ADMINISTRATION ROUTES:
PO, NG
ALTERNATIVE NAMES:
Amirol, Amitrip
ICU INDICATIONS:
-
Neurogenic pain (e.g Guillain-Barré syndrome)
-
Nocturnal sedation
PRESENTATION AND ADMINISTRATION:
PO / NG:
Amirol 10 mg (light blue), 25mg (yellow); Amitrip 10 mg (blue), 25mg (yellow), 50 mg (orange). Tablets may be crushed for nasogastric administration
DOSAGE:
Neurogenic pain and nocturnal sedation in the ICU:
Commence at 10 mg at night
Increase to 25 mg-50 mg as tolerated
Note: the usual dose for treatment of depression is up to 75-300 mg per day (this dose is rarely appropriate in ICU patients)
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function
DOSAGE IN PAEDIATRICS:
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 1-1.5 mg/kg at night
CLINICAL PHARMACOLOGY:
Amitriptyline is an antidepressant with sedative effects. It is also used in treatment of neurogenic and chronic pain. Its mechanism of action is unclear.
CONTRAINDICATIONS:
-
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
WARNINGS:
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.
PRECAUTIONS:
General:
See WARNINGS
Laboratory Tests:
No tests in addition to routine ICU tests are indicated
Drug/Laboratory Test Interactions: None known.
IMPORTANT DRUG INTERACTIONS IN ICU:
Increased sedation when combined with other sedative drugs.
ADVERSE REACTIONS:
Body as a Whole:
Hyperpyrexia; Lupus-like syndrome (migratory arthritis, positive ANA and rheumatoid factor)
Cardiovascular System:
Myocardial infarction, stroke, nonspecific ECG changes and changes in AV conduction, heart block, arrhythmias, hypotension (particularly orthostatic hypotension), syncope, hypertension, tachycardia, palpitations
Digestive System:
Paralytic ileus, constipation, dry mouth, rarely hepatitis
Nervous System:
Seizures, hallucinations, ataxia, tremors, peripheral neuropathy, numbness, tingling and paraesthesia of the extremities, extrapyramidal symptoms, drowsiness
Skin:
Rash, itch