Last Updated on September 18, 2021 by Dr.Derek Fhisher
Most popular brand: Elavil
Active ingredient: Amitriptyline
Available dosage forms: 10, 25, 50, 75 mg
Amitriptyline is an anti-depressant drug. It is not considered the same as anti-depressants such as Prozac. It belongs to a different class of drugs.
It is prescribed to patients with mood disorders, particularly depression. Patients with insomnia also have found Amitriptyline very effective. It is usually used in the acute phase of depression, that is, if you feel you are depressed. It is generally not used if the depression is already mild. Amitriptyline can be taken for 3 to 6 months, depending on the severity of your depression. Amitriptyline can be used as a second line drug when you do not get satisfactory relief from anti-depressants such as Prozac. Amitriptyline is one of the very few anti-depressants which is very widely used. Amitriptyline is available in many over the counter drugs, but in a few of them, you have to go to the doctors for prescription. This is because the dosage of the drug is very carefully controlled. You have to go to the doctor before the prescription is issued and the dosage is measured for you. If you have to take Amitriptyline, you should first tell your doctor about any medications you are already taking.
Amitriptyline is given to treat depression. Amitriptyline is sometimes used when depression is the cause of suicide.
Amipryline is an older, more commonly used anti-depressant medication. Amitriptyline is more commonly used today.
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What is Amitriptyline?
Amitriptyline is a tertiary amine and a tricyclic compound. Its mechanism of action is not completely known, but is most likely the result of a number of different actions of its primary pharmacological effects. These include inhibition of reuptake of serotonin and norepinephrine at their respective presynaptic nerve terminals, the enhancement of postsynaptic serotonin and norepinephrine actions, blockade of the reuptake of serotonin at the presynaptic terminal of serotonin neurons in the hippocampus, blockade of α1 and α2 adrenergic receptors, inhibition of 5-hydroxytryptamine2 (5-HT2) receptors, and enhancement of the antinociceptive effects of these various neurotransmitters and their actions at their respective receptors. There is also some evidence for the use of amitriptyline in the treatment of chronic neuropathic pain, including diabetic neuropathy, cancer pain, fibromyalgia, and chronic pain associated with multiple sclerosis.
How to take and dosage
Assign inside, without chewing, immediately after a meal (to reduce irritation of the gastric mucosa).
Adults with depression initial dose – 25 – 50 mg at night, then gradually the dose may be increased based on efficacy and tolerability up to a maximum of 300 mg / day. 3 admission (the greatest part of the dose is taken at night). When the therapeutic effect of the dose can be gradually reduced to the minimum effective depending on the condition of the patient. The duration of treatment is determined by the condition of the patient, efficacy and tolerability of the therapy, and can range from a few months to 1 year, and if necessary more. In old age with lung disorders, as well as bulimia nervosa, in the complex therapy of mixed emotional disorders and behavioral disorders, psychosis, schizophrenia, and alcohol withdrawal prescribed in doses of 25 – 100 mg / day. (At night), after reaching the therapeutic effect of switching to the minimum effective dose – 10 – 50 mg / day,.
For the prevention of migraine, chronic pain syndrome of neurogenic nature (including long-term headaches), as well as in the treatment of gastric ulcer and 12 – duodenum – 10 – 12.5 – 25 to 100 mg/day. (Maximum of the dose taken at night).
Babies as an antidepressant: from 6 to 12 years – 10 – 30 mg/day. or 1 – 5 mg/kg/day. fractional, in adolescence – up to 100 mg / day,.
When nocturnal enuresis in children 6 – 10 years – 10 – 20 mg/day. overnight 11 – 16 – 50 mg/day.
Amitriptyline may have some side effects. The most common side effect with this medication is drowsiness. This effect usually begins within a few days of beginning Amitriptyline and disappears over time. It can be more than just drowsiness. Other side effects include dry mouth, trouble sleeping, constipation, and headaches. If you notice any side effects, call your doctor or pharmacist. They can tell you what you should do.
The most common side effects that are seen with Amitriptyline include drowsiness, light-headedness, depression, dry mouth, constipation, trouble sleeping, and difficulty urinating.
Amitriptyline is a very safe medication. It is given in pill form and is absorbed through your stomach and intestines. This medication may not be appropriate for those who have seizures.
Related anticholinergic effect of the drug:
blurred vision, paralysis of accommodation, mydriasis, increased intraocular pressure (only in persons with local anatomical predisposition – narrow angle of anterior chamber), tachycardia, dry mouth, confusion (delirium or hallucinations), constipation, paralytic ileus, difficulty urinating.
drowsiness, fainting, fatigue, irritability, anxiety, disorientation, hallucinations (particularly in elderly patients and in patients with Parkinson’s disease), anxiety, agitation psychomotor, mania, hypomania , memory impairment, decreased ability to concentrate, insomnia, “nightmarish” dream, asthenia; headache; dysarthria, tremor of small muscles, especially arms, hands, head and tongue, peripheral neuropathy (paresthesia), myasthenia gravis, myoclonus; ataxia, extrapyramidal syndrome, acceleration and intensification of seizures; changes in the electroencephalogram (EEG).
From the cardiovascular system:
tachycardia, palpitations, dizziness, orthostatic hypotension, non-specific changes in the electrocardiogram (ECG) (interval S – t or T wave) in patients without heart disease; arrhythmia, labile blood pressure (decrease or increase in blood pressure), violation of intraventricular conduction (extension of the QRS complex, changing the interval P – Q, bundle branch block).
From the digestive tract:
nausea, heartburn, gastralgia, hepatitis (including altered liver function and cholestatic jaundice), vomiting, increased appetite and weight gain or loss of appetite and weight loss, stomatitis, taste alteration, diarrhea, darkening of the tongue.
From endocrine system:
the increase in size (swelling) of the testicles, gynecomastia; an increase in the size of the breast, galactorrhea; decreased or increased libido, reduced potency, hypo – or hyperglycemia, hyponatremia (decreased production of vasopressin), antidiuretic hormone syndrome of inappropriate secretion (ADH). Allergic reactions: skin rash, pruritus, photosensitivity, angioedema, urticaria.
hair loss, tinnitus, edema, hyperpyrexia, swollen lymph nodes, urinary retention, pollakiuria.
With long-term treatment, especially in high doses, when it stopped suddenly possible the development of the syndrome: nausea, vomiting, diarrhea, headache, malaise, insomnia, abnormal dreams, unusual excitement; while phasing out after long-term treatment – irritability, restlessness, insomnia, abnormal dreams.
The connection with taking the drug is not installed: lupus-like syndrome (migratory arthritis, the appearance of antinuclear antibodies and rheumatoid factor positive), abnormal liver function, ageusia.
Hypersensitivity, use together with MAO inhibitors and 2 weeks before starting treatment, myocardial infarction (acute and subacute periods), acute alcohol intoxication, acute intoxication with hypnotics, analgesic and psychoactive drugs, angle-closure glaucoma, the AV severe disorders and intraventricular conduction (bundle branch block, AV block II st.), lactation, children under 6 years of age.
Due to the content of the tablets of lactose monohydrate (milk sugar), the drug should not be taken by patients with rare hereditary disorders such as galactose intolerance, lactase deficiency or glucose – galactose malabsorption.
Use with caution in hepatic failure.
Amitriptyline should be used with caution in patients with alcoholism, bronchial asthma, schizophrenia (possible activation of psychosis), bipolar disorder, epilepsy, the oppression of bone – medullary hematopoiesis, cardio – vascular system (SSS) (angina, arrhythmias, heart block, congestive heart failure, myocardial infarction, hypertension), ocular hypertension, stroke, decreased motor function of the gastro – intestinal tract (GIT) (risk of paralytic ileus), liver and / or renal failure, hyperthyroidism, prostatic hyperplasia, urinary retention, hypotension, urinary bladder, pregnancy (especially I trimester), in old age.
Pregnancy and breastfeeding
Pregnant women should use the drug only if the expected benefit to the mother outweighs the potential risk to the fetus.
Penetrates into breast milk and may cause drowsiness in infants. In order to avoid the syndrome of “cancellation” in neonates (manifested by shortness of breath, drowsiness, intestinal colic, increased nervous irritability, increased or decreased blood pressure, tremor or spastic phenomena) receiving amitriptyline gradually canceled at least 7 weeks before the expected birth.