What the hell is this shit?

My Dr. gave it to me for insomnia due to chronic neck pain, but I can't find much info on it.

It sounds like a psychoactive anti-depressant similiar to Xanax. However I can't verify that.

They told me it should put me to sleep so it must be psychoactive.

6/24/2008 10:02:41 AM

it's a tricyclic antidepressant

your basic SNRI

used frequently off-label for insomnia if other treatments fail

6/24/2008 10:04:47 AM

I know that, but I don't have a degree in pharmacy so go on

6/24/2008 10:05:34 AM

amitriptyline

generic

Entire Monograph

Black Box Warnings
Suicidality

incr. risk of suicidality in children, adolescents and young adults w/ major depressive or other psychiatric disorders esp. during 1st months of tx w/ antidepressants vs. placebo; weigh risk vs. benefit; in short-term studies of antidepressants vs. placebo, suicidality risk not increased in pts >24 yo, and risk decreased in pts >65 yo; observe all pts for clinical worsening, suicidality, or unusual behavior changes; not approved for pediatric use


Adult Dosing

Dosage forms: 10,25,50,75,100,125,150

depression

50-150 mg PO qhs
Start: 25-75 mg PO qhs, incr. 25-50 mg/day q2-3 days; 10-25 mg PO qhs in elderly pts, incr. 10-25 mg/day q2-3 days; Max: 300 mg/day; Info: may give in divided doses; taper dose gradually to D/C

*pain, chronic

0.5-2 mg/kg PO qhs
Start: 0.1 mg/kg PO qhs, titrate slowly over 2-3wk; Max: 150 mg/day; Info: taper dose gradually to D/C

renal dosing

no adjustment
HD: no supplement

hepatic dosing

not defined
hepatic impairment: caution advised


Peds Dosing

Dosage forms: 10,25,50,75,100,125,150

*depression

9-12 yo
Dose: 1-3 mg/kg/day PO div tid; Start: 1 mg/kg/day PO div tid x3 days, incr. 0.5 mg/kg/day q2-3 days; Max: 5 mg/kg/day up to 200 mg/day; Info: taper dose gradually to D/C

>12 yo
Dose: 50-100 mg/day PO div qd-tid; Start: 10 mg PO tid and 20 mg qhs; incr. 10-25 mg/day q2-3 days; Max: 200 mg/day; Info: taper dose gradually to D/C

*pain, chronic

0.5-2 mg/kg PO qhs
Start: 0.1 mg/kg PO qhs, titrate slowly over 2-3wk; Info: taper dose gradually to D/C

renal dosing

see Adult Dosing
renal impairment: dose adjustment may be required although specific pediatric dosing adjustments not defined; see adult renal dosing for guidance

hepatic dosing

not defined
hepatic impairment: caution advised


Contraindications/Cautions

* hypersens. to drug/class/compon.
* see Drug Interactions
* MAO inhibitor use w/in 14 days
* MI, acute recovery
* caution if cardiovascular dz
* caution if GI/GU obstruction
* caution if urinary retention
* caution if prostatic hypertrophy
* caution if glaucoma, angle-closure
* caution if incr. IOP
* caution if seizure disorder
* caution if thyroid dz
* caution if diabetes mellitus
* caution if asthma
* caution if Parkinson's dz
* caution if impaired liver fxn
* caution if schizophrenia
* caution if bipolar disorder
* caution if electroconvulsive tx
* avoid abrupt withdrawal
* caution if alcohol abuse
* caution if suicide risk
* caution in elderly pts
* caution if <25 yo


Drug Interactions

Contraindicated

* antiarrhythmics, class Ia
* cisapride
* flumazenil
* linezolid
* MAOIs, all
* pimozide
* potassium salts
Avoid/Use Alternative

* acetaminophen/propoxyphene
* amiodarone
* cimetidine
* clarithromycins
* dofetilide
* epinephrine, inhaled
* erythromycins
* haloperidol
* ibutilide
* local anesthetics/epinephrine
* methadone
* nilotinib
* paliperidone
* pentamidine
* pramlintide
* propoxyphene
* ranolazine
* sodium oxybate
* sotalol
* sympathomimetics, direct
Monitor/Modify Tx

