Amitriptin is a classic tricyclic antidepressant. Suppresses the reverse seizure of norepinephrine and serotonin with presynaptic neurons, which leads to an increase in the concentration of these mediators and the development of antidepressant action. With regular use, it suppresses the activity of cerebral beta-adrenoreceptors and serotonin receptors, normalizes the propagation of nerve pulses through these receptors, eliminates the dismantling of these systems caused by depression, exhibits an anxolytic (eliminating anxiety) effect, reduces the match (emotional overexcitation) and manifestation of depression. It has a low-rise anesthetic effect, which, according to scientists, is due to the fluctuations in the level of monoamines (first of all - neurotransmitter serotonin) in the central nervous system and the impact on its own (internal) opiairgic systems of the body. The pronounced ability to bind to M-cholinoreceptors determine the powerful anticholinergic effect of amitriptyline, and its ability to interact with histamine H1 receptors and block alpha-adrenoreceptors - a sedative effect. It has the opponent effect, reduces the sharpness of pain in the ulcer of the stomach and the 12-rosewoman, provides the fastest scarring of ulcers. The above-mentioned anticholinergic activity of amitripthiline, which increases the elasticity of the walls of the bladder and their ability to stretch, makes it effective in the treatment of enuresis. This property of the drug reinforces direct beta-adrenergic stimulation and blocking the seizure of the mediator of serotonin by central neuronal synapses. Amitriptyline reduces the nervous bully as in the presence of a concomitant depression, and without it. The antidepressive effect of the drug begins to clearly manifest themselves for 2-3 weeks from the beginning of drug therapy.

The bioavailability of amitriptyline is about 50%, the half-life period is 30-45 hours. Elimination from the body is carried out with the urine. The drug is available in tablet and ampulylated form. Start pharmacotherapy with a dose of 25-50 mg, optimal reception time - before bedtime. Gradually, during the week, the dose is increased by 3-4 times. In the absence of improving the state in the second week, the daily dose is raised to 300 mg. The elimination of depressive manifestations is not a reason for refusing treatment: in this case, the dose is reduced to a daily 50-100 mg and continue pharmacotherapy at least three months. In the elderly, with a non-heavy flow of depression, the dose of the drug is set in the range from 30 to 100 mg per day, and when positive results achieve positive results, it is moving to a supporting daily dose of 250-50 mg. In the course of treatment, it is necessary to avoid situations requiring a sharp rise from the sedent or lying position. It is not recommended to sharply interrupt treatment: in this case, the abolition syndrome can develop. It is necessary to take the necessary measures for the use of amitriptyline in patients suffering from epilepsy, because The drug in the daily dose of over 150 mg reduces the convulsive threshold. When planning treatment, you should keep in mind the possible attempts of suicide in patients suffering from severe depressions. The joint use of amitriptyline and electrosalproof therapy is possible only under the condition of permanent medical monitoring. In patients with aggravated history and older persons, the drug can lead to pharmacological psychosis (after discontinuation of drug therapy, such phenomena quickly pass). Long use of amitriptyline can lead to the development of caries. The drug is not compatible with alcohol.

Pharmacology

Antidepressant from a group of tricyclic compounds, DiBenzocycloheptadine derivative.

The mechanism of antidepressive action is associated with an increase in the concentration of norepinephrine in synapses and / or serotonin in the central nervous system due to the oppression of the opposite neuronal capture of these mediators. With prolonged use, it reduces the functional activity of β-adrenoreceptors and serotonin brain receptors, normalizes adrenergic and serotonergic transmission, restores the equilibrium of these systems, impaired during depressive states. With anxious-depressive states, reduces the alarm, the lands and depressive manifestations.

There is also some analgesic effect, which is believed to be associated with changes in monoamin concentrations in the central nervous system, especially serotonin, and influence on endogenous opioid systems.

Has a pronounced peripheral and central anticholinergic effect due to high affinity for M-cholinoreceptors; The strong sedative effect associated with the affinity for histamine H 1 -receptors, and alpha-adrenoblocking effect.

It has an anti-sized effect, the mechanism of which is due to the ability to block histamine H 2 -receptors in the stomach parietal cells, as well as to have a sedative and M-choline-blocking effect (with ulcer and duodenal ulcer, reduces pain syndrome, contributes to accelerating the healing of ulcers).

Efficiency with night incontinence is due to the apparent anticholinergic activity, leading to an increase in the bladder ability to stretch, direct β-adrenergic stimulation, activity of α-adrenoreceptor agonists, accompanied by an increase in the tone of the sphincter and the central blockade of serotonin grip.

The mechanism of therapeutic action in nervous bulimia is not established (it is possible to be similar to depression). The distinctive effectiveness of amitriptyline with bulimia in patients as without depression and when it is presence, with the reduction of bulimia can be observed without the concomitant weakening of the depression itself.

When carrying out general anesthesia reduces blood pressure and body temperature. Does not inhibit Mao.

Antidepressant action is developing within 2-3 weeks after the start of use.

Pharmacokinetics

The bioavailability of amitriptyline is 30-60%. Binding of plasma proteins is 82-96%. V d - 5-10 l / kg. Metabolized with the formation of nodriptylin active metabolite.

T 1/2 - 31-46 h. Is removed mainly by the kidneys.

Form release

10 pieces. - Packaging cell contour (5) - packs cardboard.
50 pcs. - Polymeric banks (1) - packs cardboard.

