Tobacco Amitriptyline

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... 

Smoking tobacco reduces the plasma levels of amitriptyline, clomipramine, desipramine, imipramine and nortriptyline, but this does not appear to result in a clinically significant interaction. 

Two studies found no difference between the steady-state nortriptyline plasma levels of tobacco smokers and non-smokers, but others have found that smoking tobacco lowers the plasma levels of amitriptyline, clomipramine, desipramine, imipramine" and nortriptyline. For example a 25% reduction in plasma nortriptyline levels was found in one study, and a 45% reduction in total levels of imipramine and its metabolite, desipramine, was found in another." ... 

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