In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic function, concomitant disease and other drug therapy in elderly patients. Geriatric patients are particularly sensitive to the anticholinergic side effects of tricyclic antidepressants including amitriptyline hydrochloride. Peripheral anticholinergic effects include tachycardia , urinary retention, constipation, dry mouth , blurred vision, and exacerbation of narrow-angle glaucoma.
Central nervous system anticholinergic effects include cognitive impairment, psychomotor slowing, confusion , sedation, and delirium. Elderly patients taking amitriptyline hydrochloride may be at increased risk for falls.
Multiple drug ingestion including alcohol is common in deliberate tricyclic antidepressant overdose. As the management is complex and changing, it is recommended that the physician contact a poison control center for current information on treatment.
Signs and symptoms of toxicity develop rapidly after tricyclic antidepressant overdose; therefore, hospital monitoring is required as soon as possible.
Manifestations Critical manifestations of overdose include: Changes in the electrocardiogram , particularly in QRS axis or width, are clinically significant indicators of tricyclic antidepressant toxicity. In addition, a rightward axis shift in the terminal QRS complex together with a prolonged QT interval and sinus tachycardia are specific and sensitive indicators of first generation tricyclic overdose.
The absence of these findings is not exclusionary. Other signs of overdose may include: Protect the patient's airway, establish an intravenous line and initiate gastric decontamination. If signs of toxicity occur at any time during the period, extended monitoring is required. There are case reports of patients succumbing to fatal dysrhythmias late after overdose; these patients had clinical evidence of significant poisoning prior to death and most received inadequate gastrointestinal decontamination.
Monitoring of plasma drug levels should not guide management of the patient. Gastrointestinal Decontamination All patients suspected of tricyclic antidepressant overdose should receive gastrointestinal decontamination.
This should include large volume gastric lavage followed by activated charcoal. If consciousness is impaired, the airway should be secured prior to lavage. Intravenous sodium bicarbonate should be used to maintain the serum pH in the range of 7. If the pH response is inadequate, hyperventilation may also be used. Concomitant use of hyperventilation and sodium bicarbonate should be done with extreme caution, with frequent Ph monitoring.
Type 1A and 1C antiarrhythmics are generally contraindicated e. In rare instances, hemoperfusion may be beneficial in acute refractory cardiovascular instability in patients with the acute toxicity.
However, hemodialysis , peritoneal dialysis , exchange transfusions, and forced diuresis generally have been reported as ineffective in tricyclic antidepressant poisoning. Seizures should be controlled with benzodiazepines , or if these are ineffective, other anticonvulsants e.
Physostigmine is not recommended except to treat life-threatening symptoms that have been unresponsive to other therapies, and then only in consultation with a poison control center.
Psychiatric Follow-up Since overdosage is often deliberate, patients may attempt suicide by other means during the recovery phase.
Amitriptyline is used for depression and may be used by other conditions by the doctor. Common side effects of amitriptyline include dry mouth, loss of appetite, dizziness, drowsiness, and blurred vision.
Other side effects may include trouble concentrating, nightmares, and a decreased sex drive. This is not a complete list of the side effects associated with amitriptyline. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. When your doctor prescribes a new medication, be sure to discuss all your prescription and over-the-counter drugs, including dietary supplements, vitamins, botanicals, minerals, and herbals, as well as the foods you eat.
Tell your health care provider about any negative side effects from prescription drugs. You can also report them to the U. Does amitriptyline cause erectile dysfunction? Amitriptyline belongs to a class of drugs called tricyclic antidepressants that affects chemicals in the brain that may become unbalanced. It is used to treat symptoms of depression. Common side effects include nausea, vomiting, constipation, diarrhea, loss of appetite, dry mouth, unpleasant taste, dizziness, drowsiness, tiredness, trouble concentrating, nightmares, blurred vision, headache, ringing in the ears, decreased sex drive, impotence, and difficulty having an orgasm.
This is not a complete list of side effects that can occurs with amitriptyline. The impotence or erectile dysfunction caused by amitriptyline is related to how the drug works and the specific chemicals it affects. However, impotence can also be a symptoms of depression. So, it is important to talk to your doctor about your difficulties. Impotence that is due to amitriptyline is generally reversible with a dosage adjustment or by switching to another antidepressant.
