Amitriptyline
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- For other uses, see Amitriptyline (disambiguation).
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Amitriptyline
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| Systematic (IUPAC) name | |
| 3-(10,11-dihydro-5H-dibenzo[a,d] cycloheptene-5-ylidene)-N, N-dimethyl-1-propanamine | |
| Identifiers | |
| CAS number | 549-18-8 |
| ATC code | N06AA09 |
| PubChem | 2160 |
| DrugBank | APRD00227 |
| Chemical data | |
| Formula | C20H23N |
| Mol. weight | 277.403 g/mol |
| Pharmacokinetic data | |
| Bioavailability | 40% |
| Metabolism | Hepatic |
| Half life | 12-24 hours |
| Excretion | Renal |
| Therapeutic considerations | |
| Pregnancy cat. |
C[1] |
| Legal status | |
| Routes | Oral |
Amitriptyline hydrochloride (sold as Elavil®, Tryptanol®, Endep®, Elatrol®, Tryptizol®, Trepiline®) is a tricyclic antidepressant drug. It is a white, odorless, crystalline compound which is freely soluble in water and usually dispensed in tablet form.
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[edit] Mechanism of Action
Amitriptyline affects serotonin and noradrenaline reuptake almost equally.
[edit] Uses
[edit] Approved
Amitriptyline is approved for the treatment of endogenous depression and involutional melancholia (depression of late life, which is no longer seen as a disease in its own right),[2] and reactive depression and for depression secondary to alcoholism and schizophrenia. Adult typical dosages are 75 to 200mg daily, with half this initially for elderly or adolescents.
It may also be used to treat nocturnal enuresis (bed wetting). Children between the ages of 7 to 10 years having a dose of 10 to 20 mg, older children 25 to 50mg at night. It should be gradually withdrawn at the end of the course, which overall should be of no more than 3 months.[3]
[edit] Unapproved/Off-Label/Investigational
Amitriptyline may be prescribed for other conditions such insomnia, migraine, rebound headache, chronic pain, postherpetic neuralgia (persistent pain following a shingles attack), fibromyalgia, vulvodynia, interstitial cystitis, irritable bowel syndrome and as a preventative (prophylaxis) for patients with frequent migraines. It is also used in small (10mg) doses to act as a painkiller and ease the effects of Carpal Tunnel Syndrome. Typically lower dosages are required for pain modification of 10 to 50mg daily.[3]
Amytriptiline in very small doses (5mg a day) is also sometimes prescribed to help ease the symptoms of chronic fatigue syndrome. It is thought to help combat symptoms of insomnia primarily, in addition to other selected symptoms of the affliction.
A randomized controlled trial published in June of 2005 found that amitriptyline was effective in functional dyspepsia refractory to famotidine and mosapride combination therapy.[4]
[edit] Overdose
The symptoms and the treatment of an overdose are largely the same as for the other tricyclic antidepressants.
[edit] Footnotes
- ^ Professional Information Brochure - ELAVIL®
- ^ Weissman MM. "The myth of involutional melancholia." Journal of the American Medical Association. 1979 Aug 24-31;242(8):742-4. PMID 459064
- ^ a b British National Formulary 45 March 2003
- ^ Otaka M, Jin M, Odashima M, Matsuhashi T, Wada I, Horikawa Y, Komatsu K, Ohba R, Oyake J, Hatakeyama N, Watanabe S. "New strategy of therapy for functional dyspepsia using famotidine, mosapride and amitriptyline." Alimentary Pharmacology & Therapeutics. 2005 Jun;21 Suppl 2:42-6. PMID 15943846 Fulltext
[edit] References
- PubChem Substance Summary: Amitriptyline National Center for Biotechnology Information.
- TREPILINE®-10 TABLETS; TREPILINE®-25 TABLETS South African Electronic Package Inserts. 12 May 1978. Revised February 2004.
- SAROTEN® RETARD 25 mg Capsules; SAROTEN® RETARD 50 mg Capsules South African Electronic Package Inserts. December 1987. Updated May 2000.
