomiting, intestinal upset, headache, irritability, and sleep disturbances.

Mode of application

Amitriptyline tablets should be taken orally, during or after a meal. The exact initial and daily dose is determined by the doctor, taking into account the indications for admission, the effectiveness of the drug and its tolerability. It is recommended to use the maximum part of the dose at bedtime.

In severe cases, therapy begins with intramuscular administration of the drug with a gradual transition to taking tablets.

After a stable antidepressant effect is achieved, after 15-30 days the dose is gradually reduced. If the manifestations of a depressive state resume against the background of a decrease in the dosage, one should return to the previous, effective dose.

If the dosage recommended by the doctor is not observed, an overdose may develop, which manifests itself in the form of confusion, dilated pupils, elevated temperature body and drowsiness, shortness of breath, convulsive seizures, vomiting, arrhythmias, pressure reduction, heart failure, respiratory depression.

As a therapy, the drug Amitriptyline is immediately stopped. You should also wash the stomach, pick up funds for symptomatic treatment. In this case, it is necessary to carefully monitor the functioning of the cardiovascular system due to the risk of relapse over the next 2 days after an overdose.

Drug Interactions

Amitriptyline may increase the inhibitory effect on the central nervous system when interacting with such groups of drugs:

When combined with drugs from the group of neuroleptics, it is possible to develop a temperature reaction and paralytic ileus.

When used in conjunction with anticonvulsant drugs, as well as guanethidine, their action may be weakened.

With the simultaneous use of Amitriptyline increases the activity of anticoagulants. When combined with cimetidine, the concentration of amitriptyline in the blood plasma may increase, which increases the risk of its toxic effects on the body. The combination with carbamazepine and barbiturates leads to a decrease in the concentration of amitriptyline.

When used in conjunction with birth control pills on the basis of estrogen, the bioavailability of amitriptyline increases. Amitriptyline may contribute to an increase in depression provoked by glucocorticosteroids.

When combined with drugs from the group of MAO inhibitors, the risk of death increases. The interval between the use of Amitriptyline (as well as other drugs in this group) and drugs from the group of MAO inhibitors should be at least 14 days.

The use of Amitriptyline in the treatment of patients of older age groups should be carried out under the constant supervision of a physician. The drug is recommended to be used in the minimum effective dose.

Against the background of taking Amitriptyline during the treatment of depression, in no case should you drink alcohol.

The use of amitriptyline at certain doses may lower the threshold for seizure activity. It is necessary to be aware of the likelihood of seizures in people with a history of such a condition, as well as in patients predisposed to seizures.

Patients with depressive phases of manic-depressive psychosis are likely to go into the manic stage. Against the background of taking Amitriptyline, you should refuse to drive a car and other modes of transport, as well as perform work that requires increased attention.

Amitriptyline should be stored in compliance with the temperature regime: no more than 25 degrees in a dark place, protected from children and direct sunlight. Amitriptyline is dispensed in pharmacies upon presentation of a prescription from the attending physician.

Analogues, cost

The cost of the drug Amitriptyline is formed depending on the manufacturer:

tablets 25 mg, 50 pcs. (Ozon, Russia) - 25-35 rubles;
tab. 10 mg, 50 pcs. (Nycomed, Denmark) - 45-55 rubles;
tab. 25 mg, 50 pcs. (Grindeks, Latvia) - 55-65 rubles;
tab. 25 mg, 50 pcs. (Zentiva, Czech Republic) - 65-70 rubles.

Analogues of the drug Amitriptyline are: Amirol, Amizol, Tryptisol, Elivel, Saroten. The selection of a replacement is recommended to be carried out by prior agreement with the doctor.

In life, various troubles happen that bring serious harm to the well-being and nervous system of a person. To deal with stress emotional experiences or diseases, doctors prescribe the use of special drugs -.

But, like other medicines, they can not only heal, but also be harmful, so before using it, you must definitely read the instructions and pay attention to existing contraindications and possible side effects. One of the popular and effective drugs such a group is amitriptyline.

Amitriptyline is an antidepressant with sedative, antiulcer, and antibulimic effects. Its main active ingredient is amitriptyline hydrochloride. Excipients are lactose monohydrate, calcium stearate, colloidal silicon dioxide, gelatin, corn starch and talc.

The drug is available in the form of a solution and tablets of a round shape, convex on both sides, yellow color, film-coated.

The action of the drug is based on the suppression of neuronal reuptake of dopamine, norepinephrine and serotonin. The drug has a central analgesic, anti-bulimic and anti-ulcer effect, helps in the elimination of nocturnal enuresis - urinary incontinence.

As an antidepressant, it fully manifests its effect after 2-4 weeks of regular use of the drug.

When prescribing, the doctor must take into account the possible side effects of Amitriptyline, so trying to be treated with the drug on your own can be risky.

Appointment and use of the drug

The scope of the drug is quite wide, since it is able to treat not only depressive conditions of a different nature, but also ulcerative lesions. various organs gastrointestinal tract, headaches, and is also used as a prophylactic against migraines.

