What Meds

Psychiatric Medications


Amitriptyline
Brand Names: Elavil, Endep, Amitril, Emitrip, Enovil, Etrafon, Etrafon-A, Etrafon-Forte, PMS-Levazine, SK-Amitriptyline, Dohme, Sharpe

Overview
Elavil is a brand name for Amitriptyline, a tricyclic antidepressant (TCA.) It is a heterocyclic antidepressant - a class of drugs that inhibits the nerve cells' ability to reuptake norepinephrine and serotonin and brings the levels of these neurotransmitters back up to normal. Elavil is very sedating.

Elavil effects may be felt after one to two weeks though some patients may take longer to feel its effects depending on the dosage and the patient. Elavil may improve sleep patterns earlier than other symptoms.

Why is this drug prescribed?
Elavil is FDA-labeled in adults and in adolescents and children above 12 years old for depression. It is used primarily to treat major depression (both psychotic and endogenous), especially depression associated with a sleep disturbance. Because of its sedative effects, it may be useful in treating anxiety associated with depression. Elavil should not be used for bipolar disorder (manic depression) as it may precipitate a manic episode.

Elavil may also be prescribed to treat:

It is also useful in treatment for nerve pain, chronic pain syndromes, migraines/migraine prevention, nocturnal enuresis and insomnia.

How much of this drug is typically used?
Tablet: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg

In Adolescents: Initial: 25-50 mg/day; may give in divided doses; increase gradually to 100 mg/day in divided doses; maximum dose: 200 mg/day

In Children: Investigationally: initial doses of 1 mg/kg/day given in 3 divided doses with increases to 1.5 mg/kg/day have been reported in a small number of children (n=9) 9-12 years of age

Clinically, doses up to 3 mg/kg/day (5 mg/kg/day if monitored closely) have been proposed

Warnings and Precautions
Special care should be used in children under twelve years. Elavil must not be used in children under twelve except under the guidance of a child psychiatrist.

Adolescents (12-18 years old) have a stronger reaction to Elavil than do adults and may need smaller doses.

Elavil is not addictive. However, suddenly discontinuing Elavil may cause withdrawal symptoms. Dosages should be gradually tapered to minimize withdrawal. Even gradual dosage reduction may produce some withdrawal symptoms.

Elavil can cause photosensitivity and can reduce sweating which impairs the body's ability to adapt to heat. Patients should avoid saunas and other very hot environments.

Elavil can cause drowsiness and dizziness: a patient taking Elavil should not drive or operate heavy machinery until he knows that it does not impair his ability do engage in these activities.

For Pregnant or Nursing Mothers: Controlled studies have not been done in pregnant women, but there have been reports of newborns suffering from muscle spasms and heart, breathing, and urinary problems when their mothers had taken tricyclic antidepressants immediately before delivery. Animal studies show that some tricyclic antidepressants may have undesirable effects on a fetus. Tricyclic antidepressants pass into breast milk and are reported to cause drowsiness in nursing infants.

Contraindications
Elavil should not be used for people with the following medical conditions:

Adverse Reactions
Elavil may cause the following reactions:

Rarely:

Interactions with Drugs and Other Substances
Drugs or substances that may interact with Elavil are:

Research Studies and Use in Child Psychiatry
Amitriptyline is indicated for children above age 12. In adolescents, the manufacturer recommends 10 milligrams three times daily and 20 milligrams at bedtime as an initial dose regimen. The manufacturer does not recommend the use of amitriptyline in patients under 12 years of age. In a double-blind study in 1984, Amitriptyline 1 mg/kg/day in three divided doses, increased after 3 days to 1.5 mg/kg/day for the remainder of the 4-week study was reported to produce a favorable response in 6 of 9 children (ages 9-12) with depression (Kashani et al, 1984). Controlled clinical trials have not shown tricyclic antidepressants to be superior to placebo for the treatment of depression in children and adolescents (Dopheide, 2006 and Wagner, 2005). Therefore, due to the potential cardiac side effects, currently this medication is rarely used in child psychiatry except for nocturnal enuresis.

Sources

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