Amitriptyline Oral

Warnings
Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially children/teenagers) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. Therefore, it is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for children/teenagers), even if treatment is not for a mental/mood condition. Tell the doctor immediately if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.

Uses
This medication is used to treat mental/mood problems such as depression. It may help improve mood and feelings of well-being, relieve anxiety and tension, help you sleep better, and increase your energy level. This medication belongs to a class of medications called tricyclic antidepressants. It works by affecting the balance of certain natural chemicals (neurotransmitters) in the brain.

OTHER USES:
This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.
This medication may also be used to treat other mental/mood problems (e.g., anxiety, bipolar disorder), certain types of pain (e.g., peripheral neuropathy, neuropathic pain), eating disorders (e.g., bulimia), and trouble sleeping, or to prevent migraine headache.

How to use Amitriptyline Oral
Read the Medication Guide available from your pharmacist. Consult your doctor or pharmacist if you have any questions.
Take this medication by mouth, usually 1 to 3 times daily or as directed by your doctor. If you take it only once a day, take it at bedtime to help reduce daytime sleepiness. The dosage is based on your age, medical condition and response to therapy. Your doctor may start you at a low dose and gradually increase your dose over several weeks. Follow your doctor's instructions carefully.
This medication does not work right away. It may take up to 2 to 3 weeks before you experience the full benefits.
Use this medication regularly in order to get the most benefit from it. To help you remember, take it at the same times each day.
It is important to continue taking this medication even if you feel well. Do not suddenly stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is abruptly stopped. Muscle aches, headaches and worsening anxiety may also occur. Your dose may need to be gradually decreased.
Tell your doctor if your condition persists or worsens (e.g., your feelings of sadness get worse, or you have thoughts of suicide).

Precautions

See also Warning section.
Before taking amitriptyline, tell your doctor or pharmacist if you are allergic to it, or to other tricyclic antidepressants (e.g., nortriptyline), or if you have any other allergies.
This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: a certain eye problem (untreated narrow-angle glaucoma), a heart attack in the last 30 days.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: diabetes, kidney problems, liver problems, heart problems (e.g., QT prolongation in the EKG), problems urinating (e.g., due to enlarged prostate), eating disorders (e.g., bulimia), overactive thyroid (hyperthyroidism), long-term lung problems (e.g., pulmonary insufficiency), a certain eye problem (open-angle glaucoma), personal or family history of mental/mood conditions (e.g., bipolar disorder, psychosis), family history of suicide, seizures, conditions that may increase your risk of seizures (e.g., other brain disease, alcohol withdrawal).
This drug may make you drowsy or dizzy or cause blurred vision; use caution engaging in activities requiring alertness or clear vision such as driving or using machinery. Limit alcoholic beverages.
To minimize dizziness and the risk of fainting, get up slowly when rising from a sitting or lying position.
Before having surgery, tell your doctor or dentist that you are taking this medication.
This medication may make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths, and sunlamps. Wear sunblock (SPF 30 or greater) and a hat when outdoors.
If you have diabetes, this drug may increase your blood sugar levels. Check your blood sugar levels regularly as directed by your doctor. Tell your doctor immediately if you have symptoms such as increased thirst/urination, shakiness, unusual sweating, or hunger. Your anti-diabetic medication or diet may need to be adjusted.
Depression can lead to thoughts/attempts of suicide. Tell your doctor immediately if you have any suicidal thoughts, worsening depression, or any other mental/mood changes (including new or worsening anxiety, agitation, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, rapid speech). Keep all medical appointments so your doctor can monitor your progress closely and adjust your medication if needed.
Caution is advised when using this drug in the elderly because they may be more sensitive to its side effects, especially dizziness, drowsiness, confusion, and difficulty urinating.
Caution is advised when using this drug in children. (See also Warning section.)
This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor.
This medication passes into breast milk and may have undesirable effects on a nursing infant. Breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

Additional Information

Overdose
If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include: severe dizziness, hallucinations, fast/irregular heartbeat, fainting, widened pupils, muscle stiffness, seizures.

NOTES:
Do not share this medication with others.
Laboratory and/or medical tests (e.g., kidney function, amitriptyline blood level) may be performed from time to time to monitor your progress or check for side effects. Keep all medical appointments. Consult your doctor for more details.

