With amitriptyline

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. 

Possible interactions with Amitriptyline Diazepam Antipsychotics Astemizole... 

Despite limited success with amitriptyline in some anorexia patients, using this class of antidepressants can be problematic in AN patients and therefore cannot be routinely recommended. TCAs slow gastrointestinal function and can therefore worsen the constipation and bloating that commonly plague AN patients during refeeding. In addition, TCAs can increase the likelihood of seizure or cardiac arrhythmia in patients already at risk due to electrolyte disturbances. Moreover, they are often lethal after overdose. 

Rx with amitriptyline (Limbitrol DS 10-25) with clidinium (Clindex, Librax) Chemical Class Benzodiazepine... 

Eckmann, E, Fichte, K., Meya, U., and Sastre-y-Hernandez, M. (1988) Rolipram in major depression results of a double-blind comparative study with amitriptyline. Curr Ther Res 43 291-295. 

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. 

One of the more methodologically rigorous studies on the utility of TCA/antipsychotic combinations in treating PMD was completed by Spiker et al. [1985). In this study, 54 patients who met criteria for depression with psychotic features on the Schedule for Affective Disorders and Schizophrenia [Endicott and Spitzer 1978) and by Research Diagnostic Criteria [Spitzer et al. 1985) were randomly selected to treatment with amitriptyline alone, perphenazine alone, or the combination of two drugs. After a 7-day placebo washout, patients were treated for 35 days with doses averaging approximately 50 mg/day of perphenazine and approximately 200 mg/day of ami-... 

Coppen A, Ghose K, Montgomery S, et al Continuation therapy with amitriptyline in depression. Br J Psychiatry 133 28-33, 1978 Coppen A, Swade C, Wood K Lithium restores abnormal platelet 5-HT transport in patients with affective disorders. Br J Psychiatry 136 235-238, 1980 Coppen A, Swade C, Jones SA, et al Depression and tetrahydrobiopterin the folate connection. J Affect Disord 16 103-107, 1989 Cordell B 3-Amyloid formation as a potential therapeutic target for Alzheimer s disease. Annu Rev Pharmacol Toxicol 34 69-89, 1994 Corkin S Acetylcholine, aging, and Alzheimer s disease imphcations of treatment. Trends Neurosci 4 287-290, 1981... 

Well-controlled studies have found lofepramine to be superior to placebo and comparable with amitriptyline, imipramine. and maprotiline ( 109). It may be better tolerated than earlier HCAs, especially by elderly patients. Desipramine is its major metabolite ( Table 7-4 and Table 7-6). 

The approval of mirtazapine in the United States was based on six double-blind, placebo- and amitriptyline-controlled studies in which it was found to be superior to placebo and comparable with amitriptyline in terms of antidepressant efficacy (173,174). In a double-blind, crossover study, 63% of patients who failed to respond to 6 weeks of double-blind treatment with amitriptyline responded to mirtazapine (175). In two studies, mirtazapine was found to be efficacious in the treatment of patients hospitalized for major depression. In the first study, the antidepressant efficacy of mirtazapine was comparable with that of amitriptyline and superior to placebo (176). In the other study, the antidepressant efficacy was superior to that of fluoxetine (118). There are advantages and disadvantages to mirtazapine, including the following ... 

Stein MK, Rickels K, Weise CC. Maintenance therapy with amitriptyline a controlled trial. Am J Psychiatry 1980 137 370-371. 

Laursen AL, Mikkelsen PL, Rasmussen S, et al. Paroxetine in the treatment of depression —a randomized comparison with amitriptyline. Acta Psychiatr Scand 1985 71 249-255. 

Davidson JRT, Kudler H, Smith R, et al. Treatment of posttraumatic stress disorder with amitriptyline and placebo. Arch Gen Psychiatry 1990 47 259-266. 

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. 

Fluoxetine causes weight loss, in contrast to tricyclic antidepressants (417). In one study there was a mean fall in weight of 3.88 pounds over 6 weeks compared with a gain of 4.6 pounds with amitriptyline (418). 

Luzecky MH, Burman KD, Schultz ER. The syndrome of inappropriate secretion of antidiuretic hormone associated with amitriptyline administration. South Med J 1974 67(4) 495-7. 