Dosage

For intake, the initial dose is 25-50 mg per night. Then, for 5-6 days, the dose is individually increased to 150-200 mg / day (most of the dose is taken overnight). If there was no improvement during the second week, the daily dose increases to 300 mg. With the disappearance of signs of depression, the dose is reduced to 50-100 mg / day and continue therapy at least 3 months. In elderly patients, with light disorders, the dose is 30-100 mg / day, usually 1 time / day per night, after reaching the therapeutic effect, they go to minimally effective doses - 25-50 mg / day.

With night enuresis in children aged 6-10 years - 10-20 mg / day per night, aged 11-16 years - 25-50 mg / day.

V / M - the initial dose is 50-100 mg / day in 2-4 administration. If necessary, the dose can be gradually increased to 300 mg / day, in exceptional cases - up to 400 mg / day.

Interaction

With simultaneous use with preparations that rendered an inoperative effect on the CNS, a significant increase in the depressing effect on the CNS, hypotensive action, respiratory oppression is possible.

With simultaneous use with drugs with anticholinergic activity, an increase in anticholinergic effects is possible.

With simultaneous use, it is possible to enhance the action of sympathomimetic agents on the cardiovascular system and increase the risk of developing heart rate disorders, tachycardia, severe arterial hypertension.

With simultaneous use with antipsychotic means (neuroleptics), metabolism mutually depresses, while the threshold of convulsive readiness is reduced.

With simultaneous use with antihypertensive means (with the exception of clonidine, guanetidine and their derivatives), it is possible to strengthen the antihypertensive effect and risk of the development of orthostatic hypotension.

With simultaneous use with inhibitors of MAO, a hypertensive crisis is possible; with clonidine, guanetidine - it is possible to reduce the hypotensive action of klonidine or guanetidine; With barbiturates, carbamazepine - it is possible to reduce the action of amitriptyline due to the increase in its metabolism.

The case of serotonin syndrome is described while simultaneously use with sertraline.

With simultaneous use with sucralfat, the absorption of amitriptyline is reduced; with fluouxamine - the concentration of amitriptyline in the blood plasma increases and the risk of toxic action; with fluoxetine - the concentration of amitriptyline in the blood plasma increases and toxic reactions are developing due to the oppression of the CYP2D6 isoenzyme under the influence of fluoxetine; with quinidine - it is possible to slow the metabolism of amitriptyline; With cimetidine - it is possible to slow down the metabolism of amitriptyline, an increase in its concentration in the blood plasma and the development of toxic effects.

With simultaneous use with ethanol, ethanol is enhanced, especially during the first few days of therapy.

Side effects

CNS and peripheral nervous system: drowsiness, asthenia, faint, concern, disorientation, excitement, hallucinations (especially in elderly patients and patients with Parkinson's disease), anxiety, motor anxiety, manic state, hypomanic state, aggressiveness, violation memory, depersonalization, strengthening of depression, reduction of the ability to concentrate attention, insomnia, nightmarish dreams, yawning, activation of symptoms of psychosis, headache, myoclonus, dysarthria, tremor (especially hands, head, language), peripheral neuropathy (paresthesia), Miasthenia, myoclone , ataxia, extrapyramidal syndrome, the increase and enhancement of epileptic seizures, changes to the EEG.

From the cardiovascular system: orthostatic hypotension, tachycardia, conduction disorders, dizziness, nonspecific changes to the ECG (interval of ST or Tenten T), arrhythmia, lability of blood pressure, intraventricular conductivity (expansion of the QRS complex, changes in the interval PQ, blockade of the beam of Gis ).

From the digestive system: nausea, heartburn, vomiting, gastralgy, increase or decreased appetite (increase or decrease in body weight), stomatitis, change in taste, diarrhea, darkening of the language; Rarely - violation of the liver function, cholestatic jaundice, hepatitis.

From the endocrine system: swelling of the test, gynecomastia, increasing the mammary glands, a galactorer, a change in libido, a reduction in potency, hypo-or hyperglycemia, hyponatremia (decrease in vasopressin production), inadequate adg secretion syndrome.

From the side of the blood formation system: agranulocytosis, leukopenia, thrombocytopenia, purpura, eosinophilia.

Allergic reactions: skin rash, skin itching, urticaria, photosensibilization, swelling of the face and language.

Effects caused by anticholinergic activity: dry mouth, tachycardia, accommodation violations, vision of vision, mydriasis, increasing intraocular pressure (only in persons with a narrow angle of the anterior chamber eyes), constipation, paralytic obstruction, urine delay, decrease in sweating, confusion, delirium or hallucinations.

Others: hair loss, noise in ears, swelling, hyperpyracy, increase in lymph nodes, pollakiuria, hypoproteinemia.

Indications

Depression (especially with anxiety, matching and sleep disorders, incl. In childhood, endogenous, involutionary, reactive, neurotic, drug, with organic brain lesions, alcohol abstinence), schizophrenic psychosis, mixed emotional disorders, behavior impairment (activity and attention), night enuresis (with the exception of patients with bladder hypotension), nerve bulimia, chronic pain syndrome (chronic pain in oncological patients, migraine, rheumatic pain, atypical pain pain, postherpetic neuralgia, post-traumatic neuropathy, diabetic neuropathy, peripheral Neuropathy), prevention of migraine, ulcerative ulcer of the stomach and duodenum.

