Amitriptyline should not be given if patients show symptoms of an acute heart attack, if coronary artery disease is present, if cardiac insufficiency (heart failure) is diagnosed, if patients simultaneously show a conduction disorder of the heart or if a thigh block occurs. In addition, amitriptyline should not be given if there are neurological disorders such as epilepsy, because this drug lowers the seizure threshold, making a seizure more likely. If the patient is delirious, antidepressants should not be given either, as this could increase the delirious state.
Amitriptyline is also not indicated for manic patients. Special caution should be exercised in patients with glaucoma, as the active substance could further increase the eye pressure. In the case of benign enlargement of the prostate (prostate hyperplasia) and narrowing of the stomach outlet (pyloric stenosis), the drug should also not be given.
A combination with the drug group of MAO-inhibitors should only be given under strict indication. The drug should also not be given to patients with liver dysfunction. This also applies to patients with renal insufficiency.
During pregnancy, amitriptyline should be avoided if possible. Although the teratogenic effects which have long been suspected and which can lead to malformations of the child have not yet been confirmed, amitriptyline does lead to adaptation disorders in the newborn. Therefore, pregnant women who take this drug should give birth in special clinics with affiliated neonatology.
To treat depression, amitriptyline should be given 3 times a day in the dosage of 20-25 mg. A maximum ambulatory dose of 150 mg/day should not be exceeded. In the inpatient monitored area the maximum daily dose may be increased to 300 mg a day. In addition to administration in tablet form, the therapy can also be administered by infusion through the vein.
Other dosages must be taken into account. An infusion should be administered 1-3 times 50 mg per day (dissolved in sodium chloride solution). It should be noted that the administration should take place over 2-3 hours.
Amitriptyline can also be injected into the muscle with a syringe. Single doses of 25 mg should not be exceeded. Amitriptyline should only be administered to children and adolescents under 16 years of age after a strict indication.
A dosage of 4-5 mg/kg per day should not be exceeded. In patients with liver dysfunction or renal insufficiency, the dose must be adjusted. There is exactly one pharmaceutical supplier who offers amitriptyline in drop form.
The product is called Amitriptyline neuraxpharm or Amitriptyline neurax. As with the tablets, the indication for taking the drops is a depressive illness or pain therapy for neuropathic pain. Amitriptyline is also sometimes used for migraine therapy.
1 ml of the solution corresponds to about 20 drops and contains 40 mg of the active substance amitriptyline. The recommended dose should be determined by the treating psychiatrist. The manufacturer recommends 150 mg amitriptyline as the maximum daily dose for outpatients.
The maximum daily dose can be up to 300 mg for inpatient treatment. Common to very common side effects of the drops include weight gain, aggressive and restless behavior, loss of libido or impotence, dizziness, drowsiness, fatigue, speech disorders, tremor (shaking of the hands), difficulty focusing the eyes on an object close to the eye (accommodation disorders), Tachycardia and cardiac arrhythmia, drop in blood pressure, a stuffy nose, dry mouth, constipation, nausea, vomiting, headaches, increase in liver values in the blood, sweating, skin rash and problems with urination (micturition problems). Amitriptyline drops neuraxpharm are available only on prescription and from pharmacies. 30 ml of the drops (20 drops = 40 mg) cost just under 15 euros. On presentation of a health insurance prescription the costs are reduced to 5 Euro per prescription.