The main indications for the appointment of Amitriptyline are the following conditions or diseases:

Psychosis on the background of schizophrenia.
Mixed emotional disorders.
Nervous form of bulimia.
Behavioral disorders.
Bedwetting (in cases where enuresis is provoked by a weak muscle tone of the bladder).
Pain of a chronic type (atypical pain in the face, rheumatic pain and suffering in cancer patients, diabetic and post-traumatic neuropathy, neuralgia after herpes).

The drug showed itself well with increased excitability, nervousness, sleep disorders in patients with alcoholism.

Medication rules:

When using the drug, the dosage increases gradually, starting from 25-50 mg per day for adults. Take the tablets at night, drinking them with water and not chewing. During the week, the dosage may increase to reach 150-200 mg per day. This dose should be divided into three doses.
You can raise the dosage up to 300 mg per day if the body does not respond positively to taking the drug. This can be done after consultation with the attending physician, taking into account the possible side effects of Amitriptyline. After reduction or complete disappearance depressive symptoms the dosage is reduced to 50-100 mg of the drug during the day.
Treatment is considered ineffective and subject to cancellation if the patient does not feel improvement after using the drug for a month or 2 weeks in a row.
For elderly patients with minor health problems, the drug is usually prescribed at a dose of 30 to 100 mg per day. When the patient's condition returns to normal, they switch to a reduced dosage in the range of 25–50 mg of the drug.
In the prevention of migraines and the treatment of chronic headaches, as well as other manifestations neurological pain the patient is prescribed Amitriptyline at a dosage of 12.5 mg to 100 mg daily.
In depressive conditions in children aged 6 to 12 years, children are prescribed the drug at a dosage of 10–30 mg per day, or they are calculated according to the formula 1–5 mg per kilogram of weight. The medicine is divided into several doses.
With bedwetting in children aged 6-10 years, the drug is given at night, 10-20 mg per day, adolescents from 11 to 16 years old in this situation receive 25-50 mg of Amitriptyline per 24 hours.
At intravenous infusions or when intramuscular injections the agent must be administered slowly, 4 times a day, the dose is 20–40 mg. The duration of treatment is from six months to 8 months.

Who and when is Amitriptyline contraindicated?

The drug has the following contraindications:

Hypersensitivity to amitriptyline hydrochloride or other components of the drug.
Children's age up to 6 years.
Pregnancy.
breastfeeding period.
High scores.
Problems with the cardiovascular system (disturbances in myocardial conduction).
Bladder atony.
Diseases of the liver and kidneys in the acute stage.
Prostate hypertrophy.
Intestinal obstruction of paralytic nature.

The presence in the anamnesis of these contraindications makes it impossible to use Amitriptyline.

What side effects can it cause?

When prescribing the drug, the doctor always focuses on the potential side effects of Amitriptyline and asks the patient to be more attentive to possible manifestations reactions. When the following symptoms most often, they simply reduce the dosage to gradually get used to the patient, or cancel the drug if they feel too unwell.

The most common side effects are urination problems, dry mouth, some vision loss, growth intraocular pressure, constipation, intestinal obstruction of a functional type, hyperthermia - an increase in body temperature.

In addition to these adverse reactions The patient may complain of the following conditions:

Increased fatigue, weakness.
Sleepy state.
Confused consciousness.
Increased irritability.
Nightmares.
Insomnia.
hallucinations.
Distractedness, impaired attention.
Trembling of limbs.
Disorder of coordination of movements (ataxia).
Feeling of crawling, tingling, sensory disturbances (paresthesia).
Hair loss.
Itching of the skin and mucous membranes.
Hives.
Purpura (small hemorrhages in the skin and mucous membranes).
Enlarged lymph nodes.
The secretion of milk from the mammary glands in non-lactating and non-pregnant women, as well as in men - galactorrhea.
Potency disorders.
Swelling of the testicles.
Decreased or increased sexual desire.
Diarrhea.
Jaundice.
Increased activity of liver enzymes.
Nausea, vomiting.
Pain and discomfort in the epigastric region.
Anorexia.
Changing the color of the tongue.
Stomatitis.

Such a significant number of potential side effects means that the patient needs to be closely monitored for changes in his condition, especially when increasing the dosage of the drug. About all negative manifestations you need to inform your doctor to decide whether to reduce the dosage or to cancel the drug and switch to another drug.

Signs and dangers of overdose

When taking Amitriptyline, there is a risk of overdose, but its manifestations are related to the amount of the drug taken and may manifest differently in patients different ages, gender and health status.

It is believed that taking the drug more than 500 mg in adult patients leads to the appearance of signs of moderate or severe levels. A dose of 1200 mg or more is lethal. In children, extremely serious conditions and death can be caused by a much smaller amount of medicine.

Patients may respond differently to high doses of the drug. In some, the symptoms increase slowly, gradually, while others react immediately and violently.

The following manifestations of overdose are mainly noted:

Convulsions, seizures, loss of consciousness, which can turn into coma, serious depression of the central nervous system, impaired functioning of the respiratory center.
Increased body temperature, drying of the mucous membranes, urinary retention, tachycardia (rapid heartbeat), dilated pupils (mydriasis), problems with intestinal motility (slowdown).
With a significant overdose, the patient has an increasing pulse rate, pressure may drop, intraventricular blockade, cardiac arrest may develop.

