Indications:

Amitip 10 mg Tablet is indicated in-

• Depressive Illness: particularly where sedation is required.
• Nocturnal Enuresis in children.
• Prophylaxis of Migraine.
• Tension Headache.
• Chronic Pain.

Pharmacology:

As the mechanism of action of this drug is not fully elucidated that’s why 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.

Dosage (breakdown or, not) :

Adult: 

Bipolar illness, pregnancy, lactation elderly, CVS disease, renal or liver impairment, epilepsy, thyroid dysfunction, DM. Avoid abrupt withdrawal; urinary retention, prostatic hyperplasia; chronic constipation; angle-closure glaucoma; phaeochromocytoma. Monitor for signs of clinical worsening, suicidality or behavioural changes. May increase risks associated with electro-convulsive therapy. May affect ability to drive or operate machinery. Lactation: Distributed in breast milk; do not nurse (AAP states effect on nursing infants is unknown but may be of concern)

Child: 

Amitriptyline is a dibenzocycloheptadiene tricyclic antidepressant. It increases synaptic concentration of serotonin and/or norepinephrine in the CNS by blocking the neuronal reuptake of norepinephrine and serotonin.

Administration:

Nocturnal Enuresis: Child 7-10 years: 10-20 mg, 11-16 years: 25-50 mg at night; max. period of treatment (including gradual withdrawal) 3 months-full physical examination before the further course.

Depression: Initially 75 mg (Elderly and Adolescents 30-75 mg) daily in divided doses or as a single dose at bedtime increased gradually as necessary to 150-200 mg; Child under 16 years not recommended for depression.

Tension Headache: 10-25 mg three times daily.

Prophylaxis of Migraine: 100 mg daily.

Interaction:

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. Disulfiram and Cimetidine inhibit the metabolism of Amitriptyline. When TCA is used with diuretics, it enhances the risk of postural hypotension.

Contraindication:

Recent myocardial infarction, arrhythmias (particularly heart block), manic phase, severe liver disease.

Side Effects: 

• Cardiovascular reactions: Hypotension, syncope, postural hypotension, hypertension, tachycardia, palpitations, myocardial infarction, etc.
• Anticholinergic: Excessive perspiration, dry mouth, blurred vision, hyperpyrexia, urinary retention and urinary tract dilatation.
• CNS and Neuromuscular: Confusional states, disturbed concentration, disorientation, delusions, etc.
• Endocrine: Testicular swelling, gynaecomastia, breast enlargement, galactorrhoea, etc.
• Allergic: Skin rash, urticaria, photosensitization, etc.
• Haematological: Bone-marrow depression.
• Gastrointestinal: Nausea, epigastric distress, vomiting, anorexia, stomatitis, unpleasant taste, weight loss, diarrhoea, constipation, etc.

Pregnancy: 

Not recommended in pregnancy and lactation

Precautions & Warnings: 

Cardiac disease (particularly with arrhythmias), history of epilepsy, hepatic impairment (avoid if severe), thyroid disease, history of mania, psychoses (may aggravate psychotic symptoms), angle-closure glaucoma, history of urinary retention, concurrent electroconvulsive therapy.

Storage Conditions:

Store in a cool and dry place, below 30°C. Protect from light and moisture.