Contraindications

The acute period and early recovery period after myocardial infarction, acute alcoholic intoxication, acute intoxication by sleeping pills, analgesic and psychotropic drugs, closed-coronal glaucoma, severe violations of AV- and intraventricular conductivity (blockade of GISE beam legs, AV blockade of degree), lactation period, Children's age up to 6 years (for receiving inside), children's age up to 12 years old (for per / m and in / in administration), simultaneous treatment of Mao inhibitors and a period 2 weeks before their use, increased amitriptylin sensitivity.

Features of application

Application in pregnancy and breastfeeding

Amitriptyline should not be used during pregnancy, especially in I and III trimesters, except in cases of extreme necessity. Additional and strictly controlled clinical research on the safety of amitriptyline during pregnancy was not carried out.

Reception of amitriptyline should be gradually canceled, at least 7 weeks before the expected delivery in order to avoid the development of cancellation syndrome in a newborn.

In experimental studies, Amitriptyline provided a teratogenic effect.

Contraindicated during lactation. It stands out with breast milk and can cause drowsiness in infants.

Application in children

Contraindication: Children's age up to 6 years (for receiving inside), children's age up to 12 years (for in / m and in / in administration).

special instructions

Caution is used with IHD, arrhythmias, heart blocks, heart failure, myocardial infarction, arterial hypertension, stroke, chronic alcoholism, thyrotoxicosis, against therapy with thyroid drugs.

Against the background of therapy with amitripletin, caution is needed with a sharp transition to a vertical position from the position lying or sitting.

With a sharp discontinuation of the admission, the development of cancellation syndrome is possible.

Amitriptyline in doses of more than 150 mg / day reduces the threshold of convulsive readiness; The risk of developing epileptic attacks in predisposed patients, as well as in the presence of other factors that increase the risk of convulsive syndrome (including under the damage to the brain of any etiology, simultaneously use of antipsychotic drugs, during the denial of ethanol or cancellation of drugs, possessing anticonvulsive activity).

It should be borne in mind that suicidal attempts are possible in depression patients.

Combined with electrosalproof therapy should be applied only under the condition of careful medical observation.

In predisposed patients and elderly patients, it can provoke the development of medicinal psychosis, mainly at night (after the cancellation of the drug is held within a few days).

It may cause paralytic intestinal obstruction, mainly in patients with chronic constipation, elderly or in patients who forced to observe the bed regime.

Before carrying out general or local anesthesia, anesthesiologist should be warned that the patient takes amitriptyline.

With long-term use, an increase in the frequency of caries is observed. It is possible to increase the need for riboflavine.

Amitriptylin can be applied no earlier than 14 days after the abolition of Mao inhibitors.

Do not apply simultaneously with adreno- and sympathomimetics, incl. with epinephrine, ephedrine, isoprenaline, norepinefrine, phenylephrine, phenylpropanolamine.

Caution is used simultaneously with other drugs that have anticholinergic effects.

During the reception of amitripthiline, not to use alcohol.

Impact on the ability to driving vehicles and control mechanisms

During the treatment period, it should be refracted from potentially hazardous activities that require increased attention and rapid psychomotor reactions.

Amitriptyline is a drug-antidepressant drug from a group of tricyclic compounds. It has a soothing, analgesic, antihistamine, sleeping pills, anti-rich action. Most often, this drug is appointed with depresses of various genesis, neurosis, psychosis and some other pathological conditions.

Amitriptyline tablets are a fairly powerful tool producing a systematic effect on the body. In addition to the positive therapeutic effect of this drug, which is achieved quite quickly, many patients note the emergence of various side effects when applied. In most cases, side effects arise after 1 - 2 days after the start of drug therapy. Consider what the side effects of amitripthiline, why they arise, and to whom the treatment of this tool is prohibited.

Amitriptylin side effects

Most often, the appearance of side effects of amitriptyline is associated with its overdose (the maximum dose of the drug is individual for each person). They can also be associated with the fact that when using the drug, a person sharply changes a lying position on sedentary and standing (all movements must be smooth). Negative action is also manifested in the interaction of amitriptyline with other drugs. Among those can be noted:

• monoaminoxidase inhibitors;
• neuroleptics;
• anticoagulants;
• glucocorticoids and others.

Among the side effects of amitriptyline, we note the following:

1. From the digestive system:

• stomach ache;
• nausea;
• vomiting;
• jaundice due to stagnant phenomena in biliary ways;
• stool disorders;
• changes in the perception of taste;
• lifting the functioning of the liver.

2. From the side of the cardiovascular system and the blood formation system:

• heart rhythm;
• decrease in blood pressure;
• dizziness;
• violation of the conductive heart system;
• changes in the percentage of red blood cells, leukocytes and platelets;
• changes in the electrocardiogram.

3. From the nervous system:

• hallucinations;
• lethargy;
• fainting;
• drowsiness or insomnia;
• the emergence of uncontrolled movements of hands and legs;
• confusion of consciousness;
• head shakes and limbs;
• headache;
• convulsions;
• yawn;
• epileptic attacks;
• reduced and increasing nervous excitability.

4. From the endocrine system:

• changes of sexual attraction;
• change in glucose content;
• reduction of sodium ion content;
• increased mammary glands.

5. Other side effects, including those associated with therapeutic effects of the drug:

• a variety of allergic manifestations (swelling of quinque, urticaria, itching, etc.);
• an increase in intraocular pressure;
• violations of visual perception;
• dry mouth;
• hair loss;
• fever;
• frequent urination, etc.

Amitriptyline and alcohol

In no case, in no case, when treating this drug, use alcohol-containing drinks. The interaction of amitriptyline and alcohol inhibitively acts on the central nervous system, and in the oppression of the respiratory center, you can cause a suffocation and death.

