Just as with any other active ingredient, amitriptyline must not be used under certain circumstances. This is the case, for example, if there is hypersensitivity to the active substance. Other contraindications include:
- Benign prostate enlargement with residual urine formation.
- States of confusion or agitation with sensory delusions.
- Acute intoxication with alcohol, painkillers, sleeping pills, or psychotropic drugs.
- Untreated increased intraocular pressure (narrow-angle glaucoma).
- Urinary retention
- Narrowing of the gastric outlet (pyloric stenosis).
- Intestinal obstruction or paralysis
Similarly, amitriptyline should not be administered to patients who are prone to seizures, have potassium deficiency, have a slowed heartbeat, or have certain heart diseases or heart damage (such as conduction disorders). In patients with impaired liver and kidney function, benign prostatic enlargement without residual urine formation, or disorders of hematopoiesis, the drug should be taken only after consultation with a physician and careful consideration of the benefits and costs.
Drug interactions
Before starting treatment with amitriptyline, please discuss with your doctor whether it may interact with other medications they take. Interactions may include, but are not limited to, the following:
- Life-threatening serotonin syndrome may occur if MAO inhibitors are taken at the same time. Therefore, MAO inhibitors should not be combined with amitriptyline. Also, other antidepressants should not be taken together with amitriptyline – this applies in particular to the active substances fluoxetine and fluvoxamine.
- If amitriptyline is used concomitantly with drugs that affect QT time, there is an increased risk of cardiac arrhythmias.
- When administered with coumarin-type blood coagulants, blood coagulation levels must be checked regularly by a physician.
Reduction of the effect of amitriptyline.
When amitriptyline is taken concomitantly, the following medications and agents may have an increase in effect:
- Analgesics, sleeping pills, or sedatives.
- Antihistamines, anticholinergics, and direct sympathomimetics.
- Certain agents against cardiac arrhythmias such as amiodarone or quinidine.
- Certain active substances against epilepsy such as carbamazepine or phenytoin
At the same time, there may be a decrease in the effect of amitriptyline. Such a weakening of the effect can also be caused by taking drugs with the active ingredients carbamazepine and phenytoin. Likewise, the concentration of the antidepressant in the blood can be reduced by drugs containing active ingredients from St. John’s wort, nicotine, and hormonal contraceptives. The active ingredient itself, on the other hand, weakens the effect of some antihypertensives. Among others, active ingredients of the clonidine or guanethidine type are affected. Simultaneous use of the active substances cimetidine or methylphenidate may increase the effect and side effects of amitriptyline. This also applies to concomitant use of neuroleptics and antiepileptic drugs.
Amitriptyline in pregnancy
During pregnancy, amitriptyline should be used only when absolutely necessary. Although there is so far only limited experience with the use of the active ingredient in pregnancy – in animal studies, however, damage to the fetus was observed by taking it. Therefore, in individual cases, always clarify with your attending physician whether it is possible to take the drug during pregnancy. The active substance should also not be taken during breastfeeding, as it can pass into breast milk. If treatment with amitriptyline must be given during breastfeeding, breastfeeding should be done beforehand. Children under 18 years of age should not take amitriptyline, as there is insufficient experience in this area.
Amitriptyline and Alcohol
Patients taking amitriptyline should avoid drinking alcohol during treatment. Because the active ingredient has a sedating effect, it is also advisable to refrain from driving vehicles and other hazardous activities, at least during the first few days of treatment.Subsequently, the physician should make a decision on a case-by-case basis, taking into account the dosage as well as individual reactions.
Further notes
Please also note the following advice when taking amitriptyline:
- Taking it may increase the risk of bone fractures.
- Contact lens wearers may experience corneal damage during treatment due to decreased lacrimal gland activity.
- Intense sunlight should be avoided during treatment if possible.
- Teeth should be examined regularly during long-term treatment, as there is an increased risk of developing caries.
