Amitriptyline: Further notes

Contraindications of amitriptyline

As with any other active ingredient, amitriptyline may not be used under certain circumstances. This is the case, for example, when there is hypersensitivity to the active ingredient.

Other contraindications are:
  • Benign prostate enlargement with residual urine formation
  • Confusion or agitation states with hallucinations
  • Acute poisoning with alcohol, analgesics, sleeping pills or psychotropic drugs
  • Untreated elevated intraocular pressure (narrow-angle glaucoma)
  • retention of urine
  • Narrowing of the stomach outlet (pyloric stenosis)
  • Intestinal obstruction or intestinal paralysis

Similarly, patients should be refrained from taking amitriptyline, which is prone to seizure, is deficient in potassium, has a slow heart rate, or has some heart disease or heart damage (such as conduction disturbances).

In patients with impaired liver and kidney function, a benign prostate enlargement without residual urine formation or disorders of blood formation, the active ingredient may only be taken after consultation with a doctor and careful consideration of the benefit-cost balance.

Interactions with other drugs

Before starting treatment with amitriptyline, discuss with your doctor if there is any interaction with other medicines you are taking. Inter alia, the following interactions can occur:

  • When taken with MAO inhibitors, the life-threatening serotonin syndrome may occur. Therefore, MAO inhibitors should not be combined with amitriptyline. Other antidepressants should not be taken together with amitriptyline, especially for the active substances fluoxetine and fluvoxamine.
  • When amitriptyline is used concomitantly with medications that affect QT time, there is an increased risk of cardiac arrhythmias.
  • When coumarin-type coagulants are administered, blood coagulation levels should be checked regularly.

Reduction of the effect of amitriptyline

Concurrent use of amitriptyline may increase the effects of the following drugs and agents:

  • Painkillers, sleepers or tranquilizers
  • Antihistamines, anticholinergics and direct sympathomimetics
  • Certain agents against cardiac arrhythmias such as amiodarone or quinidine
  • Certain anti-epileptic drugs such as carbamazepine or phenytoin

At the same time, the effect of amitriptyline may be reduced. Such an attenuation of the effect can also be caused by the ingestion of drugs with the active ingredients carbamazepine and phenytoin. Likewise, the concentration of antidepressant in the blood can be reduced by drugs containing St. John's wort, nicotine and hormonal contraceptives.

In contrast, the active ingredient itself weakens some antihypertensives in their effect. Inter alia, agents of the clonidine or guanethidine type are affected. The simultaneous use of the active ingredients cimetidine or methylphenidate may increase the effects and side effects of amitriptyline. This also applies to the simultaneous use of neuroleptics and antiepileptic drugs.

Amitriptyline in pregnancy

Amitriptyline should only be used during pregnancy when absolutely necessary. Although there is little experience with the use of the active ingredient in pregnancy, animal use has been shown to damage the fetus. For this reason, always clarify in individual cases with your doctor if you can take it during pregnancy.

Even during lactation, the active ingredient should not be taken because it can pass into breast milk. If treatment with amitriptyline is required during breast-feeding, it should be weaned first. Children under the age of 18 should not take Amitriptyline as there is insufficient experience.

Amitriptyline and alcohol

Patients taking amitriptyline should refrain from consuming alcohol during treatment. Since the active ingredient is sedating, it is also advisable to refrain from driving and other dangerous activities, at least during the first few days of treatment. Subsequently, the doctor should make a decision in individual cases, taking into account the dosage and individual reactions.

More information

When taking amitriptyline, please also note the following:

  • Ingestion may increase the risk of bone fractures.
  • Contact lens wearers may experience cornea damage during treatment due to decreased lacrimal gland activity.
  • Intense sunlight should be avoided during treatment as much as possible.
  • The teeth should be examined regularly during a long-term treatment, as there is an increased risk for the development of tooth decay.
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