Catad_pgroup Antidepressants

Amitriptilin-Lance Tablets - Instructions for use

Currently, the drug is not listed by the State Register of Drugs or the specified registration number is excluded from the registry.

Registration number:

R№ 000221 / 02-2001

Tradename:

Amitriptin-Lance ®

International UnPatented Name (MNN):

amitriptyline.

Chemical rational name:
3- (10,11-dihydro-5H-dibenzo-cyclohepten-5-orden) -n, N-dimethyl-1-propane hydrochloride.

Dosage form:

pills.

Structure:

One tablet contains:
Active substance: Amitriptilina hydrochloride - 0.025
Excipients: Milk sugar (lactose), corn starch, microcrystalline cellulose, silicon colloidal dioxide (aerosil), food gelatin, calcium stearate.

Description:

Tablets from white with grayish-creamy to white with cream colors.

Pharmacotherapy group:

antidepressant.

ATX code .

Pharmacological properties

Amitriptin is a tricyclic antidepressant from a group of indiscriminate monoamin neuronal capture inhibitors. It has pronounced TimoNaleptic and sedative action.

Pharmacodynamics

The mechanism of antidepressant amitriptyline is associated with the oppression of the reverse neural capture of catecholamines (norepinephrine, dopamine) and serotonin in the central nervous system.
Amitriptin is an antagonist of muscarinic cholinergic receptors in the central nervous system and peripherals, has peripheral antihistamine (H1) and anti-adverergic properties. Also causes anti-surge (central analgesic), anti-sized and antibulmic effect, effective with night incontinence.
Antidepressant action is developing within 2-4 weeks. After the start of use.

Pharmacokinetics

Absorption is high. The time to achieve the maximum concentration (T Mach) after reception inside 4-8 hours. Bioavailability of amitriptyline from 33 to 62%, its active nodriptyline metabolite - 46-70%. Volume of distribution 5-10 l / kg. Effective therapeutic concentrations in the blood of amitriptyline - 50-250 ng / ml, for northripthiline (its active metabolite) 50-150 ng / ml. The maximum blood plasma concentration (with MAs) is 0.04-0.16 μg / ml. It passes through histohematic barriers, including a hematorencephalic barrier (including Northriptyline).
The concentrations of amitriptyline in the tissues are higher than in plasma. Communication with plasma proteins 92 - 96%.
Metabolized in the liver (by demethylation, hydroxylation) with the formation of active metabolites - northriptiline, 10-hydroxy-amitriptyline, and inactive metabolites.
The half-life of blood plasma from 10 to 28 hours for amitriptyline and from 16 to 80 hours for northriptiline. It is highlighted by the kidneys - 80%, partly with biliary, complete elimination within 7-14 days.
Amitriptylin penetrates through the placental barrier, it is released into breast milk at concentrations similar to the plasma.

Indications for use

• Depression of any etiology. By virtue of the sedative effect, the sedative effect is especially effective in anxiously depressive states.
• Mixed emotional disorders and behaviors; Phobic disorders.
• Children's enuresis (except for children with hypotonic blades bubble).
• Psychogenic anorexia, bulimic neurosis.
• Chronic pain syndrome (neurogenic), making migraine prevention.

Contraindications

• Heart failure in the decompensation stage.
• Acute and recovery period of myocardial infarction.
• Violations of the Cardiac Muscle.
• Pronounced arterial hypertension.
• Acute liver and kidney diseases with a pronounced violation of functions.
• The ulcerative disease of the stomach and 12 reps in the stages of exacerbation.
• Prostate hypertrophy.
• Atony bladder.
• Pylorostenosis, paralytic intestinal obstruction.
• Simultaneous treatment of Mao inhibitors (see Interaction).
• Pregnancy, breastfeeding period.
• Children's age up to 6 years.
• Increased sensitivity to amitripletin.

Amitriptylin should be used in persons suffering from alcoholism, with bronchial asthma, manic-depressive psychosis (TIR) \u200b\u200band epilepsy (see special instructions), in the oppression of bone marginal hematopopia, hyperthyroidism, angina and heart failure, clotted glaucoma, intraocular hypertension, schizophrenia ( Although when it takes, it usually does not exacerbate productive symptoms).

Method of application and dose

Prescribed inside (during or after meals).
The initial daily dose at admission is 50-75 mg (25 mg in 2-3 admission), then the dose is gradually increased by 25-50 mg before obtaining the desired antidepressant effect. The optimal daily therapeutic dose is 150-200 mg (the maximum part of the dose is taken overnight).
In severe depressions resistant to therapy, the dose increases to 300 mg and more, to the maximum portable dose (maximum dose for outpatient patients - 150 mg / day). In these cases, treatment is advisable to start with intramuscular or intravenous administration of the drug, applying higher initial doses, accelerating the extension of dosages under the control of the somatic state.
After receiving a persistent antidepressive effect after 2-4 weeks, the dose is gradually and slowly reduced. In case of signs of depression, with a decrease in doses, it is necessary to return to the previous dose.
If the patient's condition does not improve for 3-4 weeks of treatment, then further therapy is inexpedient.
In senior patients with light disorders, in an outpatient practice, the dose make up 25-50-100mg as much as possible, in divided doses or 1 time per day.
At Enuresya, children over 6 years 12.5-25mg before bedtime (the dose should not exceed 2,5mg / kg body weight of the child).
For the prevention of migraines, chronic pains of a neurogenic nature (including long-term headaches) from 12.5-25 mg to 100 mg / day.

Side effects

Basically are associated with the cholin-blocking effect of the drug: accommodation paresis, blurredness, increasing intraocular pressure, dry mouth, constipation, intestinal obstruction, urination delay, increase body temperature. All these phenomena usually pass after adaptation to the drug or reduce doses.

From the CNS: headache, ataxia, increased fatigue, weakness, irritability, dizziness, ears, drowsiness or insomnia, violation of the concentration of attention, nightmarish dreams, dysarthria, confusion, hallucinations, motor arousal, disorientation, tremor, paresthesia, peripheral neuropathy, changes to EEG. Rarely - extrapyramidal disorders, cramps, anxiety.

From the side of the cardiovascular system: Tachycardia, arrhythmia, conduction disorder, arterial pressure lability, expansion of the QRS complex to ECG (violation of intraventricular conductivity), symptoms of heart failure, fainting.

From the gearbox: Nausea, vomiting, heartburn, anorexia, stomatitis, violations of taste, darkening of the language, sensation of discomfort in epigastria, gastralgia, increasing the activity of "liver" transaminases, rarely cholestatic jaundice, diarrhea.

From the endocrine system: Increasing the size of the chest glands in men and women, Galathery, a change in the secretion of antidiuretic hormone (ADG), a change in libido, potency. Rarely hypo- or hyperglycemia, glucose, violation of glucose tolerance, edema of testicles.

Allergic reactions: Skin rash, itching, photosensibilization, angioedema swelling, urticaria.

Others: Agranulocytosis, leukopenia, eosinophilia, thrombocytopenia, purpura and other blood changes, hair loss, an increase in lymph nodes, an increase in body weight with long-term use, sweating, pollakiuria.

With long-term treatment, especially in high doses, with a sharp discontinuation of treatment, it is possible to develop Cancellation syndrome: Headache, nausea, vomiting, diarrhea, as well as irritability, sleep disorder with bright, unusual dreams, increased excitability.

Overdose

Sleepiness, disorientation, confusion of consciousness, oppression of consciousness up to coma, expansion of pupils, increase in body temperature, shortness of breath, dyspartia, excitation, hallucinations, convulsive seizures, muscle rigidity, vomiting, arrhythmia, arterial hypotension, heart failure, respiratory depression.

Assistance Merities: Termination of amitriphylic therapy, stomach wash, fluid infusion, symptomatic therapy, maintenance of blood pressure and water and electrolyte balance. The monitoring of cardiovascular activities (ECG) is shown for 5 days, because Recurrement may occur after 48 hours and later. Hemodialysis and forced diuresis are little effective.

Interaction with other medicines

Amitriptin increases the oppressive effect on the TSS of the following drugs: neuroleptics, sedative and sleeping pills, anticonvulsant drugs, analgesics, drugs for anesthesia, alcohol; Exhibits synergism when interacting with other antidepressants.
With the joint use of amitriptyline with neuroleptics, and / or antiholinergic preparations, a febrile temperature reaction may occur, paralytic intestinal obstruction.
Amitriptin potentifies the hypertensive effects of catecholamines and other adrenostimulants, which increases the risk of developing heart rate disorders, tachycardia, severe hypertension, but inhibits the effects of drugs influencing the release of norepinephrine.
Amitriptylin can reduce the antihypertensive effect of guanetidine and drugs with a similar mechanism of action, as well as weakening the effect of anticonvulsants.
With the simultaneous use of amitriptilin and anticoagulants - Cumarine derivatives, it is possible to increase the anticoagulant activity of the latter.
With simultaneous admission of amitriptyline and cimetidine, it is possible to increase the concentration in amitriptyline plasma with the possible development of toxic effects.
Inductors of microsomal liver enzymes (barbiturates, carbamazepine) reduce the plasma concentrations of amitriptyline.
Amitriptinyl enhances the effect of anti-chaknixic agents and other drugs causing extrapyramidal reactions.
County decesses amitriptyline metabolism.
The joint use of amitriptyline with disulfiram and other acetal dehydhydhydrogenase inhibitors can provoke delirium.
Estrogen-containing oral contraceptives can increase the bioavailability of amitripthiline; Pimozide and procuola can enhance heart arrhythmias.
Amitriptyline can enhance depression caused by glucocorticosteroids; With drugs with drugs for the treatment of thyrotoxicosis, the risk of agranulocytosis is increased.

Simultaneous reception of amitriptyline with Mao inhibitors can lead to a fatal outcome.
A break in the treatment between the admission of Mao's inhibitors \\ tricyclic antidepressants should be at least 14 days!

special instructions

Amitriptylin in doses above 150 mg / day reduces the threshold of convulsive activity, so it is necessary to take into account the possibility of convulsive seizures in patients with those in history and in the category of patients who are predisposed to this due to age or injuries.

The treatment with amitripitalin in old age should be under careful control, using minimal doses of the drug and gradually increasing them, to avoid the development of delicious disorders, hypologia and other complications. Patients with a depressive phase of TIR can go to the manic stag.

Impact on the ability to drive a car and use the technique

During the reception of amitriptyline, driving vehicles, maintenance of mechanisms and other types of work requiring increased concentration of attention, as well as the admission of alcohol.

Release form:

10 tablets in contour cellular packaging.
50 tablets in polymer or glass jars.

Storage conditions:

List B.
Store in a dry, protected from light, inaccessible to children.

Shelf life:

2 years.
The drug cannot be taken after the expiration date indicated on the package!

Conditions of vacation from pharmacies:

According to the doctor's prescription.

Manufacturer:
OJSC "Dalkhimfarm", Khabarovsk, st. Tashkentskaya, 22.
By order of CJSC "Masterlek", Moscow.

Stressful states arise in adults quite often, but they are usually associated with everyday problems and are eliminated by the usual rest, shifting of the situation or light natural drugs. In cases of more complex depressive situations, doctors can assign Amitriptyline Nicomed to the patient (25 mg), the instructions for the use of which is described below.

Indications for use

Amitriptyline Nicomed "(25 mg) testimony for use has the following:

• autism;
• hypochondria;
• depression;
• schizophrenic psychosis;
• bulimia nervous;
• bed-wetting;
• chronic painful syndromes;
• peptic diseases;
• migraine Prevention.

Among the entire list of serious nervous disorders should be allocated that the drug is appointed by experts even for patients with oncological diseases to reduce pain. With a violation of emotional state and behavior, increased anxiety, sleep disorders and mortgaged depressions, the tool helps 100%, it is important to remember only that it starts to act immediately.

Analogs and cost

"Amitriptyline Nikomed" (25 mg) in tablets in stationary pharmacies costs about 50-70 rubles per pack. Also, the medication is produced in the form of solutions for injection and infusion.

"Amitriptyline" (25 mg) is made in a tablet form by many companies under one name.

So, the analogues of the drug from the pharmaceutical company "NIKOMED" are medicines from manufacturers:

• "Zentiva";
• "Grindex".

There is also a cheaper option of domestic production and a tablet called "Vero-Amitriptyline", manufactured by many pharmacological foreign companies.

Pharmacology of preparation

"Amitriptyline Nicomed" (25 mg) Description characterizes as the strongest antidepressant of the tricyclic group. When prescribed by the doctor of this drug, it is very important to remember that its action is fully observed only 2-3 weeks after the start of therapy.

Reducing the depressive state in patients is often observed much earlier than the stated period and is due to an increased concentration in the organism of the norepinephrine. After a few days, it begins to completely leaving anxiety, and after a couple of weeks, the psychological state is fully stabilized and the assessment goes. The equilibrium of the nervous system is restored also due to normalization in the body of serotonin and β-adrenoreceptors.

"Amitriptyline Nikomed" (25 mg) Instructions for use describes both the effective remedy against strong pain syndromes. Its anesthetic effect is also associated with the normalization of serotonin in the body. Also, the drug normalizes the number of monoamines in the nervous system.

In addition, the remedy has a pronounced sedative effect and is able to block the acetylcholine in the blood of patients. This often leads to confusion of consciousness during therapy, dizziness, violations of violation, dryness in the mouth, constipation or difficulties in urination. All these effects are indicated in the instructions for the drug as possible side. By the way, it is thanks to them that it is prescribed as effective in the night incontinence of urine, because it is blocking acetylcholine that allows the bladder to stretch stronger, at the same time increasing the sphincter tone.

From what the pills "amitriptyline nicomed" (25 mg) help more? This list necessarily added peptical diseases of the stomach or duodenum. Efficiency The drug in the treatment of these paragraphs is due to its ability to block histamine receptors and provide a sedative effect. It is this that helps patients not just to reduce pain, but also accelerate the healing of the surface of the internal organs of the ulcers on the mucous membrane.

Interestingly, the effectiveness of the drug at Bulimia is not explained by its pharmacological properties, but it remains obvious. Amitriptyline Nicomed "(25 mg) helps patients with such a diagnosis even without pronounced signs of depression. The mechanism of exposure is most likely due to the drug-specific properties characteristic of the drug.

It is important to know that "amitriptyline nicomed" (25 mg), the instruction to which is attached in each pack, is able to significantly reduce blood pressure, body temperature and even slow down the breath when the dose is exceeded or during anesthesia. That is why the use of the drug should be stopped several weeks before planned operations and be sure to warn specialists about the list of used drugs.

Blocking splitting monoaminoxidase The tool does not cause.

Pharmacokinetics tablets

Finding into the patient's body, "amitriptyline" (25 mg) binds to plasma proteins by 80-96%, depending on the minor conditions. Its bioavailability is about 50%, and the half-life period is from 30 to 45 hours. The removal of drug residues is carried out mainly by the kidneys.

Instruction

"Amitriptyline Nikomed" (25 mg) Instructions for use recommends to start taking with a minimum dose for all categories of patients and regardless of diagnosis. The dosage in this case is appointed by the attending physician from 25 mg to 50 mg per day for one reception before bedtime. Only after the use of the drug in this mode, its daily amount gradually increases depending on the disease to a maximum of up to 200 mg. Most of the recommended amount of the drug is also taken overnight.

Only in the absence of a visible effect for several weeks from the AMITRIPTILIN drug, the application is allowed to participate with an increase in daily dose to 300 mg. It happens very rarely and only in special cases.

Immediately after the disappearance of visible signs of depression or other nervous disorders, the dosage of the drug is reduced to minimal (50-100 mg) and continue treatment to the end of the course prescribed by the course. Typically, the treatment with this drug lasts for several months. It is important to know that in the elderly, due to the risk of the occurrence of the side effects of Amitriptyline Nicomed (25 mg), the instruction confirms this, should be taken in the active phase with a maximum dosage of 100 mg, and with the disappearance of visible problems - 50 mg and only on night.