* alpha 2 agonists, ophthalmic
* alpha 2 agonists/beta blockers, ophthalmic
* carbamazepine
* carbonic anhydrase inhibitors, systemic
* central alpha 2 agonists
* dexmedetomidine
* duloxetine
* polyethylene glycol/electrolytes
* protease inhibitors
* rifampins
* sodium phosphate
* sympathomimetics, indirect/mixed
* valproic acid derivatives
Caution Advised

* abarelix
* acetaminophen/butalbital
* acetaminophen/caffeine/CNS depressant combos
* acetaminophen/codeine
* acetaminophen/hydrocodone
* acetaminophen/oxycodone
* acetaminophen/tramadol
* amphetamines
* anticholinergics
* anticholinergics, ophthalmic
* antidepressants, other
* antihist/decongest/DM combos
* antihist/decongestant combos
* antihistamines, sedating
* apomorphine
* aspirin/butalbital/caffeine
* aspirin/butalbital/caffeine/codeine
* aspirin/caffeine/orphenadrine
* aspirin/muscle relaxant combos
* aspirin/opiate combos
* azelastine nasal
* azole antifungals
* barbiturates
* beta 2 agonists, all
* bromocriptine
* buprenorphine
* bupropion
* butorphanol nasal
* cabergoline
* cannabinoids
* carbidopa/levodopa
* carbidopa/levodopa/entacapone
* cetirizine
* chlorpheniramine/hydrocodone
* cholinergic agents
* cholinergic agents, ophthalmic
* cinacalcet
* clozapine
* cocaine topical
* conivaptan
* cyclopentolate/phenylephrine ophthalmic
* dantrolene
* darifenacin
* dasatinib
* decongest/opiate combos
* decongestants
* decongestants, intranasal
* desvenlafaxine
* droperidol
* ethanol
* ethosuximide
* hydrocodone/ibuprofen
* ibuprofen/oxycodone
* iloprost inhaled
* imatinib
* lapatinib
* levocetirizine
* lidocaine/epinephrine iontophoretic topical
* lindane topical
* lithium
* loxapine
* maraviroc
* mefloquine
* meperidine/promethazine
* meprobamate
* methylphenidate
* metoclopramide
* mitotane
* modafinil
* molindone
* morphine liposomal
* muscle relaxants
* nalbuphine
* nevirapine
* nitrates
* olanzapine
* olanzapine/fluoxetine
* opiates
* oxcarbazepine
* pentazocine
* pergolide
* phenothiazines
* phenylephrine ophthalmic
* phenytoins
* pramipexole
* pregabalin
* promethazine/codeine
* propafenone
* quetiapine
* quinolones, QT prolongers
* reserpine
* rifapentine
* risperidone
* ropinirole
* rotigotine transdermal
* sedative/hypnotics
* solifenacin
* SSRIs, all
* sumatriptan/naproxen sodium
* telithromycin
* terbinafine
* thalidomide
* thiothixene
* tiagabine
* tramadol
* venlafaxine
* vorinostat
* yohimbine
* ziconotide intrathecal
* ziprasidone
* zonisamide


Adverse Reactions
Serious Reactions

* hypotension, orthostatic
* HTN
* syncope
* arrhythmia, ventricular
* QT prolongation
* torsades de pointes
* AV block
* MI
* stroke
* seizures
* extrapyramidal symptoms
* ataxia
* tardive dyskinesia (rare)
* paralytic ileus
* incr. IOP
* agranulocytosis
* leukopenia
* thrombocytopenia
* hallucinations
* psychosis exacerbation
* hypomania/mania
* depression, worsening
* suicidality
* SIADH
* hepatitis (rare)
* angioedema
* psychosis, anticholinergic
* hyperthermia

Common Reactions

* drowsiness
* dry mouth
* dizziness
* constipation
* blurred vision
* palpitations
* tachycardia
* incoordination
* incr. appetite
* nausea/vomiting
* sweating
* weakness
* disorientation
* confusion
* restlessness
* insomnia
* anxiety/agitation
* urinary retention
* urinary frequency
* rash/urticaria
* pruritus
* weight gain
* libido changes
* impotence
* gynecomastia
* galactorrhea
* tremor
* hypo/hyperglycemia
* paresthesias
* photosensitivity


