Elavil (Amitriptyline) Pharmacology: Info Med: "Despite its hazards, amitriptyline can still be considered as one of the most important pillars of antidepressant treatment. For no other tri- or tetracyclic antidepressant agent (including lofepramine and maprotiline) has the efficiency or tolerance been better documented. Neither the selective serotonin re-uptake inhibitors (e.g. fluoxetine) nor the MAO inhibitor modobemid are said to have a more favourable use/risk ratio; however, this has yet to be proven. *The daily dose can also be divided in 2 or 3 single doses, as a rule, however, one nightly dose is better tolerated. The treatment should normally last at least six months.**The necessity of an individual dosage cannot be emphasized enough. In the hospital higher daily doses can be permitted exceptionally (up to 300 mg). Smaller doses are often effective for pain (25 mg/day). Injection of amitriptyline is poorly documented."
http://www.infomed.org/100drugs/frames/amitfram.html

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Amitriptyline side effects: PSYweb: "Common: Blurred vision, constipation, drowsiness, dry mouth, increased sensitivity to sun, low blood pressure, increase in sweating, sleepiness, or weight gain. Rare: Confusion, increased appetite, insomnia, racing heartbeat / palpitations, seizures, sexual problems, or skin rashes / allergies.See physician always: Low blood pressure, confusion, seizures, sexual problems, or skin rashes / allergies.See physician if severe: Blurred vision, constipation, drowsiness, dry mouth, racing heartbeat / palpitations, insomnia, increased sensitivity to sun, increase in sweating, sleepiness, weight gain, or increased appetite.See physician NOW: Confusion or skin rashes / allergies.Stop taking and see physician NOW: Seizures."
http://www.psyweb.com/Drughtm/amitri.html

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Amitriptyline mechanism of Action: Parkinsons Information Exchange: "The precise action of tricyclic antidepressants is not fully understood, but it is believed that the most important effect is the decreased reuptake of norepinephrine and serotonin. Amitriptyline appears to exert effects on both norepinephrine and serotonin (5-HT), although the selective-acting desipramine is a more potent inhibitor of norepinephrine transport. Amitriptyline is metabolized to nortriptyline, which accounts for most of the norepinephrine- reuptake inhibition after amitriptyline administration. Nortriptyline itself also possesses antidepressant activity. Additional hydroxy metabolites apparently are active as well. The down-regulation of limbic œ-receptors that results from this synaptic neurotransmitter increase occurs ~5-7 days after therapeutic concentrations are reached. Monoamine oxidase is not inhibited by either amitriptyline or nortriptyline. Tricyclic antidepressants do not affect dopamine reuptake. Varying degrees of sedation can be produced, and the seizure threshold can be lowered. Amitriptyline possesses strong anticholinergic activity. Cardiac dysrhythmias can result from the direct quinidine-like effect on cardiac function combined with anticholinergic activity and norepinephrine potentiation. Changes in sex hormone concentrations and blood glucose can result from amitriptyline's effect on the endocrine system."
http://www.parkinsons-information-exchange-network-online.com/drugdb/008.html

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Content and dosage of Amitriptyline: Nurses PDR: "Antidepressant: Amitriptyline HCl, 10, 25, or 50 mg. Antipsychotic: Perphenazine, 2 or 4 mg. There are five different strengths of Triavil: Triavil 2-10, Triavil 2-25, Triavil 4-10, Triavil 4-25, and Triavil 4-50. NOTE: The first number refers to the number of milligrams of perphenazine and the second number refers to the number of milligrams of amitriptyline. Dosage Tablets Antidepressant. Adults, initial: One tablet of Triavil 2-25 or 4-25 t.i.d.-q.i.d. or 1 tablet of Triavil 4-50 b.i.d. Schizophrenic clients should receive an initial dose of 2 tablets of Triavil 4-50 t.i.d., with a fourth dose at bedtime, if necessary. Initial dosage for geriatric or adolescent clients in whom anxiety dominates is Triavil 4-10 t.i.d.-q.i.d., with dosage adjusted as required. Maintenance: One tablet Triavil 2-25 or 4-25 b.i.d.-q.i.d. or 1 tablet Triavil 4-50 b.i.d."
http://www.nursespdr.com