Children's incontinence of urine is treated with the drug only from the six-year-old, as it was forbidden to give it to children. The dosage at the same time is 10-20 mg in children under 10 years and 25-50 mg - up to 16 years.

Amitriptyline can be used as an injection for the treatment of various diseases, but contraindications and dosage are calculated completely differently.

Bans to use

"Amitriptyline Nikomed" (25 mg) contraindications has many, because it is characterized as a very strong antidepressant.

In addition to the individual intolerance to any of the components of the drug, it is forbidden to use:

• during the tooling of the fetus and lactation;
• children up to six years;
• during the reduction period after the heart attack;
• with closed-coronal glaucoma;
• with severe heart disease;

It is also strictly forbidden to take together "amitriptyline", alcohol, psychotropic, analgesic and hypnotic drugs.

Sideflines

Since "Amitriptyline Nomed" (25 mg) instructions for use characterizes as a strongest antidepressant, the list of its possible unwanted effects is very wide. Despite this, according to reviews, most patients do not arise them at all or manifest only dizziness in the first days after the start of therapy.

So the drug may cause disorders from:

• nervous system;
• digestive;
• cardiovascular;
• endocrine;
• blood-forming.

Also "amitriptyline", the instruction contains a complete list of side effects, can cause various allergic reactions on the skin in the form of rashes, swelling or itching. In addition, some patients in studies have been observed hair loss, an increase in lymph nodes and noise in the ears.

Among the most common side effects, patients identify characteristic manifestations of anticholinergic activity. It is just true for dizziness, dry mouth, tachycardia, confusion of consciousness, in particular cases are possible hallucinations.

Less often encounter disorders of the digestive system in the form of nausea, changes in taste perceptions, disorders of appetite, heartburn, stomatitis, diarrhea. Very rarely in this direction, disorders of the liver and hepatitis are manifested.

From the work of the thyroid gland, breast increases can be observed in women and breach of potency in men. The overall effect for any gender is the reduction of libido. At the work of the heart, arrhythmias, tachycardia, dizziness, nonspecific figures for electrocardiogram can occur and so on.

Special attention should be paid to the list of possible negative manifestations from the work of the nervous system. Despite the fact that the drug is directed to its stabilization, most of the risk of side effects is also associated with it.

So, patients may be observed:

• anxiety;
• drowsiness;
• strengthening depression;
• fainting;
• manic states;
• disorientation;
• psychosis;
• headaches;
• insomnia;
• nightmares in a dream;
• the participation of epilepsy attacks.

Interaction with other drugs

All patients are very important to remember, even if the depression was tortured before the exhaustion: "Amitriptyline" cannot be taken together with other additional drugs that affect the nervous system. Such an overdose can lead to the oppression of breathing and a sharp decrease in blood pressure. Also, attention should be paid to all those used parallel to drugs with anticholinergic effect, which can be at times strengthened.

Also enhanced with a negative effect in the form of tachycardius, heart rate disorders, depression of metabolism and other undesirable phenomena with simultaneous reception with other antipsychopathic medicines.

During the first days of parallel therapy, together with ethanol, his action will be pronounced pronounced. In some cases, such an effect is maintained throughout the course of reception. "Amitriptyline Nicomed" (25 mg), instructions and feedback from patients indicate this, strengthens the effect and other chemicals. Thus, simultaneous reception with antihypertensive drugs can provoke the risk of orthostatic hypotension.

Despite the fact that the medication under review does not apply to Mao inhibitors, to take it in parallel with similar drugs can be dangerous to health. Such a combination of active substances can provoke hypertensive crisis in the body.

Certain substances are able to reduce the effectiveness of amitripiline, others, on the contrary, so much increase its concentration in the blood, that the patients may have a toxic reaction. That is why such a serious drug should be taken only after consulting with a specialist. An experienced doctor is always able to assign the correct dosage and take into account the interaction of the drug with other drug received.

Amitriptyline has a very wide list of possible side effects and contraindications, but it can be even wider if not taken into account certain recommendations. So, take the drug with caution in chronic alcoholism, because with alcohol, the means in principle is incompatible. In addition, it is necessary to take into account the presence of arrhythmia, arterial hypertension, heart failure or the active phase of the thyroid gland during the prescription of the drug.

Patients undergoing therapy "amitripitalin" must take into account that the active ingredient can cause cloud during a sharp transition to the vertical position, so it is always necessary to get up smoothly. Also, with a long period of therapy and a sharp discontinuation of treatment, most develops cancellation syndrome.

Since the drug is incompatible with drugs inhibiting Mao, then begin the therapy, they should not earlier than 2 weeks after the cessation of the reception of the above funds.

Doctors should always be warned about the admission of this medication, precisely because it is able to influence other medicines. It is also necessary to exclude simultaneous reception with ephedrine, phenylephrine and similar substances.

In elderly patients, especially those who comply with bed and few moving, the drug can cause acute intestinal obstruction. Any integrated effect on the body in the form of electrotherapy is allowed only under the strict observation of doctors.

Durable drug intake can provoke the appearance of caries and the need for additional consumption of riboflavin.

If the medication is prescribed to a patient in a daily dosage of more than 150 mg, that is, the probability that the concentration of the substance in the body will provoke further increase in epileptic attacks and a bright manifestation of sudrudation syndrome in other symptoms. With long-term use, it is also necessary to take into account that patients may have suicidal inclinations, especially with a sharp abolition of the drug.

