Amitriptyline Information(Elavil, Endep)

Facts and Summary of Elavil:

Amitriptyline hydrochloride (Elavil) is used to reduce depression, and belongs to a general class of drugs called tricyclic antidepressants.

Amitriptyline hydrochloride works by increasing the amount of serotonin and norepinephrine in the brain, so that the feeling of depression is prevented or relieved. By a separate mechanism, amitriptyline hydrochloride also may reduce peripheral nerve pain.

How drug is given:
Amitriptyline hydrochloride is given orally, taken in divided doses or as a single dose at bedtime. Take pill with food if you have stomach upset. Keep pills in a tightly closed container and out of the reach of children. Amitriptyline hydrochloride may also be given by intramuscular injection.

Dosage Information:
This drug can be given at different strengths depending on the type of cancer being treated. Dosage will vary depending on your body weight and the type of cancer being treated.

FDA Approval:
This drug is approved for cancer treatment.

Possible Side Effects

Amitriptyline has numerous side effects on several of the body systems

* Cardiovascular: Myocardial infarction(heart attack); stroke; arrhythmias(irregular heartbeat); hypotension(low blood pressure), particularly orthostatic hypotension(low blood pressure upon standing); syncope(fainting); hypertension(high blood pressure); tachycardia(rapid heartbeat); palpitation.

*CNS and Neuromuscular: Coma; seizures; hallucinations; delusions; confusional states; disorientation; incoordination; ataxia(failure of muscle coordination); tremors; numbness, tingling, and paresthesias of the extremities; dysarthria(Imperfect articulation of speech due to disturbances of muscular control); disturbed concentration; excitement; anxiety; insomnia; restlessness; nightmares; drowsiness; dizziness; weakness; fatigue; headache; tinnitus(ringing in the ear);

*Allergic: Skin rash; urticaria; photosensitization; edema(swelling) of face and tongue.

*Gastrointestinal: Rarely hepatitis (including altered liver function and jaundice); nausea; epigastric distress; vomiting; anorexia; stomatitis; peculiar taste; diarrhea

*Endocrine: Testicular swelling and gynecomastia in the male(development of breasts); breast enlargement in the female; increased or decreased libido; impotence; elevation and lowering of blood sugar levels.

*Other: Alopecia(hair loss); edema; weight gain or loss; urinary frequency; increased perspiration.

Precautions and drug interactions:

Amitriptyline should not be taken with the following medications:


*Other Antidepressants

*Alcohol and barbituates


Other precautions

*The possibility of suicide in depressed patients remains until significant remission occurs. Potentially suicidal patients should not have access to large quantities of this drug. Prescriptions should be written for the smallest amount feasible.

When possible, the drug should be discontinued several days before elective surgery.

*Both elevation and lowering of blood sugar levels have been reported.

*Amitriptyline HCl should be used with caution in patients with impaired liver function.

Discontinuation of Treatment with Amitriptyline

After prolonged administration, abrupt cessation of treatment may produce nausea, headache, and malaise. Gradual dosage reduction has been reported to produce, within two weeks, transient symptoms including irritability, restlessness, and dream and sleep disturbance.

Pregnancy and Nursing Mothers

Amitriptyline has been shown to cross the placenta. Although a causal relationship has not been established, there have been a few reports of adverse events, including Central Nervous System effects, limb deformities, or developmental delay, in infants whose mothers had taken amitriptyline during pregnancy. There are no adequate and well-controlled studies in pregnant women. Amitriptyline HCl should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the fetus.

Amitriptyline is excreted into breast milk. Because of the potential for serious adverse reactions in nursing infants from amitriptyline, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use

In view of the lack of experience with the use of this drug in children, it is not recommended at the present time for patients under 12 years of age.

Geriatric Use

Clinical experience has not identified differences in responses between elderly and younger patients. In general, dose election for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased liver function, concomitant disease and other drug therapy in elderly patients.

Recommended Dosage

Dosage should be initiated at a low level and increased gradually, noting carefully the clinical response and any evidence of intolerance. 75 mg of amitriptyline HCl a day in divided doses is usually satisfactory. If necessary, this may be increased to a total of 150 mg per day. Increases are made preferably in the late afternoon and/or bedtime doses. A sedative effect may be apparent before the antidepressant effect is noted, but an adequate therapeutic effect may take as long as 30 days to develop.


Deaths may occur from overdosage with this class of drugs. Multiple drug ingestion (including alcohol) is common in deliberate tricyclic antidepressant overdose. As the management is complex and changing, it is recommended that the physician contact a poison control center for current information on treatment. Signs and symptoms of toxicity develop rapidly after tricyclic antidepressant overdose; therefore, hospital monitoring is required as soon as possible.

Symptoms of overdose include: cardiac dysrhythmias(defective heart rhythm), severe hypotension, convulsions, and CNS depression, including coma.

Amitriptyline is indicated for the relief of symptoms of depression. For technical analysis of Elavil see here.

Information for the informed athlete:

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