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Amitriptyline Contraindications: Mental Health: "In patients who have shown prior hypersensitivity to it. It should not be given concomitantly with a MAO inhibiting compound. Hyperpyretic crises, severe convulsions, and deaths have occurred in patients receiving tricyclic antidepressant and MAO inhibiting drugs simultaneously. When it is desired to substitute amitriptyline for a MAO inhibitor, a minimum of 14 days should be allowed to elapse after the latter is discontinued. Amitriptyline should then be initiated cautiously with gradual increase in dosage until optimum response is achieved. This drug is not recommended for use during the acute recovery phase following myocardial infarction and in the presence of acute congestive heart failure. See Pregnancy under Warnings.Amitriptyline should be used with caution in patients with a history of seizures, impaired liver function, a history of hepatic damage or blood dyscrasias and, because of its atropine-like action, in patients with a history of urinary retention, or with narrow-angle glaucoma or increased intraocular pressure. In patients with narrow-angle glaucoma, even average doses may precipitate an attack."
http://www.mentalhealth.com/drug/p30-e01.html#Head_3

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Amitriptyline Precautions : nlm.nih.gov: "Do not take this medicine within two hours of taking antacids or medicine for diarrhea. Taking these products too close together may make this medicine less effective.This medicine will add to the effects of alcohol and other CNS depressants (medicines that cause drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates; medicine for seizures; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are using this medicine .Before having any kind of surgery, dental treatment, or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine . Taking perphenazine and amitriptyline combination together with medicines that are used during surgery or dental or emergency treatments may increase the CNS depressant effects.This medicine may cause some people to become drowsy or less alert than they are normally, especially during the first few weeks of treatment. Even if this medicine is taken only at bedtime, it may cause some people to feel drowsy or less alert on arising. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert . Dizziness, lightheadedness, or fainting may occur , especially when you get up from a lying or sitting position. Getting up slowly may help. If the problem continues or gets worse, check with your doctor. This medicine may make you sweat less, causing your body temperature to increase. Use extra care not to become overheated during exercise or hot weather while you are taking this medicine , since overheating may result in heat stroke. Also, hot baths or saunas may make you feel dizzy or faint.Perphenazine and amitriptyline combination may cause dryness of the mouth. For temporary relief, use sugarless gum or candy, melt bits of ice in your mouth, or use a saliva substitute. However, if your mouth continues to feel dry for more than 2 weeks, check with your medical doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.Perphenazine may cause your skin to be more sensitive to sunlight than it is normally. Exposure to sunlight, even for brief periods of time, may cause a skin rash, itching, redness or other discoloration of the skin, or a severe sunburn. When you begin taking this medicine: Stay out of direct sunlight, especially between the hours of 10:00 a.m. and 3:00 p.m., if possible. Wear protective clothing, including a hat. Also, wear sunglasses. Apply a sun block product that has a skin protection factor (SPF) of at least 15. Some patients may require a product with a higher SPF number, especially if they have a fair complexion. If you have any questions about this, check with your health care professional. Apply a sun block lipstick that has an SPF of at least 15 to protect your lips. Do not use a sunlamp or tanning bed or booth. If you have a severe reaction from the sun, check with your doctor ."
http://www.nlm.nih.gov/medlineplus/druginfo/perphenazineandamitriptylinesy202453.html

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Who should not take amitriptyline and perphenazine?: A Healthy Me: "Do not take amitriptyline and perphenazine if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days, or if you have had a heart attack in the past 6 weeks. Before taking amitriptyline and perphenazine, tell your doctor if you have a bone marrow disease, high blood pressure or any type of heart disease, glaucoma or increased pressure in your eyes, epilepsy or another seizure disorder, Parkinson's disease, liver disease, an enlarged prostate or difficulty urinating. You may not be able to take amitriptyline and perphenazine, or you may require a lower dose or special monitoring during treatment if you have any of the conditions listed above. It is not known whether amitriptyline and perphenazine will harm an unborn baby. Do not take amitriptyline and perphenazine without first talking to your doctor if you are pregnant. It is not known whether amitriptyline and perphenazine passes into breast milk. Do not take this medication without first talking to your doctor if you are breast-feeding a baby "
http://www.ahealthyme.com/topic/topic100589666