Safety Monitoring

Pregnancy:C

Lactation: Probably Safe

Therapeutic Drug Levels
120-250 ng/mL (amitriptyline + nortriptyline); Toxic Levels: >500 ng/mL; Timing: just before next dose; Time to Steady State: 2-10 days; Info: max efficacy may take 6wk, not well-correlated w/ levels

Monitoring Parameters
serum drug levels; ECG; BP, HR if dose >3 mg/kg/24h (peds); sx suicidality, clinical worsening, and/or unusual behavior changes, especially during initial tx or after dose changes

Avoid Abrupt Cessation
taper dose gradually to D/C (abrupt cessation of TCAs may cause withdrawal symptoms including nausea/vomiting, diarrhea, headache, sleep disturbances, dizziness, malaise, hyperthermia, irritability, akathisia)

Look/Sound-Alike Drug Names
[from http://www.usp.org]


amitriptyline confused with: aminophylline; amlodipine; imipramine; nortriptyline


Pharmacology

Metabolism: liver extensively; CYP450: 1A2, 2D6 (primary), 3A4 substrate; Info: active metabolites incl. nortriptyline

Excretion: urine primarily (18% unchanged), feces; Half-life: 10-26h (amitriptyline), 18-44h (nortriptyline)

Class: TCA

Mechanism Of Action
exact mechanism of action unknown; inhibits norepinephrine and serotonin reuptake


Manufacturer/Pricing

Manufacturer: generic

DEA/FDA: Rx

Approximate Retail Price

tablet:

* 25 mg (90 ea): $11.00
* 50 mg (90 ea): $12.99
* 75 mg (90 ea): $13.00
* 100 mg (90 ea): $13.99
* 150 mg (90 ea): $21.98

6/24/2008 10:07:39 AM

but it doesn't work the same way as your SNRI do.

Cymbalta, Zoloft, etc take weeks to take effect and they won't make you fucked up.

This stuff impairs your ability to drive and in high dosages can cause hallucinations.

Go on Erowid if you think it's just a Cymbalta. I'm just trying to find out more on the stuff, I like to understand what I put in my body.

6/24/2008 10:08:33 AM

and in case you want it, here's what they'd give you at the pharmacy along with the rx:

Quote :

