Amtylin 10 mg Tablet

Tricyclic antidepressant, now mainly used at low doses for:

• Neuropathic pain (diabetic neuropathy, post-herpetic neuralgia), chronic pain
• Migraine and tension-type headache prevention
• Irritable bowel syndrome (low dose)
• Depression (higher doses — now second-line because of side effects)
• Night-time bedwetting in children (rarely used)

Neuropathic pain / headache prevention (adults): start 10 mg at night, increase gradually by 10 mg every 1–2 weeks to 25–75 mg at night.

Depression: 50–75 mg daily (at night or divided), up to 150 mg (specialist).

Elderly: start 10 mg, lower doses.

• Takes 2–6 weeks for full effect. Taken at night because of drowsiness.
• Do not stop suddenly after regular use — taper.

• Recent heart attack, heart block, arrhythmias, severe heart disease
• Mania, severe liver disease
• Use with MAO inhibitors (or within 14 days)
• Children under 6 (for pain), under 12 (depression)
• Porphyria

Very common: drowsiness, dry mouth, constipation, blurred vision, weight gain, dizziness on standing, headache.

Common: fast heartbeat, sweating, difficulty passing urine, sexual dysfunction, tremor, confusion (elderly).

Serious: heart rhythm problems (QT prolongation), seizures, urinary retention, angle-closure glaucoma, serotonin syndrome, suicidal thoughts (young adults), low sodium.

Very dangerous in overdose.

• Keep out of reach of children — small overdoses can be fatal.
• Heart disease, epilepsy, glaucoma, enlarged prostate, thyroid disease, diabetes, elderly: caution.
• Avoid alcohol; may impair driving.
• Low-dose prescriptions for pain: still monitor mood.

Use in pregnancy only if benefit outweighs risk (newborn withdrawal possible). Compatible with breastfeeding at low doses (monitor baby).

• MAO inhibitors (contraindicated); SSRIs, tramadol, triptans, linezolid (serotonin syndrome)
• Fluoxetine, paroxetine, bupropion, terbinafine (raise amitriptyline levels)
• QT-prolonging drugs (antipsychotics, macrolides, quinolones, antiarrhythmics)
• Alcohol, sedatives (more drowsiness); anticholinergics
• Adrenaline (high blood pressure)

Medical emergency — drowsiness, seizures, dangerous heart rhythms, low blood pressure, coma. Go to hospital immediately.

Store below 30°C, protected from light.