Elavil

Generic name: Amitriptyline

Amitriptyline tablets

What are amitriptyline tablets?

AMITRIPTYLINE (Elavil®, Endep®) is an antidepressant. Amitriptyline can lift your spirits by treating your depression, especially if it is associated with sleep disturbance. Improvement of sleep patterns can be the first benefit of treatment. Your prescriber or health care professional may prescribe amitriptyline for other conditions, such as relief from nerve pain. Generic amitriptyline tablets are available.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• an alcohol problem
• asthma, difficulty breathing
• bipolar disorder or a family history of bipolar disorder
• blood disorders or disease
• diabetes
• difficulty passing urine, prostate trouble
• glaucoma
• having intramuscular injections
• heart disease or previous heart attack
• liver disease
• over active thyroid
• Parkinson's disease
• schizophrenia
• seizures (convulsions)
• stomach disease
• thoughts or plans of suicide; a previous suicide attempt or family history of suicide attempt
• an unusual or allergic reaction to amitriptyline, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I take this medicine?

Take amitriptyline tablets by mouth. Follow the directions on the prescription label. Swallow the tablets with a drink of water. You can take the tablets with or without food. Take your doses at regular intervals. Do not take your medicine more often than directed. Do not stop taking except on your prescriber's advice.

Do not use this medication in children unless you have been specifically instructed to do so by your health care provider. Contact your pediatrician or health care professional regarding the use of this medicine in children. Special care may be needed.

Adolescents, 12 to 18 years old, and elderly patients over 65 years old may have a stronger reaction to this medicine and need smaller doses.

What if I miss a dose?

If you miss a dose normally taken at bedtime to avoid daytime drowsiness, it may be better to miss that dose. If you take more than one dose a day and miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Follow your prescriber's advice on missed doses. Do not take double or extra doses.

What drug(s) may interact with amitriptyline?

Amitriptyline can interact with many other medicines. Some interactions can be very important. Make sure your prescriber or health care professional knows about all other medicines you are taking. Many important interactions are listed below:

Do not take amitriptyline with any of the following medications:

• astemizole (Hismanal®)
• cisapride (Propulsid®)
• probucol
• terfenadine (Seldane®)
• thioridazine (Mellaril®)
• medicines called MAO inhibitors-phenelzine (Nardil®), tranylcypromine (Parnate®), isocarboxazid (Marplan®), selegiline (Eldepryl®)
• other medicines for mental depression (may be duplicate therapies or cause additive side effects)

Amitriptyline may also interact with any of the following medications:

• alcohol
• antacids
• atropine and related drugs like hyoscyamine, scopolamine, tolterodine and others
• barbiturate medicines for inducing sleep or treating seizures (convulsions), such as phenobarbital
• blood thinners, such as warfarin
• bromocriptine
• bupropion
• cimetidine
• clonidine
• cocaine
• delavirdine
• diphenoxylate
• disulfiram
• donepezil
• drugs for treating HIV infection
• female hormones, including contraceptive or birth control pills and estrogen
• galantamine
• herbs and dietary supplements like ephedra (Ma huang), kava kava, SAM-e, St. John's wort, valerian, or others
• imatinib, STI-571
• kaolin; pectin
• labetalol
• levodopa and other medicines for movement problems like Parkinson's disease
• lithium
• medicines for anxiety or sleeping problems
• medicines for colds, flu and breathing difficulties, like pseudoephedrine
• medicines for hay fever or allergies (antihistamines)
• medicines for weight loss or appetite control
• medicines used to regulate abnormal heartbeat or to treat other heart conditions (examples: amiodarone, bepridil, disopyramide, dofetilide, encainide, flecainide, ibutilide, mibefradil, procainamide, propafenone, quinidine, and others)
• metoclopramide
• muscle relaxants, like cyclobenzaprine
• other medicines for mental or mood problems and psychotic disturbances
• prescription pain medications like morphine, codeine, tramadol and others
• procarbazine
• seizure (convulsion) or epilepsy medicine such as carbamazepine or phenytoin
• stimulants like dexmethylphenidate or methylphenidate
• some antibiotics (examples: erythromycin, gatifloxacin, levofloxacin, linezolid, moxifloxacin, sotalol, sparfloxacin)
• tacrine
• thyroid hormones such as levothyroxine

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What side effects may I notice from taking amitriptyline?

Side effects that you should report to your prescriber or health care professional as soon as possible:

• abnormal production of milk in females
• anxiety, agitation, panic attacks, inability to sleep, irritability, hostility or extreme anger, aggressiveness, engaging in unusual or dangerous activities, restlessness or inability to sit still, extreme elation or feeling of happiness that may switch back and forth with a depressed or sad mood
• blurred vision or eye pain
• breast enlargement in both males and females
• confusion, hallucinations (seeing or hearing things that are not really there)
• difficulty breathing
• fainting spells
• fever with increased sweating
• irregular or fast, pounding heartbeat, palpitations
• muscle stiffness, or spasms
• pain or difficulty passing urine, loss of bladder control
• seizures (convulsions)
• sexual difficulties (decreased sexual ability or desire, difficulty ejaculating)
• stomach pain
• swelling of the testicles
• tingling, pain, or numbness in the feet or hands
• unusual weakness or tiredness
• yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):

• anxiety
• constipation, or diarrhea
• drowsiness or dizziness
• dry mouth
• increased sensitivity of the skin to sun or ultraviolet light
• loss of appetite
• nausea, vomiting
• skin rash or itching
• weight gain or loss

What should I watch for while taking amitriptyline?

Visit your prescriber or health care professional for regular checks on your progress. It can take several days before you feel the full effect of amitriptyline. A Medication Guide About Using Antidepressants in Children and Teenagers is available from your health care professional and should be read by the patients and their family or caregivers. Discuss this Medication Guide with the health care provider if this drug is being used in a child or adolescent.

If you have been taking amitriptyline regularly for some time, do not suddenly stop taking it. You must gradually reduce the dose or you may get severe side effects. Ask your prescriber or health care professional for advice. Even after you stop taking amitriptyline it can still affect your body for several days.

If you notice any unusual effects, such as restlessness, worsening of depression, agitation, difficulty sleeping, irritability, anger, acting on dangerous impulses, or suicide thoughts or attempts, you should call your health care provider immediately.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how amitriptyline affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol may increase dizziness and drowsiness. Avoid alcoholic drinks.

Do not treat yourself for coughs, colds, or allergies without asking your prescriber or health care professional for advice. Some ingredients can increase possible side effects.

Your mouth may get dry. Chewing sugarless gum or sucking hard candy, and drinking plenty of water will help.

Amitriptyline may cause dry eyes and blurred vision. If you wear contact lenses you may feel some discomfort. Lubricating drops may help. See your ophthalmologist if the problem does not go away or is severe.

Amitriptyline may make your skin more sensitive to the sun. Keep out of the sun, or wear protective clothing outdoors and use a sunscreen. Do not use sun lamps or sun tanning beds or booths.

If you are diabetic, check your blood sugar more often than usual, especially during the first few weeks of treatment with amitriptyline. Amitriptyline can affect blood glucose (sugar) levels. Call your prescriber or health care professional for advice if you notice a change in the results of blood or urine glucose tests.

If you are going to have surgery or will need an x-ray procedure that uses contrast agents, tell your prescriber or health care professional that you are taking this medicine.

Where can I keep my medicine?

Keep out of the reach of children in a container that small children cannot open.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

What is the shelf life of the pills?

• The expiry date is mentioned on each blister. It is different for different batches. The shelf life is 2 years from the date of manufacture and would differ from batch to batch depending on when they were manufactured.