" Patient Education - English Show Spanish * Generic Name: amitriptyline * Pronounced: a mee TRIP ti leen * Brand Names: Elavil, Endep, Vanatrip What is the most important information I should know about amitriptyline? Do not use this medication if you are allergic to amitriptyline, or if you have recently had a heart attack. Do not use amitriptyline if you have taken cisapride (Propulsid) or used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment. Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. What is amitriptyline? Amitriptyline is in a group of drugs called tricyclic antidepressants. Amitriptyline affects chemicals in the brain that may become unbalanced. Amitriptyline is used to treat symptoms of depression. Amitriptyline may also be used for purposes other than those listed in this medication guide. What should I discuss with my healthcare provider before taking amitriptyline? Do not use this medication if you are allergic to amitriptyline, or if you have recently had a heart attack. Do not use amitriptyline if you have taken cisapride (Propulsid) or used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take amitriptyline before the MAO inhibitor has cleared from your body. Before taking amitriptyline, tell your doctor if you are allergic to any drugs, or if you have: * heart disease; * a history of heart attack, stroke, or seizures; * bipolar disorder (manic-depression); * schizophrenia or other mental illness; * diabetes (amitriptyline may raise or lower blood sugar); * overactive thyroid; * glaucoma; or * problems with urination. If you have any of these conditions, you may not be able to use amitriptyline, or you may need a dosage adjustment or special tests during treatment. You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed. Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment. FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Amitriptyline can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give this medication to anyone under 18 years old without the advice of a doctor. How should I take amitriptyline? Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label. If you need to have any type of surgery, tell the surgeon ahead of time that you are taking amitriptyline. You may need to stop using the medicine for a short time. Do not stop using amitriptyline without first talking to your doctor. You may need to use less and less before you stop the medication completely. Stopping this medication suddenly could cause you to have unpleasant side effects. It may take up to 4 weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 4 weeks of treatment. Store amitriptyline at room temperature away from moisture and heat. What happens if I miss a dose? Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose. What happens if I overdose? Seek emergency medical attention if you think you have used too much of this medicine. An overdose of amitriptyline can be fatal. Symptoms of an amitriptyline overdose may include uneven heartbeats, extreme drowsiness, confusion, agitation, vomiting, blurred vision, feeling hot or cold, sweating, muscle stiffness, feeling light-headed, fainting, seizure (convulsions), or coma. What should I avoid while taking amitriptyline? Avoid drinking alcohol. It can cause dangerous side effects when taken together with amitriptyline. Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, or other antidepressants). Grapefruit and grapefruit juice may interact with amitriptyline. Discuss the use of grapefruit products with your doctor before increasing or decreasing the amount of grapefruit products in your diet. Amitriptyline can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Amitriptyline can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun. What are the possible side effects of amitriptyline? Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. Call your doctor at once if you have any of these serious side effects: * fast, pounding, or uneven heart rate, chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling; * sudden numbness or weakness, especially on one side of the body; * sudden headache, confusion, problems with vision, speech, or balance; * hallucinations, or seizures (convulsions), feeling light-headed, fainting; * restless muscle movements in your eyes, tongue, jaw, or neck, uncontrollable shaking or tremor; * skin rash, severe tingling, numbness, pain, muscle weakness; * easy bruising or bleeding; * extreme thirst with headache, nausea, vomiting, and weakness; or * urinating less than usual or not at all. Less serious side effects may be more likely to occur, such as: * nausea, vomiting, constipation, diarrhea, loss of appetite; * dry mouth, unpleasant taste; * feeling dizzy, drowsy, or tired; * trouble concentrating; * nightmares; * blurred vision, headache, ringing in your ears; * breast swelling (in men or women); or * decreased sex drive, impotence, or difficulty having an orgasm. Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. What other drugs will affect amitriptyline? Before taking amitriptyline, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft). Before taking amitriptyline, tell your doctor if you are currently using any of the following drugs: * cimetidine (Tagamet); * guanethidine (Ismelin); * disulfiram (Antabuse); or * heart rhythm medications such as flecainide (Tambocor), propafenone (Rhythmol), or quinidine (Cardioquin, Quinidex, Quinaglute). If you are using any of these drugs, you may not be able to use amitriptyline, or you may need dosage adjustments or special tests during treatment. There are many other medicines that can interact with amitriptyline. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you. Where can I get more information? Your pharmacist has information about amitriptyline written for health professionals that you may read. What does my medication look like? Amitriptyline is available with a prescription generically and under the brand names Elavil and Endep. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. "

6/24/2008 10:09:53 AM

I never understood the sunlight thing or the grape fruit thing.

6/24/2008 10:11:43 AM

i don't understand exactly what you want to know


tricyclics in general are usually a bad idea and are usually reserved as a treatment option for when other SNRI/SSRIs have failed

they have a much higher incidence of side effects (a lot of them quite severe) and are notorious for adverse reactions with other drugs.

p.s.

Quote :

"* gynecomastia"

YOU GON GET MAN BOOBS

6/24/2008 10:12:38 AM

grapefruit has to do with some kind of liver enzyme. by drinking it you can make some medicines act stronger--i.e. people who get off on painkillers will sometimes drink a lot of juice to make them a little stronger.

no idea if it actually does much but i was reading about it one time

6/24/2008 10:13:31 AM

Basically I just wanted to know if this was more similar to Xanax or Zoloft.

Also I don't understand why doctors keep prescribing antidepressants for non depression related problems.

6/24/2008 10:14:32 AM

grapefruit juice blocks the action of a special group of enzymes in the small intestine that destroy/prevent absorption of various drugs, therefore leading to a lower bioavailability of the drug in question

if those enzymes are not active, bioavailability can be much higher and, in some instances, can reach toxic levels from a simple theraputic dose

6/24/2008 10:16:57 AM

^^xanax and zoloft are two completely different medications.

it is similar to zoloft in that it inhibits the reuptake of serotonin

xanax is a benzodiazepine that binds to GABA receptors in your brain



also, antidepressants have been found to be good for a lot more than just depression
we're not even sure how the vast majority of them actually work, so we're still discovering things that they can do

6/24/2008 10:19:20 AM

my dad took this when he was really sick before he died. mostly it was for his depression and problems sleeping. He was on a really high dose and had hallucinations sometimes before he went to sleep.

6/24/2008 11:18:13 AM