amitriptyline pamoate Pregnancy Risk Category NR
Elavil†
How supplied
amitriptyline hydrochloride
Tablets: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg
Injection: 10 mg/ml
amitriptyline pamoate†
Syrup: 10 mg/5 ml*†
Action
Unknown. A tricyclic antidepressant (TCA) that increases amount of norepinephrine, serotonin, or both in the CNS by blocking their reuptake by the presynaptic neurons.
Indications & dosage
Depression--
Adults: initially, 50 to 100 mg P.O. h.s., increasing to 150 mg daily; maximum dose is 300 mg daily, if needed. Maintenance dose is 50 to 100 mg/day. Or, 20 to 30 mg I.M. q.i.d.
Elderly and adolescents: 10 mg P.O. t.i.d. and 20 mg h.s. daily.
Adverse reactions
CNS: coma, seizures, hallucinations, delusions, disorientation, ataxia, tremor, peripheral neuropathy, anxiety, insomnia, restlessness, drowsiness, dizziness, weakness, fatigue, headache, extrapyramidal reactions.
CV: MI, stroke, arrhythmias, heart block, orthostatic hypotension, tachycardia, ECG changes, hypertension, edema.
EENT: blurred vision, tinnitus, mydriasis, increased intraocular pressure.
GI: dry mouth, nausea, vomiting, anorexia, epigastric distress, diarrhea, constipation, paralytic ileus.
GU: urine retention.
Hematologic: agranulocytosis, thrombocytopenia, leukopenia, eosinophilia.
Hepatic: elevated liver function test results.
Metabolic: hypoglycemia, hyperglycemia.
Skin: rash, urticaria, photosensitivity, diaphoresis.
Other: hypersensitivity reaction.
After abrupt withdrawal of long-term therapy: nausea, headache, malaise (doesn't indicate addiction).
Interactions
Drug-drug. Barbiturates, CNS depressants: enhanced CNS depression. Avoid concomitant use.
Cimetidine, fluoxetine, fluvoxamine, oral contraceptives, paroxetine, sertraline: increased TCA blood levels. Monitor for increased antidepressant adverse effects.
Clonidine: may cause hypertensive crisis. Avoid coadministration.
Epinephrine, norepinephrine: increased hypertensive effect. Use with caution.
MAO inhibitors: may cause severe excitation, hyperpyrexia, or seizures, usually with high doses. Avoid concomitant use.
Drug-lifestyle. Alcohol use: enhanced CNS depression. Avoid concomitant use.
Smoking: may lower plasma levels of drug. Monitor for lack of effect.
Sun exposure: increased risk of photosensitivity reactions. Avoid unprotected or prolonged exposure to sun.
Effects on diagnostic tests
None reported.
Contraindications
Contraindicated in patients with hypersensitivity to drug and in those who have received an MAO inhibitor within past 14 days; also contraindicated during acute recovery phase of MI.
Nursing considerations
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING