AMITRIPTYLINE

INDICATIONS

Amitriptyline is used for treating depression. Amitriptyline is a tricyclic antidepressant. How tricyclic antidepressants are thought to increase the activity of certain chemicals in the brain (norepinephrine, serotonin), which help improve mood.

INSTRUCTIONS

Use Amitriptyline as directed by your doctor.

• Amitriptyline may be taken with food or on an empty stomach.
• Avoid eating grapefruit or drinking grapefruit juice while taking Amitriptyline.
• Amitriptyline may take up to 30 days to control symptoms of depression. Continue using Amitriptyline even if you feel well. Do not miss any dose.
• If you miss a dose of Amitriptyline, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Amitriptyline.

STORAGE

Store Amitriptyline at room temperature, below 86 degrees F (30 degrees C) in a tightly closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Amitriptyline out of the reach of children and away from pets.

Do NOT use Amitriptyline if:

• you are allergic to any ingredient in Amitriptyline
• you are currently taking or have taken a monoamine oxidase inhibitor (MAOI) (eg, phenelzine, selegiline) within the last 14 days
• you are taking antihistamines (eg, diphenhydramine), cisapride, droperidol, a ketolide (eg, telithromycin) , a macrolide (eg, erythromycin), mibefradil, or pimozide
• you are recovering from a heart attack.

Contact your doctor or health care provider right away if any of these apply to you.

Some medical conditions may interact with Amitriptyline. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
• if you have allergies to medicines, foods, or other substances
• if you have a history of mental illness (eg, bipolar disorder, mania, manic-depression), or have considered or attempted suicide
• if you have glaucoma, an irregular heartbeat, heart disease, chest pain, liver disease, prostate problems, thyroid disease, or are unable to urinate (urinary retention)
• if you have a history of seizures, epilepsy, or porphyria.

Some medicines may interact with Amitriptyline. Tell your health care provider if you are taking any other medicines, especially any of the following:

• MAOIs (eg, phenelzine, selegiline) because they can cause serious, sometimes life-threatening, reactions. Do NOT take MAO inhibitors with, or within 2 weeks of taking Amitriptyline
• Anticholinergics (eg, scopolamine), bupropion, cimetidine, fluconazole, phenothiazines (eg, chlorpromazine), SSRIs (eg, fluoxetine), terbinafine, or valproic acid because side effects such as blurred vision, difficult urination, drowsiness or sedation, dry mouth, or lightheadedness may occur
• Antihistamines (eg, diphenhydramine), cisapride, droperidol, ketolides (eg, telithromycin), macrolides (eg, erythromycin), mibefradil, pimozide, or streptogramins (eg, quinupristin/dalfopristin) because serious side effects on the heart (eg, racing heartbeat, dizziness, fainting, life-threatening abnormal heartbeat leading to unconsciousness, and lack of heartbeat, may be increased by Amitriptyline
• Carbamazepine, thyroid medicines (eg, levothyroxine), or stimulants (eg, albuterol, pseudoephedrine) because their side effects may be increased by Amitriptyline
• Warfarin because side effects such as serious bleeding may be increased by Amitriptyline
• Clonidine, guanethidine, or guanfacine because the effectiveness of these medicines may be decreased.

This may not be a complete list of all interactions that may occur. Ask your health care provider if Amitriptyline may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

Important safety information:

• Amitriptyline may cause dizziness, drowsiness, or blurred vision. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Amitriptyline. Using Amitriptyline alone, with other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks.
• Avoid drinking alcohol or taking other medicines that cause drowsiness (eg, sedatives, tranquilizers) while taking Amitriptyline. Amitriptyline will add to the effects of alcohol and other depressants. Ask your pharmacist if you have questions about which medicines are depressants.
• Amitriptyline may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.
• Involuntary and uncontrollable movements may develop in patients taking Amitriptyline. Occurrence is highest among the elderly, especially women. The risk of developing these involuntary movements and the likelihood they will become permanent are increased with long-term use and with high doses. However, it is possible to develop these symptoms after short-term use at low doses. Contact your health care provider at once if any of the following occur: involuntary movements of the tongue, face, mouth, or jaw (eg, protrusion of tongue, puffing of cheeks, puckering of mouth, chewing movements), sometimes accompanied by involuntary movements of the arms and legs.
• Amitriptyline may cause sensitivity to sunlight. Avoid prolonged exposure to the sun and other ultraviolet light (eg, tanning beds). Use sunscreens and wear protective clothing until tolerance is determined.
• Do not become overheated in hot weather or during exercise or other activities since heatstroke may occur.
• Diabetes patients – Amitriptyline may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.
• Before you have any medical or dental treatment, emergency care, or surgery, tell the doctor or dentist that you are using Amitriptyline.
• Use caution in the elderly; they may be more sensitive to its effects, especially lightheadedness upon standing; rapid heartbeat; breathing problems; difficult urination; and constipation.
• Pregnancy and breast-feeding:If you plan on becoming pregnant, discuss with your doctor the benefits and risks of using Amitriptyline during pregnancy. Amitriptyline is excreted in the breast milk. Do not breastfeed while taking Amitriptyline.

All medicines may cause side effects, but many people have no, or minor, side effects.

Check with your doctor if any of these most common side effects persist or become bothersome:

Blurred vision; change in sexual desire or ability; constipation; diarrhea; dizziness; drowsiness; dry mouth; headache; loss of appetite; nausea; tiredness; trouble sleeping; weakness.

Seek medical attention right away if any of these severe side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; confusion; dark urine; delusions; difficulty speaking or swallowing; fainting; fast or irregular heartbeat; fever, chills, or sore throat; hallucinations; new or worsening agitation, anxiety, panic attacks, aggressiveness, impulsiveness, irritability, hostility, exaggerated feeling of well-being, restlessness, or inability to sit still; numbness or tingling in an arm or leg; one-sided weakness; seizures; severe or persistent dizziness or headache; severe or persistent trouble sleeping; slurred speech; suicidal thoughts or actions; tremor; trouble urinating; uncontrolled muscle movements (eg, of face, tongue, arms, legs); unusual bleeding or bruising; unusual or severe mental or mood changes; vision problems; yellowing of the skin or eyes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider.