Drowsiness amitriptyline

Tricyclic Antidepressants (TCAs). The TCAs have been nsed to treat ADHD for 30 or more years. Most often used are imipramine (Tofranil) and desipramine (Norpramin), mainly becanse they are the TCAs that most specihcally increase norepinephrine activity. Remember, boosting norepinephrine activity in the brain shonld improve attention. Other TCAs, namely, amitriptyline (Elavil, Endep) and nortriptyline (Pamelor), have been used, though they also increase norepinephrine activity. TCAs do offer a modest benefit for both the inattention and the hyperactivity of ADHD. In addition, they are often effective at doses mnch lower than those required to treat depression. However, their effectiveness nsnally falls short of the stimulant medications. In addition, TCAs have considerable side effects including dry mouth, constipation, drowsiness, weight gain, and adverse cardiac effects. 

Amitriptyline is a tricylic antidepressant and these have antimuscarinic side-effects, such as urinary retention, blurred vision, dry mouth and sweating. They also tend to cause drowsiness. 

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... 

In a controlled comparison between clomipramine and amitriptyline, the former caused adverse effects more often, especially drowsiness (3). Overdose toxicity is the same as with other tricyclic antidepressants (4) fatal interactions with monoamine oxidase (MAO) inhibitors have been reported (SEDA-18, 16 5). Altogether, toxic effects are not substantially different. 

Lofepramine is an imipramine analogue whose animal pharmacology suggests low toxicity (1). Its clinical efficacy is similar to that of imipramine and amitriptyline. Patients on lofepramine report less dryness of the mouth, fewer disturbances of accommodation, and less drowsiness, but a greater incidence of tremor (2). 

Pentazocine 30 mg had no effect on motor skills but impaired sensory processing and extraocular muscle imbalance (3). Other effects reported in this study were slight respiratory depression (enhanced by concurrent amitriptyline) and feelings of clumsiness, drowsiness, friendliness, and contentedness, and a muzzy head. 

Frequent Drowsiness headaches gastrointestinal upset Occasional Ventricular arrhythmias peripheral edema Rare Priapism in men increased libido TRICYCLIC ANTIDEPRESSANTS (amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, nortriptyline, protriptyline, trimipramine)... 

Part of the explanation for the increased C3S1S depression is that both alcohol and some of the tricyclics, particularly amitriptyline, cause drowsiness and other CNS depressant effeets, which can be additive with the effects of alcohol. The sedative effects have been reported to be greatest with amitriptyline, then doxepin and imipramine, followed by nortriptyline, and least with amoxapine, clomipramine, desipramine, and protriptyline. In addition acute alcohol intake causes marked increases (100 to 200%) in the plasma levels of amitriptyline, probably by inhibiting its first pass metabolism. Alcohol-induced liver damage could also result in impaired amitriptyline metabolism. The lower serum levels of imipramine and desipramine seen in abstinent alcoholics are attributable to induction of the cytochrome P450 isoenzymes by alcohol. ... 

A study in 12 healthy subjects found that both sublingual buprenorphine 400 micrograms and oral amitriptyline 50 mg impaired the performanee of a number of psychomotor tests (digit symbol substitution, flicker fusion, Maddox wing, hand-to-eye coordination, reactive skills), and the subjects felt drowsy, feeble, mentally slow and muzzy. When amitriptyline 30 mg, increased to 75 mg daily was given for 4 days before a single dose of buprenorphine, the psychomotor effects were not significantly increased, but the respiratory depressant effects of the buprenorphine were enhanced. ... 

Fifteen patients with rheumatoid arthritis given a single 25-mg dose of amitriptyline and dextropropoxyphene (up to 65 mg three times daily) experienced some drowsiness and mental slowness. They complained of being clumsier and had more pain, but these effects were said to be mild. ... 

Both pentazocine and amitriptyline given alone caused 11 healthy subjects to feel drowsy, muzzy and clumsy, and reduced the performance of a number of psychomotor tests. However, when the same subjects were... 

Concurrent use is not uncommon and normally appears to be uneventful However, three patients became drowsy, forgetful and appeared uncoordinated and drunk while taking amitriptyline and chlordiazepoxide. A combined preparation of amitriptyline and chlordiazepoxide (Limbitrot) is available but its advantages have been questioned adverse effects have been seen in four patients. Diazepam may increase the risks of carrying out complex tasks (e.g. driving) if added to amitriptyline, as may other combinations of benzodiazepines and tricyclics. 

There seems to be no reason for avoiding the concurrent use of benzodiazepines and tricyclics although the advantages and disadvantages remain the subject of debate. Other combinations of tricyclic antidepressants and benzodiazepines would not be expected to behave differently from those described here. Some patients will possibly experience increased drowsiness and inattention with the more sedative antidepressants such as amitriptyline, particularly during the first few days, and this may be exaggerated by benzodiazepines such as diazepam. Driving risks may therefore be increased. 

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