amitriptyline (Rx)

Brand and Other Names:Elavil, Levate
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 10mg
  • 25mg
  • 50mg
  • 75mg
  • 100mg
  • 150mg
more...

Depression

Outpatient: 25-50 mg PO qHS initially; increase by 25 mg every 5-7 days to 100-200 mg/day (may divide doses throughout day or give at bedtime); if needed, may increase to 300 mg/day

Inpatient: 100-300 mg PO qDay

Postherpetic Neuralgia (Off-label)

65-100 mg PO qDay for at least 3 weeks

Migraine Prophylaxis (Off-label)

10-25 mg PO qHS; 10-400 mg PO qHS dose range

Eating Disorder (Off-label)

150 mg PO qHS for 8 weeks

Geriatric Dosing

Depression

10-25 mg PO qHS; may increase by 10-25 mg increments qWeek if needed and as tolerated

Dosage range: 25-150 mg/day

Dosing Considerations

  • Avoid; strong anticholinergic and sedative effects; may cause orthostatic hypotension (Beers criteria)
  • Consider alternatives; if must use, initiate with lower initial dose

Dosage Forms & Strengths

tablet

  • 10mg
  • 25mg
  • 50mg
  • 75mg
  • 100mg
  • 150mg
more...

Depression

Adolescents

  • Initial: 25-50 mg/day PO in divided doses
  • Increase gradually to 100 mg/day in divided doses

Children (Off-label)

  • First 3 days: 1 mg/kg/day divided q8hr PO, THEN 
  • 1.5 mg/kg/day divided q8hr PO

Analgesia for Chronic Pain (Off-label)

Load: 0.1 mg/kg PO qHS; may increase as tolerated over 2-3 weeks 

Maintenance: 0.5-2 mg/kg PO qHS

Migraine Prophylaxis (Off-label)

0.25 mg/kg/day PO qHS; may increase dose by 0.25 mg/kg/day; not to exceed 1 mg/kg/day 

Dose range: 0.1-2 mg/kg/day; not to exceed 2 mg/kg/day or 75 mg/day; if dose >1 mg/kg/day, divide dose q12hr

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Interactions

Interaction Checker

and amitriptyline

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Agitation

            Agranulocytosis

            Alopecia

            Anxiety

            Anorexia

            Ataxia

            Arrhythmia

            Blurred vision

            Coma

            Confusion

            Constipation

            Diarrhea

            Dizziness

            Dry mouth

            ECG changes

            Eosinophilia

            Extrapyramidal symptoms (EPS)

            Fatigue

            Hallucination

            Headache

            Hypertension

            Increased LFTs

            Insomnia

            Lethargy

            Leukopenia

            MI

            Nausea

            Ocular pressure increased

            Orthostatic hypotension

            Palpitation

            Paresthesia

            Photosensitivity

            Rash

            Restlessness

            Sedation

            Seizure

            Sexual dysfunction

            SIADH

            Stroke

            Stomatitis

            Syncope

            Sweating

            Tachycardia

            Thrombocytopenia

            Tinnitus

            Urinary retention

            Urticaria

            Vomiting

            Xerostomia

            Weakness

            Weight gain

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            Warnings

            Black Box Warnings

            In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses; this increase was not seen in patients over age 24 years; a slight decrease in suicidal thinking was seen in adults over age 65 years

            In children and young adults, the risks must be weighed against the benefits of taking antidepressants

            Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during the initial 1-2 months of therapy and dosage adjustments; the patient’s family should communicate any abrupt changes in behavior to the healthcare provider

            Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy

            This drug is not approved for use in pediatric patients <12 years

            Not FDA approved for treatment of bipolar depression

            Contraindications

            Hypersensitivity

            Acute recovery phase following MI

            Concurrent use with cisapride

            Contraindicated within 14 days of MAOIs; if linezolid or IV methylene blue (MAOIs) must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity; may resume 24 hr after last linezolid or methylene blue dose, or after 2 weeks of monitoring, whichever comes first

            Cautions

            Bone marrow suppression reported

            Avoid use in narrow-angle glaucoma

            May cause sedation and impair mental and physical abilities

            Avoid use with any drugs or conditions that prolong QT interval

            May cause orthostatic hypotension

            Use caution in patients with cardiovascular disease, diabetes, mania, hepatic and renal impairment, thyroid dysfunction, and seizure disorder

            May worsen mania symptoms or precipitate mania in patients with bipolar disorder

            Clinical worsening and suicidal ideation may occur despite medication in adolescents and young adults (18-24 years)

            Risk of anticholinergic side effects; may cause constipation, urinary retention, blurred vision, and xerostomia

            Use caution in patients with urinary retention, open-angle glaucoma, BPH, decreased gastrointestinal motility, or paralytic ileus

            Possibility of EPS and neuroleptic malignant syndrome

            Abrupt discontinuation of therapy not recommended in patients receiving high doses for prolonged periods

            Fractures reported with therapy

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Distributed in breast milk; do not nurse (AAP states effect on nursing infants is unknown but may be of concern)

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Neurotransmitter (especially norepinephrine and serotonin) reuptake inhibitor; anticholinergic

            Absorption

            Peak serum time: 4 hr

            Metabolism

            Metabolized by hepatic CYP2C19, CYP3A4

            Metabolites: Nortriptyline

            Elimination

            Half-life: 9-27 hr

            Excretion: Urine (18%), small amounts in feces

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            Images

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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