Dyskinesia 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... 

Most APDs, as well as TCAs, are inhibitors of the cytochrome P450 enzymes, thus potentially increasing each other s serum levels. For haioperidoi, an increase in serum levels of TCAs (by about 2-fold) is found in up to 10% of patients treated with ciomipramine or nortriptyiine (but is not found with desipramine). Levomepromazine can significantly increase ciomipramine serum levels. Perphenazine has been found to increase serum levels of amitriptyline, desipramine, and nortriptyiine, while thioridazine has been reported to increase desipramine serum levels. Thiothixene levels are usually increased by TCAs such as doxepin, nortriptyline, and clomipramine (the latter combination increases the risk for tardive dyskinesia). 

An 82-year-old woman took amitriptyline 50 mg/day for 1 year for insomnia and was then given amiodarone 200 mg/day for atrial fibrillation 1 month later she developed oro-buccal dyskinesia, shaking in all limbs, and a dry mouth. Amitriptyline was withdrawn, and she recovered within 2 days after treatment with benzatropine. 

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