Technical information of Amitriptyline (Elavil)

Trade Name : Elavil
Generic Name: amitriptyline hydrochloride

Metabolism: Well absorbed from GI tract. Distributed to lungs, heart, brain, liver; highly bound to plasma, proteins. Plasma half-life of 10-50 hours. Metabolized in liver, excreted in urine and, to a lesser degree, in bile and feces.

Dosage Range:Adult:

Oral: 25-100 mg PO hs divided or single dose; may increase to 200-300 mg/day (300 mg maximum).
Cancer pain: 25 mg/day hs; may increase by 25 mg of 1-2 days to 75-100 mg, when desired relief is reached; may start at 10 mg in elderly.
Elderly: 30 mg/day in divided doses.
Intramuscular (IM): 20-30 mg qid or as single dose at bedtime.

Drug Preparation:

Oral: Store in well-closed containers at 15-30o C (59-86o F); store Elavil 10-mg capsules away from light. Administer as a single bedtime dose.

Drug Interactions:

Monamine oxidase inhibitors (MAOIs): increased excitation, hyperpyrexia, seizures; use together cautiously (especially if high dose is used).
CNS depressants (alcohol, sedatives, hypnotics): increase CNS depression; use together cautiously.
Sympathomimetic (epinephrine, amphetamines): increased hypertension; AVOID concurrent use.
Cimetidine methylphenidate: increased amitriptyline levels, increased toxicity; use cautiously and monitor for increased toxicity.
Warfarin: may increase PT; monitor closely and decrease dose of Warfarin as needed.

Lab Effects:

None known; bone marrow depression uncommon.

Special Considerations:

Antidepressant effect may take 2 weeks or longer.
Adjuvant analgesic useful in cancer pain management.
May also decrease depression associated with chronic cancer pain and promote improved sleep.
Contraindicated in patients with myocardial infarction, seizure disorder, or benign prostatic hypertrophy.
Use cautiously in patients with urine retention, narrow-angle glaucoma, hyperthyroidism, hepatic dysfunction, or suicidal ideation.
Drug should be gradually discontinued rather than abruptly withdrawn to prevent anxiety, malaise, dizziness, nausea/vomiting.
May be helpful in treating hiccups.
Increased anticholinergic side effects in elderly.

Drug Administration:

IM: Administer IM in large muscle mass; change to oral as soon as possible.

Mechanism:Blocks reuptake of neurotransmitters at neuronal membrane, thus increasing available serotonin, norepinephrine in CNS, and potentiating their effects. Appears to have analgesic effect separate from antidepressant action. May increase bioavailability of morphine. Indicated in the treatment of depressive (affective) mood disorders. Also used as an adjuvant analgesic in cancer pain management.

Class:Tricyclic antidepressant.

Side Effects:

I. ALTERATIONS IN SENSORY/PERCEPTUAL PATTERNS related to DROWSINESS, FATIGUE, EPS
Defining Characteristics: Drowsiness, dizziness, weakness, lethargy, and fatigue are common; confusion, disorientation, hallucinations may occur in the elderly. Extrapyramidal symptoms may occur (fine tremor, rigidity, dystonia, dysarthria, dysphagia), as may peripheral neuropathy and blurred vision.

Nursing Implications:Assess baseline gait, neurologic and mental status, and monitor during therapy. Instruct patient to report signs/symptoms; discuss benefit/risk ratio with physician. Assess for signs/symptoms of suicidal ideation; if they occur, refer for psychiatric evaluation. Inform patient that drowsiness, dizziness will resolve after 1-2 weeks; instruct to avoid hazardous activities while drowsy (e.g., driving a car, operating machinery).

II. ALTERATION IN CARDIAC OUTPUT related to POSTURAL HYPOTENSION, TACHYCARDIA

Defining Characteristics: Postural hypotension, EKG changes, tachycardia, hypertension may occur.

Nursing Implications: Assess baseline orthostatic BP, heart rate, and monitor during therapy. Instruct patient to report abnormalities including postural dizziness, palpitations. Drug should be stopped several days before surgery to prevent hypertensive crisis, especially if high dose.

III. ALTERATION IN NUTRITION, LESS THAN BODY REQUIREMENTS, related to GI SIDE EFFECTS

Defining Characteristics: Dry mouth, anorexia, nausea, vomiting, diarrhea, abdominal cramping may occur; also, elevated LFTs.

Nursing Implications: Assess baseline nutrition and elimination patterns and LFTs, and monitor during therapy. Discuss abnormalities with physician, and discuss drug modification. Teach patient to self-administer prescribed antiemetics as appropriate. LFTs should be repeated, and if still elevated, the drug should be discontinued. Teach patient to take full dose at bedtime. Suggest patient use sugar-free hard candy, frequent ice chips, or artificial saliva for dry mouth.

IV. ALTERATION IN URINARY ELIMINATION related to URINARY RETENTION

Defining Characteristics: Urinary retention may occur. Increased risk if patient has history of urinary retention.

Nursing Implications: Assess baseline urinary elimination pattern and risk. Assess for urinary retention, and instruct patient to report signs/symptoms. Discuss alternative drug with physician if this occurs.

V. ALTERATIONS IN SKIN INTEGRITY related to ALLERGY

Defining Characteristics: Urticaria, erythema, rash, and photosensitivity may occur.

Nursing Implications: Assess baseline drug allergy history and skin integrity. Instruct patient to report skin changes. If angioedema of face, tongue develops, discuss drug discontinuance with physician. Instruct patient to avoid sunlight or to use sunblock protection.

Remember:

You should read and understand the following information. If any of it causes you special concern, check with your doctor.

Should I avoid any other medications, foods, alcohol, and/or activities?
Your prescription and nonprescription medications may interact with other drugs, causing a harmful effect. Certain foods or alcohol can also interact with drug products. Never begin taking a new medication, prescription or nonprescription, without asking your doctor or nurse if it will interact with alcohol, foods or other medications. Some drug products can cause drowsiness and may affect activities such as driving. Your prescription and nonprescription medications may interact with other drugs, causing a harmful effect. Certain foods or alcohol can also interact with drug products. Never begin taking a new medication, prescription or nonprescription, without asking your doctor or nurse if it will interact with alcohol, foods or other medications. Some drug products can cause drowsiness and may affect activities such as driving.

SIDE EFFECTS

Side effects may occur whilst taken this drug although this is very rare. Side effects may include headache, vomiting, constipation, diarrhea, upset stomach, joint pain, menstrual pain, swelling, and loose stools.

Medical attention must be sought if any of the following side effects occur: blood in urine, confusion, fever, rash, urinating less than usual or not at all, itching and yellow skin and eyes. For more information in layman terms and to buy Elavil see here

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