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Pharmacological action – antidepressant, anxiolytic, sedative, antidizuric. Inhibits reuptake of neurotransmitters (noradrenaline, serotonin, etc.) by presynaptic nerve endings of neurons, causes accumulation of monoamines in synaptic cleft and increases postsynaptic impulsation. With prolonged use reduces the functional activity (desensitization) of beta-adrenergic and serotonin receptors of the brain, normalizes adrenergic and serotonergic transmission, restores the balance of these systems that is disturbed in depressed states. It blocks m-choline and histamine receptors of the CNS.
In anxiety-depressive states it reduces anxiety, agitation and depressive manifestations. Antidepressant effect develops within 2-3 weeks after the start of treatment. Withdrawal syndrome may develop if the drug is suddenly discontinued after long-term treatment.
Depression (endogenous, involutional, reactive, neurotic, with organic brain damage, medication), depression syndrome, schizophrenic psychosis, anxiety-depressive states of different genesis, mixed emotional disorders, behavioral disorders, psychogenic anorexia, bedwetting (adjuvant treatment), severe pain of neurogenic nature.
Hypersensitivity, glaucoma, epilepsy, prostatic hyperplasia, bladder atony, paralytic bowel obstruction, pylorostenosis, history of myocardial infarction, use of MAO inhibitors in the previous 2 weeks, pregnancy, lactation, childhood (under 6 years).
Contraindicated in pregnancy. Breast-feeding should be stopped during the treatment.
Incompatible with MAO inhibitors. Potentiates the effect of CNS depressant compounds (including sedatives, hypnotics, alcohol), sympathomimetics, anti-Parkinsonian drugs, weakens the effect of hypotensive and anticonvulsant drugs. Microsomal oxidation inducers (barbiturates, carbamazepine) decrease, and cimetidine increases the plasma concentration.
Directly inside, without chewing, after a meal, in an initial dose for adults – 25 mg 2-4 times a day. Maximal doses for outpatient treatment are up to 150 mg/day, for inpatients – up to 300 mg/day, in elderly patients – up to 100 mg/day.
In/m or v/v (administered slowly) at a dose of 20-40 mg 4 times daily. Injections are gradually replaced by oral administration. The course of treatment should not exceed 6-8 months.
6 to 12 years old – 10-30 mg or 1-5 mg/kg/day fractionally, in adolescents – 10 mg 3 times daily (up to 100 mg daily if necessary), for treatment of nocturnal enuresis in children under 6 years old – 10 mg at night, 6-10 years old – 10-20 mg/day, 11-16 years old – 25-50 mg/day.
Amitriptyline may not be taken earlier than 14 days after withdrawal of MAO inhibitors. Reduced doses are recommended for the elderly and children. Manic patients and patients with suicidal tendencies should not be prescribed. Caution is used with CHD, arrhythmias, heart failure. During treatment, alcohol consumption should be avoided and activities requiring increased attention and quick reactions should be avoided.
Elavil - antidepressive medicine. Renders also some analgesic, H2-histamineblocking and antiserotonin action, promotes elimination of bedwetting and reduces appetite.
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