More information about antidepressants can be found in the video:

If symptoms of an overdose are present, Amitriptyline should be discontinued and appropriate measures taken. Physostigmine is administered intramuscularly or intravenously at a dosage of 1–3 mg every one to two hours.

It is necessary to introduce solutions to maintain electrolyte balance, equalize blood pressure indicators, and eliminate other symptoms of overdose. The patient remains under medical supervision for at least 5 days, it is necessary to monitor cardiac activity, as unexpected deviations are possible, since there is a risk of intoxication and disruption of the heart within 2 days after an overdose.

Interaction with other drugs

When treating with the drug, it is necessary to take into account not only the side effects of Amitriptyline, but also its possible interactions with other drugs. This drug when taking MAO inhibitors can cause the so-called serotonin syndrome. At the same time, do not prescribe decongestants, painkillers and other drugs containing epinephrine, ephedrine and related substances.

Simultaneous use with antihistamines can enhance their action, which leads to the suppression of the normal functioning of the central nervous system. When using Amitriptyline, even without other drugs, it is not recommended to drive vehicles and use complex and dangerous devices and fixtures.

Co-administration of neuroleptics, antiarrhythmic drugs, antihistamines with Amitriptyline can provoke ventricular arrhythmia. Tachycardia can be provoked by the use of antifungal agents.

Barbiturates can cause a decrease in the effectiveness of the drug.

There are quite a few different dangerous combinations Amitriptyline with other drugs, which only once again emphasizes the exceptional danger of self-administration of such a complex drug. When talking with a doctor, it is imperative to fully list all the medicines that are taken by the patient and can enter into a negative reaction with the antidepressant.

Hello!

A little preface:

I am one of those people who was considered the soul of any company. Familiar start, isn't it?

But mostly such people do not withstand strong blows of fate. Why? Yes, because an always cheerful and cheerful person cannot suddenly become gloomy, unsociable and hate heaven itself for the grief that has fallen. You have to pretend in public, and slowly go crazy.

Most importantly, you do not realize that something is no longer right. It seems to you that time will dull the pain and you will climb out of the abyss of despair.

This was my biggest mistake on the way to Amitriptyline and many heavy sedative pills and sleeping pills.

The list of antidepressants was long, including the new generation drugs Reksetin, and Lenuxin, and Velaksin, and more names that I can’t remember now.

It's only small part drugs

I will start the review with Amitriptyline, since it was he who gave me the long-awaited effect, coupled with sleeping pills.

My symptoms deep depression and severe insomnia:

It all started quite ordinary - lost sleep. In the beginning, I just didn’t sleep well at night, you know, such a state is like sleeping, but your head is not there, the brain is constantly at work: it thinks, remembers, scrolls through the past day and so through the night. This is very exhausting. Then I slept a day later, then I didn’t sleep for two days ... it came to four days.

Insomnia was accompanied by irritability, fear that something bad was about to happen, midges flashed before my eyes, it seemed that someone was standing nearby and constant anxiety that did not pass for a second.

I ignored private psychologists and neuropathologists and went directly to mental asylum to a narcologist-psychotherapist.

My personal opinion is that doctors working in mental, narcological departments see the problem immediately and do not break such prices as private traders.

And prescriptions are written out and consultation by phone and you can come and change the medicine at any time if it doesn’t fit.

Amitriptyline:

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

Dosage:

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, up 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.

My dosage was 25 mg in the morning and evening. The course of treatment for depression was prescribed for at least a year and a half.

The dose is relatively small, as it was taken with diazepam in the morning, with heavy tizercine and lighter sleeping pills in the evening.

Due to the large number of heavy drugs, a week later, startling in a dream began. The jaw was constantly compressed and it was impossible to relax it. The doctor said that these were convulsions, and in order to stop them, he prescribed Carbamazepine (Taver) in the morning and in the evening. After two weeks, the shuddering stopped, and together with all the drugs on permanent basis continued to take carbamazepine.

Side effects Amitriptyline:

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 angle of the anterior chamber), tachycardia, dry mouth, confusion (delirium or hallucinations), constipation, paralytic ileus, difficulty urinating.
From the side of the central nervous system: drowsiness, fainting, fatigue, irritability, anxiety, disorientation, hallucinations (especially in elderly patients and in patients with Parkinson's disease), anxiety, psychomotor agitation, mania, hypomania, memory impairment, decreased ability to concentrate, insomnia, "nightmare" dreams, asthenia ; headache; dysarthria, tremor of small muscles, especially arms, hands, head and tongue, peripheral neuropathy (paresthesia), myasthenia gravis, myoclonus; ataxia, extrapyramidal syndrome, increase and increase epileptic seizures; changes in the electroencephalogram (EEG).
From the CCC: tachycardia, palpitations, dizziness, orthostatic hypotension, non-specific changes in the electrocardiogram (ECG) (S-T interval or T wave) in patients without heart disease; arrhythmia, lability of blood pressure (decrease or increase in blood pressure), impaired intraventricular conduction (expansion of the QRS complex, changes interval P-Q, blockade of the legs of the bundle of His).
From the gastrointestinal tract: nausea, heartburn, gastralgia, hepatitis (including liver dysfunction and cholestatic jaundice), vomiting, increase in appetite and body weight or decrease in appetite and body weight, stomatitis, change in taste, diarrhea, darkening of the tongue.
From the endocrine system: an increase in size (swelling) of the testicles, gynecomastia; an increase in the size of the mammary glands, galactorrhea; decrease or increase in libido, decrease in potency, hypo- or hyperglycemia, hyponatremia (decrease in the production of vasopressin), syndrome of inappropriate secretion of antidiuretic hormone (ADH). Allergic reactions: skin rash, itching, photosensitivity, angioedema, urticaria.
Others: hair loss, tinnitus, edema, hyperpyrexia, swollen lymph nodes, urinary retention, pollakiuria.
With prolonged treatment, especially at high doses, with its abrupt cessation, it is possible development of withdrawal syndrome: nausea, vomiting, diarrhea, headache, malaise, sleep disturbances, unusual dreams, unusual agitation; with gradual withdrawal after long-term treatment- irritability, restlessness, sleep disturbances, unusual dreams.
The relationship with the drug has not been established: lupus-like syndrome (migratory arthritis, the appearance of antinuclear antibodies and a positive rheumatoid factor), impaired liver function, ageusia.

Amitriptyline is an old generation drug and it is easier to tell what side effects it does not have. While taking antidepressants, she drank kidney tea and liver cleanse pills.

My side effects:

- At the beginning of the reception, I had increased irritability and anxiety. But the treatment itself began without the headaches that I always had with other antidepressants. After two weeks, the body began to soften, and the condition became softer. All the symptoms remained, but not in such an aggressive form.

-Drunken state, lethargy, coupled with irritability and anxiety. At the beginning of taking amitriptyline, it seemed that everything was only getting worse, but after half a month it became easier.

- Decreased appetite. And in this regard, I was lucky, because when taking other antidepressants, a strong appetite appeared and I quickly gained weight.

- The taste has changed. All the food seemed to be some kind of cotton.

- Retention of urine. The condition is as if everything inside is numb and it is difficult to walk in a small way.

-Unpleasant smell of sweat. With amitriptyline, some pungent odor appeared and threw it into a cold sweat.

-Tachycardia. But this is to be expected since tachycardia is my diagnosis and without taking any drugs.

-Libido-zero . But in cases of severe depression, it seems to me that few people want anything.

Outcome:

She took Amitriptyline for 5 months continuously. Withdrawal was not severe as I had more at night Tizercin and lighter sleeping pills Phenazepam, Somnol, Phenobarbital, and in the morning Diazepam. At the beginning of the cancellation, the morning dose was removed, then two weeks later and the evening dose.

But completely from all sleeping pills I departed very hard. As I remember that period, I still do not understand how I got out. Believe me, I was tormented by the cancellation for two months. But gradually the body got used to sleep without sleeping pills.

After five months, I decided to pull myself together and not take any more medications.

But the doctor prescribed amitriptyline every six months for a month as a preventive measure.

For a month of taking it, I did not have a pronounced addiction, but still ten days after the abolition is a very uncomfortable state, I want drowsiness and indifference, which the drug gives.

I'm not crazy) I'm the most ordinary person, who could not withstand two blows of fate in a row. Grief from the loss of loved ones does not let go, but I can sleep at night and now do without sleeping pills. Amitriptyline helped me get back to an adequate state.

Remember! After the biggest hurricane, there's always a rainbow

From a chemical point of view, amitriptyline belongs to the category of tricyclic antidepressants. This is the name of this class medicines received because of their characteristic shape of the molecule, consisting of three carbon rings. The principle of action of amitriptyline is based on the inhibition of the reuptake of various neurotransmitters, such as dopamine, norepinephrine and serotonin.

This means that the drug does not allow nerve cells to retain these neurotransmitters at the time of impulse transmission. As a result, it increases total neurotransmitters in the area of synaptic connections between neurons. As a result, neural connections become more stable, the work of the adrenergic and serotonin systems of the body is normalized.

Why is this so important in case of depression? It's no secret that depression isn't just blues or a bad mood. This serious illness nervous system, in which neural connections do not function properly, and in the nervous system there is a lack of various neurotransmitters and a violation of the transmission of impulses between individual parts of the central nervous system. And this disease can be cured only with the help of taking special medicines, which include amitriptyline.

This drug has not only an antidepressant effect. It also provides:

moderate analgesic effect of central origin,
anticholinergic (central and peripheral),
antihistamine,
alpha-blocker,
antiarrhythmic (due to slowing ventricular conduction),
sedative (sedative)
anxiolytic (anti-anxiety) action.

In addition, amitriptyline causes a decrease in appetite. Thanks to all these properties, the positive effect of the drug is manifested not only with mental disorders. Also drug:

contributes to the reduction of pain syndrome,
has an antiulcer effect (due to the blocking of histamine receptors in the parietal cells of the stomach),
contributes to the normalization of urination (due to the anticholinergic effect and an increase in the degree of distension of the bladder).

The drug does not inhibit MAO. With general anesthesia, it lowers body temperature and blood pressure.

