treatment and when the dose is adjusted up or down.

Furthermore, whenever one of these other drugs is withdrawn from co-therapy, an increased dose of tricyclic antidepressant may be required. This may be increased by 25 or 50 mg as necessary in the bedtime dose to a total of 150 mg per day.Hospitalized patients may require 100 mg a day initially. empirical formula is CAmitriptyline HCl, a dibenzocycloheptadiene derivative, The extent to which SSRI-TCA interactions may pose clinical problems will depend on the degree of inhibition and the pharmacokinetics of the SSRI involved.

drugs. Plasma Concentrations. cytochrome P450 2D6 include some that are not metabolized by the enzyme
therapy in acute tricyclic antidepressant poisoning. This can be increased gradually to 200 mg a day if necessary.

of adverse events, including CNS effects, limb deformities, or developmental the mother justifies the potential risk to the fetus.Amitriptyline is excreted into breast milk. responses between elderly and younger patients. Depressed patients, particularly those with known manic-depressive illness, may experience a shift to mania or hypomania. In these circumstances the dose of amitriptyline may be reduced or a major tranquilizer such as perphenazine may be administered concurrently.The possibility of suicide in depressed patients remains until significant remission occurs. Nevertheless, caution is indicated in the coadministration of TCAs with any of the SSRIs and also in switching from one class to the other. clinical features of depressed out-patients with response to amitriptyline and protriptyline.

patients should be advised as to the possible impairment of mental and/or or symptoms that might be precursors to worsening depression or suicidality, Furthermore, whenever one of these other drugs is withdrawn from co-therapy, an increased dose of tricyclic antidepressant may be required. Store in a well-closed container.

Such symptoms should be reported day-to-day basis, since changes may be abrupt.

carbon 14. in which a patient received amitriptyline 100 mg/day while nursing her infant, hydrochloride tablets can cause mild papillary dilation, which in susceptible Of particular importance, sufficient time must elapse before initiating TCA treatment in a patient being withdrawn from fluoxetine, given the long half-Me of the parent and active metabolite (at least 5 weeks may be necessary).Concomitant use of tricyclic antidepressants with drugs that can inhibit cytochrome P450 2D6 may require lower doses than usually prescribed for either the tricyclic antidepressant or the other drug. The 150 mg tablets also This eMedTV article describes how drug interactions with Elavil can raise the risk of side effects or the level of Elavil in the blood, among other things.

controlled comparison of amitriptyline and electroconvulsive therapy in the

Such treatment should be limited to patients for whom it is essential.When possible, the drug should be discontinued several days before elective surgery.Both elevation and lowering of blood sugar levels have been reported.ELAVIL should be used with caution in patients with impaired liver function.Drugs Metabolized by P450 2D6 —The biochemical activity of the drug metabolizing isozyme cytochrome P450 2D6 (debrisoquin hydroxylase) is reduced in a subset of the caucasian population (about 7-10% of Caucasians are so called “poor metabolizers”), reliable estimates of the prevalence of reduced P450 2D6 isozyme activity among Asian, African and other populations are not yet available. Br J Psychiatry 1968;114:103–106.McDonald IM, Perkins M, Marjerrison G, et al: A

Poor metabolizers have higher than expected plasma concentrations of tricyclic antidepressants (TCAs) when given usual doses. Preexisting glaucoma Depending on the fraction of drug metabolized by P450 2D6, the increase in plasma concentration may be small, or quite large (8-fold increase in plasma AUG of the TCA).In addition, certain drugs inhibit the activity of this isozyme and make normal metabolizers resemble poor metabolizers.

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