Tricyclics and the second- and third-generation agents differ mainly in the degree of sedation they produce (greatest with amitriptyline, doxepin, trazodone, and mirtazapine) and their antimuscarinic effects (greatest with amitriptyline and doxepin Table 30-3). SSRIs are generally free of sedative effects and remarkably safe in overdose. Combined with the ease of once-a-day dosing, these qualities may explain why they have become the most widely prescribed antidepressants. 

Gillin JC, Wyatt RJ, Fram D, Snyder F (1978) The relationship between changes in REM sleep and clinical improvement in depressed patients treated with amitriptyline. Psychopharmacology 59 267-272... 

Altamura, A. C., De Novalis, F., Guercetti, G. et al. Fluoxetine compared with amitriptyline in elderly depression a controlled clinical trial. Int. ]. Clin. Pharmacol. Res. 9 (1989) 391-396. 

Sleight AJ, Smith RJ, Marsden CA, Palfrey man MG. The effects of chronic treatment with amitriptyline and MDL 72394 on the control of 5-HT release in vivo. Neuropharmacology 1989 28 477-480. 

Two cases of non-thrombocytopenic purpura occurred in patients taking tricyclic antidepressants. Both improved on withdrawal (107). True thrombocytopenia, with platelets counts as low as 120 x 1012/1, occurred in a 79-year-old woman taking doxepin. During later treatment with amitriptyline, thrombocytopenia recurred, but not when she took imipramine (108). Cross-sensitivity must be highly specific to chemical structure, doxepin and amitriptyline being more like each other than imipramine. 

Casarino JP. Neuropathy associated with amitriptyline. Bilateral footdrop. NY State J Med 1977 77(13) 2124-6. 

Donmez O, Cetinkaya M, Canbek R. Hemoperfusion in a child with amitriptyline intoxication. Pediatr Nephrol 2005 20 105-7. 

Amitriptyline N-oxid, et nyt antidepressivum sammen-lignende klinisk vurdering i forhold til amitriptylin. [Amitriptyline N-oxide. A new antidepressant. A clinical double-blind comparison with amitriptyline.] Nord Psykiatr Tidsskr 1971 25(3) 237-46. 

Lingjaerde O, Asker T, Bugge A, Engstrand E, Eide A, Grinaker H, Herlofsen H, Ose E, Ofsti E. Noxiptilin (Agedal)—a new tricyclic antidepressant with a faster onset of action A double-blind, multicentre comparison with amitriptyline. Pharmakopsychiatr Neuropsychopharmakol 1975 8(1) 26—35. 

Cardiotoxic effects are relatively uncommon with mianserin (2). In a placebo-controlled study in 50 patients with a variety of cardiac conditions who were taking anticoagulants, mianserin (up to 30 or 60 mg) had no effects on electrocardiography, blood pressure, or pulse rate after 3 weeks. In a second phase, mianserin (up to 60 mg/day) was compared with amitriptyline (up to 150 mg/day) and placebo in 18 healthy volunteers. Measurements included systolic time intervals, electrocardiography at rest and during exercise, echocardiography, and blood pressure. Amitriptyline had a negative inotropic effect mianserin increased ejection fraction. The results of both these experiments led the authors to conclude that mianserin is an antidepressant with very low cardiac toxicity. 

BETA-BLOCKERS AMITRIPTYUNE, CLOMIPRAMINE Risk of T levels of beta-blockers with amitriptyline and clomipramine These TCAs inhibit CYP2D6-mediated metabolism of beta-blockers Monitor BP at least weekly until stable. Warn patients to report symptoms of hypotension (light-headedness, dizziness on standing, etc)... 

Corneal lesions in rats increased by use of cionidine with amitriptyline... 

Curry SH, DeVane CL, Wolfe MM. Cimetidine interaction with amitriptyline. Eur J Chn Pharmacol 1985 29(4) 429-33. 

There were signs of opiate toxicity, reversible with naloxone, in an 80-year-old woman after concomitant treatment with amitriptyline and co-codamol (codeine plus paracetamol) (SEDA-18, 79). 

An interaction of fluconazole with amitriptyline has been reported (69). 

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