Amitriptyline does not have an immediate effect. In order for its therapeutic effects to appear, it takes some time, at least 2-3 weeks.

The effect of the drug largely depends on the dose. At low doses, below the therapeutic threshold, the drug has only a slight sedative effect, and there is no antidepressant effect. With an increase in the dose, an antidepressant effect is manifested, while the sedative effect gives way to a stimulating one.

In general, compared with other tricyclic antidepressants, the sedative properties of the drug predominate. Due to this, such side effects, characteristic of antidepressants with a stimulant effect, such as delusions and hallucinations, are not characteristic of amitriptyline.

The drug is especially effective in anxiety-depressive conditions. Treatment with amitriptyline in such cases successfully relieves not only depression itself, but also anxiety, psychomotor agitation (agitation), internal tension and fear, and normalizes sleep.

What is Amitriptyline?

The medicine should be taken orally after meals with plenty of water.

Amitriptyline is one of the most prominent representatives of the first generation of antidepressants. It has an effect directly on the nerve cells of the brain, allowing you to suppress anxiety and reduce the degree of manifestation of depressive states.

Important! Unlike a number of analogues, Amitriptyline does not cause hallucinations, and therefore it is often prescribed for migraines and chronic headaches.

The drug is available in tablet form and as a solution for injection. The tablets are small, round in shape and covered with a white shell. The solution appears as a clear liquid that is either colorless or slightly colored.

This remedy has a pronounced sedative effect, which is why it is often used to treat depressive conditions. It helps to reduce marked emotional arousal and anxiety. In addition, the drug has the following properties:

antihistamine;
thymoleptic;
antiserotonin;
analgesic;
anxiolytic;
antiulcer;
M-anticholinergic.

Amitriptyline is also used to lower body temperature and blood pressure during general anesthesia.

The effect of taking the drug occurs no earlier than two weeks after the start of its administration.

The expediency of taking this drug arises in the following cases:

The patient was diagnosed with severe depression. There are symptoms of sleep disorder, emotional overexcitation and anxiety. We can talk about depression caused by mental trauma, alcoholism or organic brain damage.
Violations mental activity arising against the background of the development of schizophrenia. Amitriptyline is often used in the treatment of depression in schizophrenic patients.
Emotional disorders mixed character. If a complication mental state the patient was caused by several factors, then this remedy also helps to stabilize the patient's well-being.
Disorders of attention, the inability of the patient to conduct any active activity.
Bulimia, which has a nervous character.
Nocturnal enuresis.
Chronic pain observed in cancer patients, with rheumatic diseases and migraines. Amitriptyline is also prescribed for patients with postherpetic neuralgia, atypical pain in the region of the heart and neuropathies of various genesis.
Peptic ulcer of the duodenum and stomach.

This drug has quite wide list contraindications, and therefore its use should be carried out exclusively under the supervision of a physician.

Do not take amitriptyline if you have the following diseases and states:

Myocardial infarction in acute form or subacute period of development.
Serious problems in the functioning of the heart muscle. We are talking about violations of intraventricular conduction, atrioventricular blockade, etc. The drug should be used with caution in patients with coronary heart disease, arrhythmias.
Acute alcohol intoxication.
Diseases thyroid gland.
Angle-closure glaucoma.
Pregnancy. It is strictly forbidden to prescribe this drug during the 1st and 3rd trimesters. In case of emergency, Amitriptyline is taken under medical supervision.
Breast-feeding. If therapy with Amitriptyline is absolutely necessary, breast-feeding should be discontinued.
The presence of acute intoxication with hypnotics, analgesics and psychoactive drugs.

Amitriptyline is not prescribed for children under 6 years of age.

Side effects

When taking the drug, tachycardia and heart rhythm disturbances may occur.

When taking this drug, it is necessary to take into account a number of possible side effects, which manifest themselves as follows:

Confusion of consciousness, weakness and dizziness, fainting.
Heart rhythm disorder, tachycardia.
Urinary retention, constipation, development of paralytic ileus.
Minor weight gain.

Due to the large number of side effects, many doctors use inappropriately low doses of amitriptyline in the treatment, resulting in a significant decrease in the effectiveness of treatment.

In case of overdose, this drug can lead to the development of severe poisoning. Therefore, it is often acquired by persons with suicidal tendencies. The doctor's task in this case is the timely recognition of such a patient and the prevention of death.

This drug allows you to treat the following disorders:

depression;
nocturnal bulimia;
restlessness and anxiety;
mental disorders etc.

To evaluate the effectiveness of this drug in the fight against depression, you should consider the mechanism of its effect on the body. With the development of depression, a sharp decrease in norepinephrine and serotonin is observed in the patient's body. This is because they begin to flow to the brain cells.

The high efficiency of Amitriptyline in the treatment of depression is to improve the patient's mood due to the release of norepinephrine and serotonin from the brain structures. As a result, the symptoms of depression are alleviated. If the absorption of neurotransmitters in cells occurs repeatedly, then this no longer affects the mood of a person.

