Fields of application | Amitriptyline

Fields of application

The main field of application of amitriptyline is depressive disorders. However, it must be said that this substance is nevertheless more likely to be used as a second choice for the treatment of depression. First choice drugs are the so-called serotonin reuptake inhibitors.

For depression associated with arousal, amitriptyline is used as the drug of first choice. Amitriptyline is absorbed to a high degree. Due to its high metabolism in the first pass, a large part of the substance is already inactivated in the liver, so that only a small part can reach the rest of the body and take effect. The drug is also completely metabolized in the liver. In the case of poisoning with amitriptyline, draining antidotes cannot provide a remedy for this reason.

Interactions with other drugs

All drugs that also have an antidepressant, sedative or respiratory depressant effect should be combined with amitriptyline only with caution. This includes combination with alcohol, antihistamines, barbiturates, benzodiazepines, hypnotics, narcotics, neuroleptics, opiodes and muscle relaxants. These substances lead to so-called pharmacodynamic agonism, i.e. these drugs act similarly to amitriptyline and intensify the effect accordingly.

The combination of these preparations should be avoided or an appropriate dose adjustment should be made. Anticholinergics, such as atropine and antiparkinson drugs as well as sympathomimetics (Sympathicus) add their anticholinergic and sympathomimetic effects of amitriptyline. So-called MAO inhibitors, which are also used in individual cases in the treatment of depression, can increase effects of the central nervous system (so-called excitation).

This can lead to a reduction of the cramping threshold and thus to seizures. In addition, disturbances of consciousness (vigilance reduction) can occur. The combination of amitriptyline with drugs that are actually used to treat high blood pressure (hypertension) can reduce the antihypertensive effect.

These drugs include clonidine, guanethidine and methyldopa. Drugs used to treat cardiac arrhythmia and combined with amitriptyline may have an increased antiarrhythmic effect. The side effects described for the following medicines may also be increased: Amiodarone, quinidine, and possibly other class I antiarrhythmic drugs (drugs for cardiac arrhythmias).

The drug amitriptyline is a so-called psychotropic drug. This means that amitriptyline can have an effect on the psyche of a person, for example on their emotional state. Most psychotropic drugs should not, or only to a very small extent, be taken with alcohol.

Every pharmacist and physician must warn the patient against the combination of amitriptyline and alcohol, as this can lead to interactions. In general it often happens that the alcohol further intensifies the amitriptyline side effects. For the patient, this means that the alcohol in the case of amitriptyline intake increases the central sedation, so the patient very quickly becomes very tired and exhausted.

In addition, it is possible that the actual antidepressive and mood-lifting effect of amitriptyline is weakened by alcohol. All in all, the alcohol thus promotes the side effects of amitriptyline and at the same time ensures that the actual effect is weakened. Nevertheless, many patients who have been taking amitriptyline for years have learned to cope so well with the drug and its side effects that they can now and then drink a glass of champagne or wine without suffering any serious side effects.

Dangerous interactions by taking amitriptyline and alcohol together are not usually to be expected. Nevertheless, you should try to take the medication in the morning, for example, if you know that you want to drink a glass of alcohol in the evening. It is particularly important that large amounts of alcohol and amitriptyline are not tolerated, as psychotropic drugs are broken down by the liver in the same way as alcohol, and liver damage can occur if you drink too much alcohol and take psychotropic drugs at the same time.

However, a rare, moderate alcohol consumption is not a problem, especially since most patients take amitriptyline over a long period of time (usually about 0.5-1 year) and can therefore easily assess how they react to the drug and its side effects. Nevertheless, it is important to be aware of the possible side effects of taking amitriptyline with alcohol consumption. In addition to a stronger sedation (increased tiredness, exhaustion), it can also lead to reduced ability to drive.

This means that even a glass of sparkling wine can make the patient unable to drive a car, as amitriptyline makes the patient feel more insecure (“drunk”) than he would without the antidepressant. Accordingly, driving a car should be avoided at all costs in patients who are taking Amitriptyline and have had a few drinks. Furthermore, the combination of amitriptyline and alcohol leads to a faster reduction of the patient’s gait and speech ability.