Indications :
– Major depressive episodes.
– Peripheral neuropathic pain in adults.
– Nocturnal enuresis in children in cases where any organic pathology has been excluded.
Dosage in neuropathic pain:
Treatment should start at low doses: 10 mg to 25 mg per day for 3 weeks. The dose is then gradually increased in increments of 10 mg to 25 mg every week as tolerated. The dosage is individual, it varies from 10 mg to 150 mg per day and must take into account associated analgesic treatments.
Note that antidepressant doses are between 75 and 150 mg per day.
Contraindications:
– Hypersensitivity to amitriptyline.
– Known risk of angle closure glaucoma.
– Risk of urinary retention.
– Recent myocardial infarction.
– Non-selective MAOIs (iproniazide, nialamide) and sultopride.
Precaution for use:
– Insomnia or nervousness at the start of treatment may justify a reduction in dosage or temporary symptomatic treatment.
– In the event of a frank manic turn, treatment with amitriptyline will be interrupted and, most often, a sedative neuroleptic will be prescribed.
– In patients with epilepsy or with a history of epilepsy, it is prudent to reinforce clinical and electrical monitoring, due to the possibility of lowering the seizure threshold. The occurrence of convulsive seizures requires discontinuation of treatment.
Amitriptyline should be used with caution:
– In the elderly with greater sensitivity to orthostatic hypotension and sedation, chronic constipation, possible prostatic hypertrophy;
– In subjects with certain cardiovascular conditions, due to the quinidine, tachycardia and hypotensive effects of this class of products;
– In patients with neuropathies with severe neurovegetative disorders, due to the increased risk of orthostatic hypotension;
– In hepatic and renal insufficiency, due to the risk of overdose.
The oral solution contains alcohol: it is not recommended for patients suffering from liver disease, alcoholism, epilepsy, as well as pregnant women.
Side effects :
– Dry mouth, constipation, accommodation disorders, tachycardia, sweating, micturition disorders and possibly urinary retention, orthostatic hypotension, impotence. They most often give in to continued treatment or a reduction in dosage.
– Frequently observed: more marked drowsiness or sedation at the start of treatment.
– Much rarer: tremors, seizures on predisposed terrain, transient confusional states, serotonin syndrome (in combination with other treatments).
– Lifting of psychomotor inhibition, with suicidal risk.
– Mood inversion with the appearance of manic episodes.
– Reactivation of a delusion in psychotic subjects.
– Paroxysmal manifestations of anxiety.
– Cases of suicidal ideation and behavior have been reported during treatment with Laroxyl or shortly after stopping it.
Imipramine antidepressants may also cause:
– Weight gain.
– Conduction or rhythm disturbances (with high doses).
– Endocrine disorders: breast enlargement, galactorrhea.
– Hot flashes.
– Allergic skin reactions.
– Dysarthria.
– Exceptional cytolytic or cholestatic hepatitis.
– Hematological disorders: hypereosinophilia, leukopenia, agranulocytosis, thrombocytopenia.
– Syncope.
– Increased risk of bone fractures in patients receiving selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants. The mechanism leading to this risk is unknown.
– Withdrawal reaction with the following undesirable effects: nausea, vomiting, abdominal pain, insomnia, headache, nervousness, anxiety, frequently occur on abrupt cessation of treatment or during a reduction in dosage.
Some of these undesirable effects can be prevented or combated by adjuvant or corrective therapies, or even a reduction in dosage.
Overdose:
In the event of voluntary or accidental overdose, we observe:
– Severe cardiovascular manifestations (essentially conduction disorders determining the severity of the poisoning),
– A strengthening of anticholinergic symptoms, possibly a confusional state or a coma (sometimes delayed).
In this case, the patient should be immediately hospitalized in a specialized department and the ingested product should be evacuated.
Management should include symptomatic treatment and monitoring of vital functions, including cardiac and respiratory, for at least 5 days.
Pregnancies and lactation.
No teratogenic risk observed, treatment to be re-evaluated if necessary, continue as monotherapy. Lower the doses a little at the end of pregnancy. Monitoring of the newborn.