Contraindications

The main scope of the drug are diseases of the psyche and the central nervous system. These include primarily:

depression of various origins, primarily endogenous;
anxiety states;
psychoses;
schizophrenia;
neurogenic pain syndrome;
sleep disorders;
alcohol withdrawal;
behavioral disorders, including in children;
phobias;
epilepsy;
bulimia nervosa (excessive appetite for nervous ground);
chronic pain syndrome (migraine, rheumatism, cancer, neuralgia and neuropathy);
migraine prevention;
peptic ulcer stomach and duodenum;
neurogenic urinary incontinence (with the exception of cases with hypotension of the bladder).

For depression, the drug can be used as monotherapy, for other diseases, amitriptyline is most often used as part of complex therapy

Amitriptyline is contraindicated in:

severe forms of heart and kidney failure;
decompensated heart defects;
hypertension in severe form;
acute or subacute forms myocardial infarction;
acute intoxication with alcohol, sleeping pills, analgesics and psychoactive substances;
angle-closure glaucoma,;
atrioventricular blockade 2 tbsp;
under the age of 6;
while taking MAO inhibitors.

During pregnancy, the drug can be prescribed only if there is no other alternative, after the doctor weighs the pros and cons. As experiments on animals have shown, the drug has a teratogenic effect. Newborns born to women who took the drug during pregnancy may suffer from increased drowsiness or tearfulness for some time.

The drug, in addition, is contraindicated in people who drive vehicles and perform work that requires concentration.

The drug is prescribed with caution when:

problems with the cardiovascular system (in particular, coronary disease heart, arrhythmia, heart failure),
chronic alcoholism,
bronchial asthma,
decrease in intestinal motility,
the presence of a convulsive symptom in history,
manic-depressive psychosis,
strokes,
renal and hepatic pathologies,
urinary retention and hypotension of the bladder,
thyrotoxicosis,
epilepsy,
prostatic hyperplasia.

Treatment of patients with severe endogenous depression and high risk of suicidal behavior should be carried out only in a hospital setting.

Method of application for depression

The initial dose in tablets is 25-50 mg (1-2 tablets of 25 mg) per day. In such a case, it is advisable to take the drug at bedtime. Then the dose is gradually increased (25 mg daily) to 150-200 mg. In this case, the daily dose should be divided into three doses. The largest amount of the drug should be taken at night.

In mild cases, in patients taking the drug for the first time, in patients with severe somatic diseases, in the elderly or adolescence slower dose escalation (25 mg over 2-3 days) is recommended. In severe, suicidal dangerous depressions on the contrary, it should be started immediately with large daily doses (100 mg).

The maximum daily dose for outpatient treatment is 200 mg, for inpatient treatment - 300 mg. In some cases, with severe depression and good tolerability of the drug, it is possible to increase the maximum daily dose to 400-450 g.

At bulimia nervosa, emotional disorders, schizophrenia aggravated by psychosis, alcohol withdrawal begin with a dose of 25-100 mg (1-4 tablets of 25 mg) at night. After achieving a therapeutic effect, it is necessary to switch to the minimum effective dose- 10-50 mg per day.

Prevention of migraine, chronic neurogenic pain, gastrointestinal ulcers require daily doses of 10-100 mg (the dose is prescribed by the doctor based on specific circumstances). Moreover, most of the dose is taken at night.

In the treatment of depressive conditions in children 6-12 years of age, the drug should be taken at a dose of 10-30 mg per day. Or you can calculate the dosage based on weight - 1.5 mg / kg.

With nocturnal enuresis in children 6-12 years old, 10 mg is prescribed, less often 20 mg. Children over 12 years old - up to 50 mg. The drug is taken once at night.

The duration of treatment depends on many factors - the patient's condition, the type of disease and can vary from several months to one year.

In case of impaired renal function, dose adjustment is required. Dose adjustment is also required for the elderly.

To avoid adverse reactions, the drug should be taken immediately after meals.

With a sharp withdrawal of the drug, a withdrawal syndrome may occur. Therefore, it is recommended to reduce the dosage of the drug before the end of the course gradually.

Parenterally (intramuscularly or intravenously), the drug can be administered only in a hospital, under the supervision of a physician. The usual dosage is 20-40 mg 4 times a day. At the first opportunity, it is necessary to switch to oral administration.

The daily dose is to be gradually reduced when a positive effect is obtained.

Amitriptyline should only be taken when prescribed by a doctor. In most cases, the dosage is calculated on an individual basis, taking into account the severity of the disease.

The medicine should be taken orally after meals with plenty of water. It is forbidden to chew the tablets, because in this case, irritation of the walls of the stomach is possible.

Consider how to take Amitriptyline for depression:

The initial daily dose is 50-75 mg. Thus, the drug is taken one tablet (25 mg), twice or thrice a day. The course of treatment of depression with Amitriptyline is carried out until the patient's condition stabilizes.
The optimal dose of the drug is 175-200 mg. Moreover, most of this dose is taken at night.
If we are talking about the development of severe depressions that are not susceptible to therapy, then the daily dose can be increased to 300 mg. In some cases, it is possible to take a larger dose of the substance, which is calculated for each patient individually.

In the latter case, the drug is administered by injection. Initial doses in this case are higher than usual, and their increase occurs at a faster rate. This requires constant monitoring of the somatic condition of the patient.

