section name header

Pronunciation ⬇

a-mee-TRIP-ti-leen

Classifications ⬆ ⬇

Therapeutic Classification: antidepressants

Pharmacologic Classification: tricyclic antidepressants

Indications ⬆ ⬇

BEERS REMS

Unlabeled Use:
  • Anxiety, insomnia, treatment-resistant depression.
  • Chronic pain syndromes (i.e., fibromyalgia, neuropathic pain/chronic pain, headache, low back pain).

Action ⬆ ⬇

  • Potentiates the effect of serotonin and norepinephrine in the CNS.
  • Has significant anticholinergic properties.
Therapeutic effects:
  • Antidepressant action.

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed from the GI tract.

Distribution: Widely distributed.

Protein Binding: 95% bound to plasma proteins.

Metabolism/Excretion: Extensively metabolized by the liver, primarily by the CYP2D6 isoenzyme; the CYP2D6 enzyme system exhibits genetic polymorphism (∼7% of population may be poor metabolizers and may have significantly ↑ amitriptyline concentrations and an ↑ risk of adverse effects). Some metabolites have antidepressant activity. Undergoes enterohepatic recirculation and secretion into gastric juices. Probably crosses the placenta and enters breast milk.

Half-Life: 10–50 hr.

Time/Action Profile ⬆ ⬇

(antidepressant effect)

ROUTEONSETPEAKDURATION
PO2–3 wk (up to 30 days)2–6 wkdays–wk



Contraind./Precautions ⬆ ⬇

Contraindicated in:

Use Cautiously in:

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension, ARRHYTHMIAS, QT interval prolongation, TORSADES DE POINTES

Derm: photosensitivity

EENT: blurred vision, dry eyes, dry mouth

Endo: changes in blood glucose, gynecomastia

GI: constipation, hepatitis, paralytic ileus

GU: ↓libido, urinary retention

Hemat: blood dyscrasias

Metab: ↑appetite, weight gain

Neuro: lethargy, sedation, SUICIDAL THOUGHTS

Interactions ⬆ ⬇

Drug-drug:

Drug-Natural Products:

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

(Generic available)

Assessment ⬆ ⬇

Lab Test Considerations:

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

Canadian Brand Names ⬆ ⬇

Elavil

Pill Image

amitriptylinehcl_195-1815.jpg

Code ⬆

NDC Code