Amitriptyline

Question 1

Drug Class

Answer 1

Tricyclic Antidepressants (TCA)

Question 2

Active

Answer 2

Amitriptyline

Question 3

Indications

Answer 3

Major depression

Nocturnal enuresis (amitriptyline, imipramine, nortriptyline)

Neuropathic pain (amitriptyline, doxepin)

OCD (clomipramine)

ADHD (imipramine, nortriptyline)

Migraine prophylaxis (amitriptyline)

Question 4

Dose Range

Answer 4

Depression:
25 - 75mg daily, increasing by 25-50mg every 2-3 days to
75 - 150mg d (M=300mg d*)

Question 5

SE’s

Answer 5

• sedation (H1)
• dry mouth (anti-cholinergic)
• blurred vision
• constipation
• urinary retention
• sinus tachycardia
• orthostatic hypotension (%1)
• dizziness
• impotence loss of libido
• sweating
• agitation
• seizures
• prolonged QT interval

Question 6

Counselling

Answer 6

Labels: 1, 9, 16, 13

• This medication may cause drowsiness and may increase the effects of alcohol. Avoid driving and operating machinery until you know how you react to the medication and your doctor says that you can.
• Full effect may not be seen for several weeks. Continue taking it and do not stop suddenly unless the doctor tell you to.
• You may feel dizzy on standing when taking this medicine. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy.
• You may also get side effects such as blurred vision, drowsiness and dry mouth. They may be troublesome but may lessen or disappear after about 7 days. Try taking this medicine at night to reduce daytime drowsiness. Sips of water, sugarless gum/sweets/drinks may help relieve dry mouth Discuss any problems with your doctor or pharmacist.

Question 7

Monitoring

Answer 7

• monitor patient’s behaviour regularly (increased suicidal thoughts and behaviour during initial treatment)
• Regular psychiatric review to monitor for compliance, tolerability and any signs of worsening disease
• BP (before and after treatment and after each dose change)