The daily dose is subject to a gradual decrease in obtaining a pronounced effect. If at the same time there is a resumption of depression, it is necessary to return to the original dosage.

If no changes in the patient's condition are observed on the fourth week of treatment, then further therapy is considered inappropriate. In this case, the doctor prescribes another drug.

Interaction with other substances

When using Amitriptyline, you should consider the features of its interaction with other drugs:

Barbiturates, antidepressants and other CNS depressants. When taken simultaneously with Amitriptyline, there is an increase in the inhibitory effect on the central nervous system, hypotensive effect, depression respiratory function.
Clonidine, antihistamines. The effect is the same as above.
Phenothiazines, Atropine, antiparkinsonian drugs, antihistamines. An increase in anticholinergic action is observed, side effects from the bladder, intestines, organs of vision and central nervous system are possible. Perhaps the development of intestinal obstruction of the paralytic type.
Anticonvulsants. There is an increase in CNS depression, a decrease in the effectiveness of these drugs.
Phentothiazines, anticholinergics, benzodiazepines. Arises high risk the development of epileptic seizures, the patient may develop a malignant syndrome of the neuroleptic type.
Guanethidine, Clonidine, Mutildopa, Reserpine, Betanidine. When taken simultaneously with Amitriptyline, the hypotensive effect of these drugs is reduced.
Thyroid hormones. There is a mutual enhancement of both the therapeutic effect and the toxic effects on the patient's body.
Probucol, pimozide. Severe cardiac arrhythmias may occur.

The drug is incompatible with alcohol. Therefore, during the course of therapy, it is necessary to give up alcohol. Do not take the drug with other tricyclic antidepressants. Use with antidepressants of the group of selective serotonin reuptake inhibitors can lead to serotonin syndrome.

Absolutely incompatible with another class of antidepressants - MAO inhibitors. With simultaneous use with MAO inhibitors, severe convulsions and hypertensive crises can develop, which often end in the death of the patient. Therefore, the interval between courses of treatment with amitriptyline and MAO inhibitors should be at least 2 weeks.

With simultaneous administration with benzodiazepines, a mutual enhancement of the therapeutic effect may be observed. When used with other antidepressants, barbiturates, sedatives, benzodiazepines, general anesthetics, the inhibitory effect on the central nervous system increases, a hypotensive effect develops, respiratory depression is possible.

Amitriptyline also enhances the effect on the cardiovascular system of epinephrine, ephedrine and similar drugs, resulting in a risk of tachycardia, arrhythmias and arterial hypertension. Therefore, during anesthesia (the composition of anesthetics usually includes epinephrine), the doctor should be informed about the patient taking this antidepressant drug in order to adjust the doses of anesthetics.

Raises therapeutic effect anticholinergic, antihistamines, which may lead to an increase side effects. Amantadine increases the anticholinergic effect.

The drug reduces the effectiveness of alpha-blockers, anticonvulsants and antihypertensive drugs. clonidine and antihistamines increase the inhibitory effect on the central nervous system, atropine increases the risk of intestinal paralysis. At the same time, the hypotensive effect of clonidine and methyldopa is reduced.

Barbiturates, nicotine reduce the effectiveness of the drug. Cocaine increases the risk of developing arrhythmias. In local adrenomimetics, the vasoconstrictor effect increases. The use of thyroid hormones together with the drug increases both mutual therapeutic effect and toxic effects.

Analogues

It is taken orally immediately after a meal (irritates the gastric mucosa), washed down with a small amount of water.

If it is impossible to prescribe Amitriptyline to the patient, the doctor may prescribe one of the following analogues:

Saroten;
Anafranil;
doxepin;
Novo-Triptin;
Melipramine.

It should be understood that each of the above drugs has its own side effects and contraindications, which should be considered when using these drugs.

Structural analogues of Amitriptyline are:

Amizol,
Amirol,
Saroten,
Triptizol,
Elivel.

In addition, there are other antidepressant drugs. The group of tricyclic antidepressants also includes imipramine and clomipramine. However, of course, it is the prerogative of a psychotherapist, neurologist or neuropathologist to select the necessary remedy for depression, and self-medication here is inappropriate and even dangerous.

A classic and highly effective tricyclic antidepressant is Amitriptyline Nycomed. Reviews about him are usually positive. This medicine has wide range applications.

pharmachologic effect

The drug "Amitriptyline" is an antidepressant from a number of tricyclic compounds. It is a derivative of dibenzocycloheptadine. The action of amitriptyline is associated with the stimulation of serotonergic and adrenergic mechanisms of the brain by suppressing the reuptake of mediators. It gives a sedative effect, exhibits antihistamine and anticholinergic activity. The antidiuretic benefit in nighttime incontinence is achieved through anticholinergic activity. The drug has an analgesic effect, which is believed to be associated with changes in the concentration of monoamines in the central nervous system and the effect of tricyclic compounds on opioid endogenous systems.

Pharmacokinetics

It is believed that the drug "Amitriptyline" has good bioavailability. Reviews usually confirm this. The bioavailability of the drug is 31-61%. It binds to blood proteins by 82-96%. Metabolization is carried out with the formation of the metabolite nortriptyline (active). The half-life is 31-46 hours. The drug is excreted mainly through the kidneys.

