Amitriptylline PO, NG
1 tablet 10mg
1 tablet 25mg
Neurogenic pain (eg GBS)
PO / NG:
Amirol 10mg (light blue), 25mg (yellow); Amitrip 10mg (blue), 25mg (yellow), 50mg (orange). Tablets may be crushed for nasogastric administration
Neurogenic pain and nocturnal sedation in the ICU:
Commence at 10mg at night; increase to 25mg to 50mg as tolerated
Note – the usual dose for treatment of depression is up to 75-300mg per day (this dose is rarely appropriate in ICU patients)
In view of the lack of experience with the use of this drug in paediatric patients, it is not recommended for patients under 12 years of age.
Quoted paediatric dosing for enuresis is 1-1.5mg/kg at night.
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY
Dose as in normal renal function
Amitriptyline is an antidepressant with sedative effects. It is also used in treatment of neurogenic and chronic pain. Its mechanism of action is unclear.
Hypersensitivity to amitriptyline
Should not be given concomitantly with monoamine oxidase inhibitors.
This drug is not recommended for use during the acute recovery phase following myocardial infarction.
Amitriptyline should be used with caution in patients with a history of seizures and, because of its atropine-like action.
Amitriptyline has been reported to produce arrhythmias, sinus tachycardia, and prolongation of the conduction time. Myocardial infarction and stroke have been reported with drugs of this class.
No tests in addition to routine ICU tests are indicated
Drug/Laboratory Test Interactions:
Increased sedation when combined with other sedative drugs.
Body as a Whole:
Hyperpyrexia; Lupus-like syndrome (migratory arthritis, positive ANA and rheumatoid factor).
Myocardial infarction; stroke; nonspecific ECG changes and changes in AV conduction; heart block; arrhythmias; hypotension, particularly orthostatic hypotension; syncope; hypertension; tachycardia; palpitation.
Paralytic ileus; constipation; dry mouth; rarely hepatitis.
Seizures; hallucinations; ataxia; tremors; peripheral neuropathy; numbness, tingling, and paraesthesias of the extremities; extrapyramidal symptoms; drowsiness.