Amitriptyline interaction

Bertschy G, Vandel S, Jounet JM, Allers G. Interaction valpromide-amitriptyline. Augmentation de la biodisponi-bilite de 1 amitriptyline et de la nortriptyline par le valpro-mide. [Valpromide-amitriptyline interaction. Increase in the bioavailability of amitriptyline and nortriptyline caused by valpromide.] Encephale 1990 16(l) 43-5... 

PisaniF, Primerano G, D Agostino AA, Spina E, Fazio A. Valproic acid-amitriptyline interaction inman. TherDrugMonit 9%6) 8, 382-3. 

Fig. 20.13. Potential H-bonding energy, released upon interaction with the transmembrane domains of P-gp (in arbitrary energy units, EU) for progesterone (1), propranolol (2), amitriptyline (3), diltiazem (4), amiodarone (5), colchicine (7), gramicidin S (8), daunorubicin (9), vinblastine (10), cyclosporin A, in comparison with verapamil...

Additional ADRs linked to diet pills include psychosis myocardial ischemia drug interactions, such as the interaction of fenfluramine with imipramine, fenfluramine with amitriptyline or desipramine, or the toxic reaction between fluoxetine and phentermine and the release of serotonin while inhibiting its reuptake, contributing to hyperserotonin reactions. When the next craze takes hold of patients and their physicians, hopefully physicians and pharmacists will take a more vocal position and recommend restraint, xmtil some proof of efficacy and lack of toxicity is shown for new faddish off-label combinations. 

For the silanol interaction S, we found that the retention of amitriptyline corrected for the hydrophobic contribution to its retention is most suitable ... 

Possible interactions with Amitriptyline Diazepam Antipsychotics Astemizole... 

Amitriptyline Amitriptyline, 5-(3-dimethylaminopropyliden)-10,ll-dihydrodibenzocy-cloheptene (7.1.4), differs from imipramine in that the nitrogen atom in the central part of the tricyclic system is replaced by a carbon, which is bound to a side chain by a double bond. Amitriptyline (7.1.4) is synthesized by interaction of 10,ll-dihydro-A,iV-dimethyl-57f-dibenzo[a,d]cyclohepten-5-one with 3-dimethylaminopropyhnagnesium bromide and the subsequent dehydration of the resulting tertiary alcohol (7.1.3) using hydrochloric acid [ 11]. 

Dose Initial 0.25 mg PO tid, wkly 10.25 mg/dose, to 3 mg max max 4 mg for RLS Caution [C, /-] Sev e CV, renal, or hepatic impair Contra Component allergy Disp Tabs SE Syncope, postural X BP, NA, HA, somnolence, dosed-related hallucinations, dyskinesias, dizziness Interactions t Risk of bleeding W/ ASA, NSAIDs, fevCTfew, garlic, ginger, horse chestnut, red clover, EtOH, tobacco t effects OF amitriptyline, Li, MTX, theophylline, warfarin t risk of photosensitivity W/ dong quai— use sunscreen, St. John s wort X effects W/ antacids, rifampin X effects OF ACEIs, diuretics EMS t Bleeding risk w/ concurrent EtOH, tobacco, ASA, and NSAID use t effects of warfarin OD May cause N/V, drowsiness, hypotension, and CP symptomatic and supportive... 

Determination of amitriptyline plasma concentrations is not routinely recommended but maybe useful in identifying toxicity, drug interactions, or noncompliance (adjustments in dosage should be made according to clinical response not... 

Jerling, M., Bertilsson, L., and Sjoqvist, F. (1994) The use of therapeutic drug monitoring data to document kinetic drug interactions an example with amitriptyline and nortriptyline. Ther Drug Monit 16 1-12. 

This chapter describes the structure and neurochemical function of TCAs, metabolism and significant interactions with other medications, side effects, and specific recommendations for monitoring of side effects in children and adolescents. Because of the recent concern regarding the sudden deaths of children stabilized on TCAs, particular attention will be paid to the potential cardiovascular effects of these medications. The chapter will focus on the five TCA medications that have been most widely used in children amitriptyline (AMI), nortriptyline (NT), imipramine (IMI), desipratnine (DMI), and clomipramine (CMI). 

Schmider J, von Moltke LL, Shader Rl, et al. Extrapolating in vitro data on drug metabolism to in vivo pharmacokinetics evaluation of the pharmacokinetic interaction between amitriptyline and fluoxetine. Drug Metab Rev 1999 31 545-560. 

Although most physicians avoid the combination of an MAOl with most other antidepressants, a number of reports indicate that MAOIs combined with a TCA can be effective and safe in treatment-resistant patients. This combination should be used only by a physician skilled in their use and familiar with their potential adverse effects and drug interactions. Generally, tertiary amine TCAs have been used in combination with MAOIs. Once the dose of the TCA is established, the MAOl should be slowly added. Never attempt the reverse order without a 2-week delay. It may also be prudent to lower the TCA dose slightly before starting the MAOl. An example might be the addition of phenelzine to amitriptyline, starting with an initial dose of 15 mg and subsequent dose increments weekly as needed. The total dose of an MAOl, used in combination with TCA, is usually lower than when used alone (e.g., 30 to 60 mg per day). When the combination is discontinued, the MAOl should be stopped first. 

Galantamine (Razadyne) [Cholinesterase Inhibitor] Uses Alzheimer Dz Action Acetylcholinesterase inhibitor Dose 4 mg PO bid, T to 8 mg bid after 4 wk may T to 12 mg bid in 4 wk Caution [B, ] T Effect w/ suc-cinylcholine, amiodarone, dildazem, verapamil, NSAIDs, digoxin X- effect w/ anticholinergics, T risk of death vs placebo Contra Severe renal/hepadc impair Disp Tabs, soln SE GI disturbances, wt loss, sleep disturbances, dizziness, HA Interactions T Effects W/ amitriptyline, cimeddine, erythromycin, fluoxetine, fluvoxamine, ketoconazole, paroxetine, quinidine EMS Use succinylcholine w/ caudon, may need a reduced dose monitor ECG for induced conduction abnormalities OD May cause cholinergic Sxs (SLUDGE), muscle weakness, resp depression, and Szs atropine may be used as antidote... 

Saarialho-Kere, U., Mattila, M.J., and Seppala, T., Parenteral pentazocine effects on psychomotor skills and respiration, and interactions with amitriptyline, Euk J. Clin. Pharmacol., 35, 483, 1988. 

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