Indications

The drug is used during the depressive phase of manic-depressive psychoses, various depressions (including children's), with mixed emotional disorders, with pathological behavioral disorders. In children's enuresis (with the exception of patients with hypotonic bladder pathology), the medicine "Amitriptyline" has proven itself quite well. Reviews about its action are good. The drug is also prescribed for bulimia nervosa and chronic pain syndromes. Also, this remedy is prescribed for the treatment of bulimic neurosis, psychogenic anorexia, with chronic neurogenic pain, in order to prevent migraine.

Dosing

Amitriptyline tablets are taken orally (without chewing) after meals. For adults, the initial dose is 25 mg 2 to 4 times a day. Maximum dosages for outpatient treatment - 150 mg per day, for inpatient treatment - 300 mg per day, and for the elderly 100 mg. The medication can be administered intravenously or intramuscularly at a dose of 20-40 mg four times a day. Over time, injections can be replaced by oral administration. Course - no more than 6 months. For children, the drug is prescribed as an antidepressant in dosages of 10-30 mg, for adolescents - 10 mg three times a day, for the treatment of enuresis in children over six years of age - 12-25 mg at night. The dosage should not exceed the proportion of 2.5 mg per 1 kg of body weight.

Side effects

As a rule, the medicine "Amitriptyline" is well tolerated. Feedback on the use is positive. However, various side effects are possible. CNS: disorientation, hallucinations, drowsiness, extrapyramidal disorders, fatigue, anxiety, trembling. Cardiovascular system: tachycardia, orthostatic hypotension, conduction disturbance. Gastrointestinal: cholestatic jaundice, vomiting, stomatitis. reproductive system: delayed ejaculation, various disorders, changes in libido, decreased potency. Endocrine system: diabetes, glucosuria, hyperglycemia, decreased glucose tolerance, inadequate ADH secretion. Metabolism: weight gain. Allergic reactions: skin rashes, itching. Effects caused by anticholinergic activity: disturbances of accommodation, dry mouth, urinary retention, increased intraocular pressure, blurred vision, constipation. Side effects occur infrequently when taking the medication "Amitriptyline". Reviews about it are generally positive.

Contraindications

The drug should not be prescribed against the background of the following diseases: with angle-closure glaucoma, atony of the bladder, prostate hypertrophy, paralytic ileus, pyloric stenosis, epilepsy, early recovery period after a heart attack. The drug also can not be used simultaneously with MAO inhibitors. It is also contraindicated to use the drug for decompensated heart defects, blood diseases, glaucoma, severe liver and kidney diseases, stomach ulcers and hypersensitivity To active ingredient and other components of the drug.

Pregnancy and lactation

The drug "Amitriptyline" should not be used during pregnancy, and especially in the 1-3 trimesters. The use of the drug is allowed only when absolutely necessary. The point is that adequate clinical research the effect of the drug on the fetus and the mother's body was not carried out. Therefore, it is not known how safe it is. In experimental studies, the drug gave a teratogenic effect in dosages much higher than normal.

special instructions

With great care, this drug is used for heart failure, arrhythmias, coronary artery disease. Abrupt discontinuation of medication can lead to the development of a withdrawal syndrome. This tool can be used no earlier than two weeks after taking MAO inhibitors. You can not use the drug simultaneously with sympathomimetic medications: with epinephrine, isoprenaline, ephedrine, phenylephrine, norepinephrine, phenylpropanolamine. Prescribed with great care this medicine together with drugs that have an anticholinergic effect. Do not drink alcohol while taking the medication. Means "Amitriptyline" affects the ability to control mechanisms. During therapy, it is necessary to refrain from activities associated with a potential danger, requiring a good speed of reactions and increased attention. This drug was included in the list of essential drugs. With an overdose of Amitriptyline, the following symptoms are observed: disorientation, drowsiness and confusion, fever, dysarthria, shortness of breath, dilated pupils, hallucinations, stupor, convulsions, arrhythmia, muscle rigidity, hypotension, respiratory depression, heart failure.

drug interaction

As a rule, with the simultaneous use of Amitriptyline with other drugs that have a depressant effect on the central nervous system, as well as with alcohol, an excessive increase in depression of the central nervous system is possible. The effect of alcohol is enhanced. In addition, hypotensive effects and respiratory depression may be observed. If you take the medicine together with other drugs that are characterized by anticholinergic activity, it is possible to increase the anticholinergic effect. Taking the drug "Amitriptyline" with symptomatic medications enhances their effect on the heart and the cardiovascular system as a whole. Because of this, the risk of developing various rhythm disturbances, arterial hypertension (severe forms), and tachycardia increases. Reception with guanethidine and clonidine reduces the hypotensive effect of these drugs. Use together with barbiturates: with quinidine - slowing down the metabolism of the drug "Amitriptyline", with carbozepine - a significant decrease in the effect of the drug due to a strong acceleration of its metabolism. Simultaneous use together with cimetidine also slows down the metabolism of Amitriptyline, and also increases its plasma concentration and increases the risk of toxic effects.