Description of the active substance (INN) Amitriptyline.
Pharmacology: Pharmacological action – antidepressant, anxiolytic, sedative, antidysuric. https://elavilnews.com/ inhibits the reuptake of neurotransmitters (norepinephrine, serotonin, etc.) by the presynaptic nerve endings of neurons, causes the accumulation of monoamines in the synaptic cleft, and enhances postsynaptic impulse. With prolonged use, it reduces the functional activity (desensitization) of beta-adrenergic and serotonin receptors in the brain, normalizes adrenergic and serotonergic transmission, and restores the balance of these systems, which is disturbed in depressive states. Blocks the m-choline and histamine central nervous system receptors.
In anxiety-depressive states, it reduces anxiety, agitation and depressive symptoms. The antidepressant effect develops within 2-3 weeks after the start of treatment. With a sudden cessation of administration after prolonged treatment, the development of the “withdrawal” syndrome is possible.
Indications: Depression (endogenous, involutional, reactive, neurotic, with organic brain damage, medication), depressive syndrome, schizophrenic psychoses, anxiety-depressive states of various origins, mixed emotional disorders, behavioral disorders, psychogenic anorexia, nocturnal enuresis (auxiliary treatment), severe pain of a neurogenic nature.
Contraindications: Hypersensitivity, glaucoma, epilepsy, prostatic hyperplasia, atony of the bladder, paralytic ileus, pyloric stenosis, a history of myocardial infarction, use of MAO inhibitors in the previous 2 weeks, pregnancy, breast-feeding, children (up to 6 years).
Use during pregnancy and lactation: Contraindicated in pregnancy. At the time of treatment should stop breastfeeding.
Side effects: Blockade of peripheral m-cholinergic receptors: dry mouth, urinary retention, constipation, impaired vision, accommodation, increased sweating.
From the cardiovascular system: tachycardia, orthostatic hypotension, increased pressure, impaired conductivity, ECG changes (especially QRS).
From the side of the central nervous system: drowsiness, dizziness, tremor.
Allergic reactions: skin rash, etc.
Interaction: Incompatible with MAO inhibitors. Potentiates the effect of compounds that depress the central nervous system (including sedatives, hypnotics, alcohol), sympathomimetics, antiparkinsonian drugs, weakens hypotensive and anticonvulsants. Inductors of microsomal oxidation (barbiturates, carbamazepine) reduce, and cimetidine increases the concentration in the plasma.
Overdose: Symptoms: hallucinations, convulsions, delirium, coma, cardiac conduction disturbance, extrasystole, ventricular arrhythmias, hypothermia, etc.
Treatment: gastric lavage, taking a suspension of activated carbon, laxatives, maintaining body temperature, monitoring the function of the cardiovascular system for at least 5 days; with severe cholinolytic symptoms (hypotension, arrhythmia, coma) – 0.5-2 g of physostigmine in / m or / in. Hemodialysis and forced diuresis are ineffective.
Dosage and administration: Inside, without chewing, after eating, for adults in an initial dose – 25 mg 2-4 times a day. The maximum doses for outpatient treatment are up to 150 mg / day, in a hospital – up to 300 mg / day, in elderly patients – up to 100 mg / day.
Intramuscularly or iv (injected slowly) at a dose of 20-40 mg 4 times a day. Injections are gradually replaced by ingestion. The course of treatment is not more than 6-8 months.
Children, as an antidepressant: from 6 to 12 years old – 10-30 mg or 1-5 mg / kg / day fractionally, in adolescence – 10 mg 3 times a day (if necessary, up to 100 mg per day), for the treatment of night enuresis for children under 6 years – 10 mg per night, 6-10 years – 10-20 mg / day, 11-16 years – 25-50 mg / day.
Precautions: Taking amitriptyline is possible no earlier than 14 days after the withdrawal of MAO inhibitors. Reduced doses are recommended for elderly and children. It should not be prescribed to manic patients and patients with suicidal tendencies. Used with caution in coronary heart disease, arrhythmias, heart failure. During treatment, alcohol should be avoided, as well as abandoning activities that require increased attention and speed of reactions.