MISSED DOSE:
If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE:
Store at room temperature between 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.
Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

MEDICAL ALERT:
Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA) or 1-800-668-1507 (Canada).

Side Effects

See also Warning section.
Drowsiness, dizziness, dry mouth, blurred vision, constipation, fast heartbeat, nausea, vomiting, loss of appetite, changes in taste, weight gain, tiredness, or trouble urinating may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.
To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or use a saliva substitute.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor immediately if any of these unlikely but serious side effects occur: persistent heartburn, confusion, mental/mood changes (e.g., agitation, excitement), loss of coordination, shaking, restlessness, uncontrollable movements of the mouth/face/hands, fast/irregular heartbeat, numbness/tingling of the hands/feet, decreased sexual ability/desire, enlarged/painful breasts, ringing in the ears, nervousness, shakiness, sweating, unusual hunger, increased thirst/urination, fainting, muscle weakness/spasms, severe vomiting, severe constipation, swelling of the hands/feet.
Tell your doctor immediately if any of these rare but very serious side effects occur: seizures, easy bruising/bleeding, signs of infection (e.g., fever, persistent sore throat), yellowing eyes/skin, severe stomach/abdominal pain, dark urine, persistent nausea/vomiting, pain/redness/swelling of arms or legs.
Seek immediate medical attention if any of these rare but very serious side effects occur: weakness on one side of the body, slurred speech, vision changes.
A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching, swelling, severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Interactions

Your healthcare professionals (e.g., doctor or pharmacist) may already be aware of any possible drug interactions and may be monitoring you for it. Do not start, stop or change the dosage of any medicine before checking with them first.
This drug should not be used with the following medications because very serious (possibly fatal) interactions may occur: arbutamine, sibutramine, iomeprol, lumefantrine, MAO inhibitors (e.g., furazolidone, isocarboxazid, linezolid, moclobemide, phenelzine, procarbazine, selegiline, tranylcypromine).
Avoid taking MAO inhibitors within 2 weeks before and after treatment with this medication. In some cases a serious, possibly fatal drug interaction may occur.
If you are currently using any of these medications listed above, tell your doctor or pharmacist before starting amitriptyline.
Other drugs besides amitriptyline that may affect the heart rhythm (QT prolongation in the EKG) include pimozide, cisapride, halofantrine, disopyramide, grepafloxacin and sparfloxacin, among others. Before using this drug, report all medications you are currently using to your doctor or pharmacist. QT prolongation can infrequently result in serious (rarely fatal) fast/irregular heartbeat and other symptoms (e.g., severe dizziness, fainting) that require immediate medical attention. Ask your doctor or pharmacist for more details and for instructions on how you may reduce the risk of this effect.
Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: alcohol, amprenavir/fosamprenavir, duloxetine, clonidine, ethchlorvynol, guanadrel, guanethidine, levodopa, warfarin, barbiturates (e.g., phenobarbital), cimetidine, drugs for heart rhythm (e.g., flecainide, propafenone, quinidine), phenothiazines (e.g., chlorpromazine), SSRI antidepressants (e.g., citalopram, fluvoxamine, sertraline, fluoxetine), stimulants (e.g., amphetamines, methylphenidate), certain sympathomimetics (e.g., albuterol, epinephrine, phenylephrine), St John's wort, terbinafine, reserpine, thyroid supplements, disulfiram.
If you have been taking fluoxetine, wait at least 5 weeks before starting amitriptyline.
Cigarette smoking decreases blood levels of this medication. Tell your doctor if you smoke or if you have recently stopped smoking.
Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as: certain antihistamines (e.g., diphenhydramine), anti-seizure drugs (e.g., phenytoin, carbamazepine), medicine for sleep or anxiety (e.g., alprazolam, diazepam, zolpidem), muscle relaxants, narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., fluphenazine, risperidone, trazodone).
Check the labels on all your medicines (e.g., cough-and-cold products) because they may contain drowsiness-causing ingredients. Ask your pharmacist about the safe use of those products.
Also report the use of drugs which might increase seizure risk (decrease seizure threshold) when combined with amitriptyline (e.g., bupropion, isoniazid (INH), theophylline, tramadol, among others).
Consult your doctor or pharmacist for details.
This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.