Amitriptyline

When ATH:
N06AA09

Characteristic.

Tricyclic antidepressants. Amitriptyline hydrochloride - a white crystalline powder;, easily soluble in water, ethanol, xloroforme.

Pharmacological action.
Timolepticheskoe, antidepressant, anxiolytic, sedation.

Application.

Depression (Endogenous, involution, reactive, neurotic, with organic brain damage, medication), depressive syndrome, schizophrenic psychoses, anxiety and depressive states of different genesis, mixed emotional disorders, behavioral disturbances, psihogennaya anorexia, children enuresis (except for children with hypotonic bladder), severe pain neurogenic nature, prevention of migraine.

Contraindications.

Hypersensitivity, glaucoma, epilepsy, prostatic hyperplasia, atonic bladder, pseudoileus, pyloristenosis, myocardial infarction, use of MAO inhibitors in the previous 2 Sun, pregnancy, lactation, Children up to age 6 years (for injectable forms — to 12 years).

Restrictions apply.

Be wary of CHD, Arrhythmia, Heart Failure.

Pregnancy and breast-feeding.

Contraindicated in pregnancy. At the time of treatment should stop breastfeeding.

Side effects.

Blockade of peripheral m-cholinergic receptors: dry mouth, urinary retention, constipation, blurred vision, akkomodacii, desudation.

CNS: drowsiness, dizziness, tremor.

Cardio-vascular system: tachycardia, orthostatic hypotension, pressurization, asequence, ECG changes (especially QRS).

Allergic reactions: skin rashes, etc..

Cooperation.

Incompatible with MAO inhibitors. Potentiates the effect of the compounds, CNS depressants (incl. sedativnyh, hypnotics, alcohol), sympathomimetics, antiparkinsonian, ters of gipotenziveh and protivosudorozhnykh drugs —. Inductors of microsomal oxidation (barbiturates, Carbamazepine) lower, cimetidine and increases the concentration in plasma.

Overdose.

Symptoms: hallucinations, convulsions, delirium, coma, violation of cardiac conduction, arrythmia, ventricular arrhythmias, hypothermia etc..

Treatment: gastric lavage, receiving a suspension of activated charcoal, laxatives, maintenance of body temperature, monitoring function of the cardiovascular system at least 5 days; in severe anticholinergic symptoms (gipotenziya, arrhythmia, coma) — 0.5-2 g fizostigmina in/m or/in. Hemodialysis and forced diuresis are not effective.

Dosing and Administration.

Inside, without chewing, after meal, adults initial dose is on 25 mg 2-4 times a day. The maximum dose for outpatient treatment is to 150 mg / day, in the hospital, until 300 mg / day, in older patients, until 100 mg / day.

/ M or I / (administered slowly) at a dose of 20-40 mg 4 once a day. Injections are gradually replacing ingestion. The course of treatment no more than 6-8 months.

Babies, as an antidepressant: from 6 to 12 years is 10-30 mg or 1-5 mg/kg/day batches, in adolescence — by 10 mg 3 once a day (optionally up 100 mg per day); for the treatment of nocturnal enuresis children over 6 years — 12.5-25 mg per night (dose should not exceed 2,5 mg / kg body weight).

Precautions.

Admission amitriptyline possible not earlier than 14 days after discontinuation of MAO inhibitors. Older children and recommended lowering the dose. It should appoint a manic patients. Due to the possibility of suicide attempts in depressed patients require regular monitoring of patients, particularly in the first weeks of treatment, and the appointment to the minimum necessary dose to reduce the risk of overdose. In the absence of improvement of the patient for 3-4 weeks is necessary to reconsider the tactics of treatment. During treatment should avoid alcohol, and abandon activities, requiring attention and quick response.

Cooperation