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Side effects to be aware of while taking Amitriptyline: Health Square: "Abnormal secretion of milk, abnormalities of movements and posture, anxiety, asthma, black tongue, blood disorders, blurred vision, body rigidly arched backward, breast development in males, change in pulse rate, chewing movements, coma, confusion, constipation, convulsions, delusions, diarrhea, difficulty breathing, difficulty concentrating, difficulty swallowing, dilated pupils, disorientation, dizziness, drowsiness, dry mouth, eating abnormal amounts of food, ejaculation failure, episodes of elation or irritability, excessive or spontaneous flow of milk, excitement, exhaustion, eye problems, eye spasms, eyes in a fixed position, fatigue, fever, fluid accumulation and swelling (including throat and brain, face and tongue, arms and legs), frequent urination, hair loss, hallucinations, headache, heart attacks, hepatitis, high blood pressure, high fever, high or low blood sugar, hives, impotence, inability to stop moving, inability to urinate, increased or decreased sex drive, inflammation of the mouth, insomnia, intestinal blockage, intolerance to light, involuntary jerky movements of tongue, face, mouth, lips, jaw, body, or arms and legs, irregular blood pressure, pulse, and heartbeat, irregular menstrual periods, lack of coordination, light-headedness upon standing up, liver problems, lockjaw, loss or increase of appetite, low blood pressure, muscle stiffness, nasal congestion, nausea, nightmares, odd taste in the mouth, overactive reflexes, pain and stiffness around neck, palpitations, protruding tongue, puckering of the mouth, puffing of the cheeks, purple-reddish-brown spots on skin, rapid heartbeat, restlessness, rigid arms, feet, head, and muscles, ringing in the ears, salivation, sedation, seizures, sensitivity to light, severe allergic reactions, skin rash or inflammation, scaling, spasms in the hands and feet, speech problems, stomach upset, stroke, sweating, swelling of breasts, swelling of testicles, swollen glands, tingling, pins and needles, and numbness in hands and feet, tremors, twisted neck, twitching in the body, neck, shoulders, and face, uncontrollable and involuntary urination, urinary problems, visual problems, vomiting, weakness, weight gain or loss, writhing motions, yellowed skin and whites of eyes"
http://www.healthsquare.com/newrx/TRI1456.HTM

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Drug and other interactions for Amitriptyline: What drugs: "Drugs or substances that may interact with Etrafon include: Antacids containing aluminum or magnesium (2 hours before or after Etrafon) — can decrease Etrafon's effects Epinephrine (Adrenalin) — can cause very low blood pressure (hypotension) and fast heartbeat when taken with Etrafon Levodopa (Dopar) — Etrafon may prevent this medication from working antithyroid agents (medicine for overactive thyroid), cimetidine (Tagamet), methyldopa (Aldomet), metoclopramide (Reglan), metyrosine (Demser), Pemoline (Cylert), pimozide (Orap), promethazine (Phenergan), rauwolfia alkaloids (alseroxylon), trimeprazine (Temaril) — these medications increase the risk of serious side effects amphetamines, appetite suppressants (diet pills), medicine for asthma, medicine for colds, sinus problems, or allergies (including nose drops and sprays) — these medications increase the risk of serious effects on the heart central nervous system (CNS) depressants — these medications increase CNS depression lithium — dosage may need to be adjusted MAO Inhibitors — when taken with Etrafon may lead to sudden high fever, extremely high blood pressure, and severe convulsions; in rare cases, these medications may be used together under close supervision"
http://www.whatmeds.com/meds/amit_perp.html

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Triavil- Combination Amitriptyline and Perphenazine Adverse reactions: Lotus Biochemical: "A potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with antipsychotic drugs. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmias).The diagnostic evaluation of patients with this syndrome is complicated. In arriving at a diagnosis, it is important to identify cases where the clinical presentation includes both serious medical illness, (e.g., pneumonia, systemic infection, etc.) and untreated or inadequately treated extrapyramidal signs and symptoms (EPS). Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever and primary central nervous system (CNS) pathology. The management of NMS should include 1) immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy, 2) intensive symptomatic treatment and medical monitoring, and 3) treatment of any concomitant serious medical problems for which specific treatments are available. There is no general agreement about specific pharmacological treatment regimens for uncomplicated NMS.If a patient requires antipsychotic drug treatment after recovery from NMS, the potential reintroduction of drug therapy should be carefully considered. The patient should be carefully monitored, since recurrences of NMS have been reported "
http://www.lotusbiochemical.com/work/triavil1.htm