Application under certain conditions

At any age, patients should avoid control of vehicles and complex mechanisms during therapy. The fact is that Amitriptyline is able to inject human attention and reduce the speed of its psychomotor reactions.

In childhood, medication applies only from age in 6 years in the form of tablets. There are still large restrictions on injection fluids. They can be used for children only from age in 12 years.

During pregnancy, the drug is prohibited because, according to research results, it is able to have a negative impact on the development of the fetus. The use of the medication is allowed in very rare cases and only in the second trimester if the benefits completely overlaps possible. It is also necessary to stop therapy in time so that the baby does not develop after the birth of the cancellation syndrome. The drug must be canceled for at least 7 weeks before the expected date of delivery.

During the feeding "Amitriptyline Nikomed", they do not use at all, because it is able to cause drowsiness and addictiveness in children.

In patients of old age, the drug often causes intestinal obstruction, which is necessary to eliminate symptomatic or drug replacement to another. Also in the elderly, medicinal psychoses may be observed, which are most often manifested after the discharge of the drug at night.

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This drug is produced in the form of tablets and injection solutions. In his instructions for use, the reader will be able to find all the necessary information regarding its dosages, side effects, contraindications, and so on. Immediately, we note that amitriptyline can not be used to patients with those or other malfunctions in the work of the cardiovascular system. In this case, we are talking about myocardial infarction, and about hypertension, as well as decompensated heart failure. Various violations of the normal health of the liver or kidney is also considered to be contraindicated to the use of this drug. If the patient has a bladder atony, the individual intolerance to any components of this medicine, the disease of the blood formation system or the growth of the prostate gland, then it is also necessary to abandon the reception of amitriptyline. It is categorically contraindicated in the event of an exacerbation of the ulcer of the stomach or duodenum.

Using this medication should not be forgotten that amitriptyline can be used along with all the drugs. Often, when using this medicine, various violations on the part of the central nervous system are noted, which each patient is obliged to know. If the course of therapy is stopped very suddenly, it can cause the development of cancellation syndrome.

If you speak directly about the reviews that relate to this drug, they are actually a lot. Approximately fifty percent cases, people complain about the side effects that arise from them every other or two treatment with this medicine. Most often they allocate apathy and excessive drowsiness. Considering the occurrence of such side effects, patients are forced to take this drug mainly before going to bed. There are such cases when patients complain about the same signs, while pointing to the fact that they continue to pursue them for more than two months. In such cases, the drug is most often replaced by another pharmaceutical agent. There are also such reviews in which people with confidence suggest that against the background of using amitriptyline they did not have a single side effect. The most common feedback are words that this medication is not very well tolerated by the body, but all people can cause completely different side effects. Even if the body does not perceive it, then this medicine can be replaced at any time with another drug.

Using this drug, it is recommended to extremely gently change the lying position on the sedent or standing. All movements should be performed smoothly. We note the fact that in the case of a sharp abolition of this medication, it is quite possible to occur the so-called cancellation syndrome. Using this drug in the dosage more than one hundred fifty milligrams per day, there is a decrease in the threshold of convulsive readiness. It must be remembered that if a person is predisposed to convulsive states, then an epilepsy attack may arise from him at any time. Such attacks may also occur in those patients who use certain antipsychotic medicines.

Do not forget that the patients suffering from depression may also be attempts to suicide. Use amitriptyline along with electrosalproof treatment can only be under constant control of the specialist. In the elderly, as well as citizens who are predisposed to the development of certain disorders, this medication may cause drug psychos. Most often, such psychosis are celebrated at night. After the cancellation of the medicine, they disappear independently after three to five days.

With extreme caution to the use of amitriptylin, all those patients who have chronic constipation in stock. The fact is that with this pathological state, the reception of this medicine can provoke the development of paralytic intestinal obstruction. This phenomenon can be observed in those patients who, for one reason or another, are chained to bed. If a person takes this medication, and he needs a common or local anesthesia, he must inform this fact anesthesiologist. This drug can be used no earlier than two weeks after the course of therapy of Mao inhibitors. In no case cannot be used by a given drug, along with norepinephrine, epinephrine, phenylpropanolamine and other sympathomimetics.
Passing the course of amitriptyline therapy is very important that the patient led a truly healthy lifestyle, in which the very first place should be a place with alcoholic beverages.

Contraindications for the use of this drug
This pharmaceutical remedy can be used far from all and all because it is inherent in numerous contraindications for use. So, for example, in no case cannot be prescribed by patients who pass the course of therapy inhibitors
monoaminoxidase. From the use of this drug, it is worth refusing to refuse and in the case of the presence of hypertrophy of the prostate gland, the atony of the bladder, paralytic obstruction of the intestine, pylororezase. When glauing and myocardial infarction, it is also not recommended. It is very important not to use this medication and during pregnancy, as well as during the lactation period. In childhood it should be used only on the recommendation of the specialist. It should be extremely careful about this medicine and all the patients who have arrhythmia, heart failure, ischemic heart disease or various heart rate disorders.

Immediately pay attention to readers and on the fact that against the background of the use of apotripitiline can also be given to know and very diverse side effects. This can be like impairment of vision and dry mouth, constipation, excessive submission of sweat, urination delay, dizziness, excessive drowsiness, ventricular arrhythmia, tremor, heart rate impaired, and so on. Often, there are also various kinds of allergic reactions, accompanied by the emergence of not only skin rash, but also itch. Using this pharmaceutical agent, it is very important to pay close attention and existing precautionary measures to use it along with other drugs.