Amitriptyline is a tricyclic antidepressant and painkiller (analgesic) that is often prescribed for migraine prevention. Patients with chronic migraine should be given preventive treatment (prophylactic therapy). Prophylactic therapy is warranted when migraine attacks occur more than 2 to 3 times per month for more than 48h. It can also be prescribed if migraine attacks cause substantial functional impairment, or if conventional treatments for migraine relief are ineffective or cause serious side effects.
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Amitriptyline (also known as Elavil) is a white, odorless, crystalline compound which is soluble in water. Most preventive medications for migraine have been secondarily adopted as treatments for migraine, as is the case for amitriptyline, a tricyclic antidepressant. Clinical studies have shown that oral Amitriptyline helps with diabetic neuropathic pain, neurogenic pain syndromes, non-malignant pain (e.g., post-herpetic neuralgia, fibromyalgia).
Each tablet for oral administration contains 10 mg, 25 mg, 50 mg, 75 mg, 100 mg or 150 mg amitriptyline hydrochloride. The strengths available through Medzino are 10mg and 25mg, if you require something stronger, we recommend that you speak to a doctor face-to-face. The anti-migraine mechanisms are generally speculative and little understood. Amitriptyline works on nerve cells in the brain and spinal cord. It inhibits the body’s uptake of serotonin and norepinephrine, which may potentially enhance diffuse toxic inhibition. Other possible mechanisms in migraine could be the ability of Amitriptyline to block sodium channels, enhance GABA-mediated inhibition, potentiate endogenous opioids, and intensify descending inhibition on nociceptive pathways. Its effectiveness with regard to migraine headache is unrelated to whether or not the patient suffers from depression.
Please note that different strengths of tablet may contain different coloring agents. In addition, different brands of generic medication may contain different active ingredients.
As a preventive agent for adults with migraine attacks, amitriptyline should initially be taken at low doses 10-25 mg daily. It should be ingested at night given its extremely sedating effects. If tolerated, the dosage can be increased in steps of 10-25 mg every 3-7 days in 1-2 divided doses. The usual dose is 25-75 mg. Doses over 100 mg should be used with caution. Doses above 75 mg should be used with caution in the elderly and patients with cardiovascular disease. The maximum strength per dose should be 75 mg.
Note that after long administration of Amitriptyline, patients should not abruptly stop the treatment as it can cause nausea, headache, and malaise. Furthermore, gradual dosage reduction has been reported to produce symptoms such as irritability, restlessness, nightmares and sleep disturbances. Withdrawal symptoms may occur within 5 days of stopping treatment. They are usually mild, but can be severe in some cases. It is advised to reduce the dose gradually over about 4 weeks or longer if these withdrawal symptoms emerge.
Yes. If an adult ingests 750 mg or more, this can lead to a high level of toxicity. This can be significantly aggravated if you ingest amitriptyline together with alcohol or other psychotropic agents. Symptoms of overdose include low blood pressure, confusion, convulsions, dilated pupils and other eye problems, lack of concentration, drowsiness, hallucinations, impaired heart function, rapid or irregular heartbeat, low body temperature, stupor, unresponsiveness, coma. If you fear that you or someone you know is overdosing, then immediate medical and hospital attention required.
If you miss a dose of Amitriptyline, take it as soon as you remember. In case you only remember when it is time for your next dose, stick to your regular dose and do not take it twice to make up for the dose you missed. Try to take your doses at the same time each day in order to avoid forgetting it.
Common side-effects of amitriptyline:
If any of these side-effects persist or manifest themselves in a severe way, consult your GP.
Potential serious side-effects include:
If you experience any of these severe side-effects, contact your GB immediately or go to an emergency room right away.
Patients should consult their physicians and use amitriptyline with caution if they have a history of cardiovascular disease, chronic constipation, diabetes, epilepsy, bipolar disorder, psychosis, hyperthyroidism, increased intra-ocular pressure, suicidal behavior, phaeochromocytoma, prostatic hypertrophy, susceptibility to angle-closure, glaucoma, urinary retention.
Some drugs may interfere with the effects of Amitriptyline. Do not take Amitriptyline at the same time as the following drugs: Arbutamins, Disulfiram, thyroid supplements, NSAIDs (such as Ibuprofen), blood thinners (such as Warfarine), anticholinergic drugs (such as Benztropin, Balladonna, Alkaloids), certain drugs for high blood pressure (such as Clonidine, Guanabenz, and Resperine), Monoamine Oxidase Inhibitors (such as Isocarboxazid, linezolid, Methylene Blue, Moclobemide, Phenelzine, Procarbazine, Rasagiline, Safinamide, Selegiline, Tranylcypromine), Cimetidine, Terbinafine, drugs to treat irregular heart rate (such as Quinidine, Propafenone, Flecainide), antidepressants (such as SSRIs including Paroxetine, Fluoxetine, Fluvoxamine), antihistamines (such as Cetirizine, Diphenhydramine), drugs for sleep or anxiety (such as Alprazolam, Diazepam, Zolpidem), muscle relaxants, and narcotic pain relievers (such as Codeine). Always inform your doctor of the medications you are taking before using this Amitriptyline.
There is little data on whether pregnant women can use Amitriptyline, but it has been shown to cross the placenta, although the effects of this have not been adequately studied. Generally, it is not recommended unless absolutely necessary. In this case, very careful consideration is necessary of both risks and benefits. Do not self-medicate if you are pregnant but talk to your health physician. Regarding breastfeeding, risks to the baby must be considered as Amitriptyline and its metabolites are emitted into breast milk. Due to the benefits of the breast milde for the child in contrast to the benefits of the therapy for the mother, a decision on whether to continue or abort the therapy should be carefully taken with the help of a physician.
Some clinical studies on animals have shown reproductive toxicity. However, there are no data on the repercussions of Amitriptyline for human fertility.
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