Depressive illness, particularly with anxiety & nocturnal enuresis in children.
Tricyclic; Antidepressant
The mechanism of action of this drug is not fully elucidated. It is suggested that amitriptyline inhibits the membrane pump mechanism responsible for the re-uptake of transmitter amines, such as norepinephrine and serotonin, thereby increasing their concentration at the synaptic clefts of the brain. These amines are important in regulating mood. The monoamine hypothesis in depression, one of the oldest hypotheses, postulates that deficiencies of serotonin (5-HT) and/or norepinephrine (NE) neurotransmission in the brain lead to depressive effects. This drug counteracts these mechanisms, and this may be the mechanism of amitriptyline in improving depressive symptoms. Whether its analgesic effects are related to its mood-altering activities or attributable to a different, less obvious pharmacological action (or a combination of both) is unknown.
25-50 mg a day in divided dose.
TCA enhances the sedative effect of alcohol and opioid analgesics. When TCA is used with Moxifloxacin or Terfenadine, it increases the risk of ventricular arrhythmias. Disulfirum and Cimetidine inhibit the metabolism of Amitriptyline. When TCA is used with diuretics, it enhances the risk of postural hypotension.
Myocardial infarction; arrythmias, particularly heartblock of any degree; mania; severe liver disease. Caution in patients with a history of epilepsy, glaucoma, urinary retention, prostatic hypertrophy, constipation, cardiac disease, diabetes, pregnancy, hepatic impairment, thyroid disease, increased intraocular pressure, psychoses (may aggravate mania).
Hypotension, syncope, postural hypotension, hypertension, tachycardia, palpitations, myocardial infarction, arrythmias, & heart block stroke. Confusional states, disorientation, delusions, & hallucinations. Dry mouth, blurred vision, mydriasis, increased intraocular pressure, hyperplasia. Skin rash, urticaria, & photosensitization. Bone-marrow depression, Gastrointestinal: Nausea, epigastric distress, vomiting anorexia, diarrhoea. Testicular swelling, gynaecomastia; breast enlargement, galactorrhoea. Dizziness, weakness, fatigue, headache, weight loss.
The drug should be used during pregnancy & lactation if potential benefit justifies the potential risk to the fetus.
Store in a cool and dry place, below 30°C. Protect from light and moisture.
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