Do not stop or change the amount of medication you take without talking to your doctor first. Dosage changes should only be done with the supervision of your doctor and suddenly stopping an antidepressant can cause withdrawal side effects. Consult your doctor for specific recommendations. Your doctor is best able to guide your treatment decisions based on your specific circumstances. For more specific information, consult with your doctor or local pharmacist for guidance based on your health status and current medications, particularly before taking any action.
My doctor prescribed 10 to 20 mg of amitriptyline at bedtime. Another medic has warned me that it should never be prescribed for seniors. What do you recommend? Amitriptyline is a tricyclic antidepressant, an older group of medications that have been used to treat depression for many years. It is also used for other conditions such as pain, anxiety, fibromylagia, and migraines.
The reason that this medication should not be used in older individuals is because of the possibility of the patient having other medical conditions that amitriptyline may aggravate. Amitriptyline is not recommended during the acute recovery phase following a heart attack or in the presence of congestive heart failure. The medication has been shown to cause low blood pressure, arrhythmias, and heart conduction abnormalities so caution is advised if used in patients with pre-existing cardiovascular disease.
The elderly appear to be more sensitive to Elavil, which can increase their risk of side effects, such as delirium and confusion. In these particular situations, a health care provider will start people on lower doses of Elavil and monitor them more closely. As long as the physician who is prescribing amitriptyline is aware of any other health conditions you may have, there should be no problem in taking this medication. If you experience any strange side effects or unusual feelings you should contact the prescriber as soon as possible.
Lori Poulin, PharmD Q: It is used in addition to other medications for pain. When used in general anesthesia, it reduces blood pressure and body temperature. Each amitriptyline tablet contains the active substance of amitriptyline hydrochloride, 25 mg, and excipients: Pharmachologic Effect At the moment, amitriptyline is considered the most reliable and affordable tricyclic antidepressant. In the tricyclic class, amitriptyline is second only to trimipramine and fluorocycin by the strength of the sedative, hypnotic and anti-anxiety effect.
Amitriptyline is taken by mouth. Antidepressant effect develops within weeks after the beginning of application. Amitriptyline has the properties of antiarrhythmic drugs like e.
In therapeutic doses, it slows down the ventricular conduction in case of an overdose it can cause severe intraventricular blockade. Dosage form Coated tablets, blue, with a biconvex surface, with a risk on one side. The risk on the pill is intended solely to facilitate halving. Clinical application and indications Amitriptyline is applied mainly to treat major depressive disorder but can also be used in the treatment of depression of any other etiology. Especially effective in anxiety-depressive states; amitriptyline eliminates anxiety, psychomotor agitation, inner tension and fear, insomnia and other depressive manifestations.
It is also used for the treatment of phobic disorders, children's enuresis except for children with hypotonic urinary bladder , psychogenic anorexia, bulimic neurosis, chronic pain syndrome of a neurogenic nature, and also for the prevention of migraine. Usually amitriptyline does not cause exacerbation of delusions, hallucinations and other productive symptoms, which is possible with the use of antidepressants with a predominant stimulating effect imipramine, etc. Before prescribing amitriptyline, always inform your doctor about the following changes in your health propensity to develop orthostatic hypotension and sedation during treatment with amitriptyline; chronic constipation; diseases of the cardiovascular system; hypothyroidism, reception of thyroid hormone preparations; hepatic or renal insufficiency.
Before using amitriptyline, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. Talk to your doctor about using amitriptyline safely. This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely.
Talk to your doctor if you are using marijuana.
Patients may wish to be examined to determine whether they are susceptible to angle closure, and have a prophylactic procedure e. What can counteract the bloat and sleepiness associated with amitriptyline? More than one-half of those who experience a single episode of depression will continue to have episodes that occur as frequently as once or even twice a year. To improve sleep, the drug can be taken in the evening, amitriptyline hcl with alcohol. After 3 weeks of effective treatment, the daily dose can be individually revised. These side amitriptyline include fast hcl rate, difficulty urinating, constipation, dry mouth, and blurred vision, amitriptyline hcl with alcohol. In some people, however, it can cause alcohol loss and strange dreams. Keep out of reach of children. Do not take a double dose in case of missing the next dose! Do not worry - most people do sports as normal while taking amitriptyline. Do not stop taking or change the dose of your medication without talking to your physician first. If the pH response is inadequate, hyperventilation may also be used. Depressed patients, particularly those with known manic-depressive illness, may experience a with to mania or hypomania.
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