Details About Generic Salt ::  Amitript

Main Medicine Class:: Tricyclic antidepressant   

(am-ee-TRIP-tih-leen HIGH-droe-KLOR-ide)
Elavil, Endep, Enovil,  APO-Amitriptylene, Elavil, Levate, Novo-Tryptin
Class: Tricyclic antidepressant

 

Drugs Class ::

 Action Inhibits presynaptic reuptake of norepinephrine and serotonin in CNS.

Indications for Drugs ::

 Indications Relief of depression. Endogenous depression is more likely to be allevated than are other depressive states. Unlabeled use(s): Management of chronic pain associated with migraine, tension headache, phantom limb pain, tic douloureux, diabetic neuropathy, peripheral neuropathy, cancer or arthritis; treatment of panic and eating disorders.

Drug Dose ::

 Route/Dosage

ADULTS: Titrate dosage over 2 wk to 1 mo. Give maintenance dose 6 mo to 1 yr. Do not interrupt therapy abruptly; reduce over 2 wk period. OUTPATIENTS: PO 75 to 150 mg/day in divided doses; give in evening or at bedtime because of sedative effects. HOSPITALIZED PATIENTS: PO 100 to 300 mg/day. ADOLESCENT & ELDERLY PATIENTS: PO 10 mg tid and 20 mg at bedtime. MAINTENANCE: PO 40 to 100 mg/day. PARENTERAL FORM: PO Do not use IV route. IM 20 to 30 mg qid. Change to oral dosing as soon as possible.

Contraindication ::

 Contraindications Hypersensitivity to any tricyclic antidepressant; use during acute recovery phase of MI; concomitant use with monoamine oxidase (MAO) inhibitors, except under close medical supervision; may block the antihypertensive action of guanethidine or similarly active compounds.

Drug Precautions ::

 Precautions

Pregnancy: Category D. Lactation: Excreted in breast milk. Children: Not recommended for children < 12 yr. Changing from MAO inhibitor to amitriptyline: Waiting period of 7 to 10 days is necessary to prevent hypertensive crisis. Special risk patients: Caution is needed with history of seizures; urinary retention; urethral or ureteral spasm; angle-closure glaucoma or increased IOP; cardiovascular disorders; hyperthyroidism and patients receiving thyroid medication; hepatic or renal impairment; schizophrenia; paranoia. Serotonin syndrome: Some TCAs inhibit neuronal reuptake of serotonin and can increase synaptic serotonin levels.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CV: Orthostatic hypotension; hypertension; tachycardia; palpitations; arrhythmias; ECG changes. CNS: Confusion; hallucinations; disturbed concentration; decreased memory; delusions; nervousness; restlessness; agitation; panic; insomnia; nightmares; mania; exacerbation of psychosis; drowsiness; dizziness; weakness; emotional lability; numbness; tremors; extrapyramidal symptoms (eg, pseudoparkinsonism, movement disorders, akathisia); seizures. DERM: Rash; pruritus; photosensitivity reaction; dry skin; acne; itching. EENT: Conjunctivitis; blurred vision; increased IOP; mydriasis; tinnitus; nasal congestion; peculiar taste in mouth. GI: Nausea; vomiting; anorexia; GI distress; diarrhea; flatulence; dry mouth; constipation. GU: Impotence; sexual dysfunction; menstrual irregularities; dysmenorrhea; nocturia; urinary frequency; UTI; vaginitis; cystitis; urinary retention and hesitancy. HEMA: Bone marrow depression, including agranulocytosis; eosinophilia; purpura; thrombocytopenia; leukopenia. HEPA: Jaundice. META: Elevation or depression of blood sugar levels. RESP: Pharyngitis; rhinitis; sinusitis; cough. OTHER: Breast enlargement.

Drug Mode of Action ::  

 Action Inhibits presynaptic reuptake of norepinephrine and serotonin in CNS.

Drug Interactions ::

 Interactions

Barbiturates, charcoal: May cause decreased blood levels of amitriptyline. Cimetidine, fluoxetine: May cause increased blood levels of amitriptyline. Clonidine: Use with product may result in hypertensive crisis. CNS depressants: Depressant effects may be additive. MAOIs: May cause hyperpyretic crises, severe convulsions, and death when given with amitriptyline.

Drug Assesment ::

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Take vital signs and monitor during initial therapy.
  • Assess patient’s mental status, affect, energy level, sleeping, and eating habits and suicidal tendencies.
  • Record I&O, noting bowel elimination pattern.
  • Encourage high intake of fiber and fluid, and offer laxatives or stool softeners as necessary.
  • Restrict amount of medication available to patient. Check patient’s mouth after administration to detect possible hoarding of medication or noncompliance with therapy.
  • Provide frequent oral hygiene.
  • Assist patient in rising slowly. Supervise ambulation and institute measures to prevent falling.
  • Monitor ECG, WBC with differential, serum glucose level, and cardiac, renal, and hepatic function regularly.
  • Perform baseline and periodic leukocyte and differential counts and liver function studies.
  • Document patient’s mental status and vital signs every shift until response to therapy is evaluated.
  • Monitor closely for oversedation, especially if patient is taking antihistamines, narcotic analgesics or sedatives/hypnotics.
  • If systolic BP increases or decreases 10 to 20 mm Hg from baseline or if pulse rate or rhythm shows significant change, withhold drug and notify physician.
OVERDOSAGE: SIGNS & SYMPTOMS
  Confusion, agitation, hallucinations, seizures, status epilepticus, clonus, choreoathetosis, hyperactive reflexes, positive Babinski’s sign, coma, cardiac arrhythmias, renal failure, flushing, dry mouth, dilated pupils, hyperpyrexia

Drug Storage/Management ::

 Administration/Storage

  • Use IM route only if patient is unable to take oral form.
  • Give drug with or immediately after food or fluid and in late afternoon or at bedtime because of sedative effect. Tablets may be crushed.
  • Store at room temperature and protect from light.

Drug Notes ::

 Patient/Family Education

  • Caution patient not to stop taking medication abruptly without consulting physician.
  • Warn patient of the risk of seizure.
  • Reinforce importance of follow-up visits to physician for monitoring drug’s effectiveness and side effects.
  • Explain that drug effects may not be evident for 4 to 6 wk but that side effects are usually noted early.
  • Patient should complete the full course of therapy.
  • Tell patient that side effects are reduced if drug is taken at bedtime.
  • Advise patient that weight gain often results from increased appetite caused by drug.
  • Inform patient that urine may turn blue-green.
  • Emphasize the need for regular dental care because oral dryness can increase risk for dental caries.
  • Instruct patient to report the following symptoms to physician: Blurred vision, sore throat, fever, increased heart rate, impaired coordination, difficult urination, excessive sedation, or seizures.
  • Instruct patient to take sips of water frequently, suck on ice chips or sugarless hard candy, or chew sugarless gum if dry mouth occurs.
  • Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
  • Instruct patient to avoid intake of alcohol beverages or other CNS depressants.
  • Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness.
  • Caution patient to avoid exposure to sunlight, and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
  • Instruct patient not to take otc medications without consulting physician.

Disclaimer ::

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