Amitriptyline

What is Amitriptyline?

  • Amitriptyline is an antidepressant drug that is used in treatment of depression and prophylaxis of

Amitriptyline generic and brand name

  • The drug is available under generic name Amitriptyline and various brand names such as Amitor, Elavil, Endep, Kamitrin, Levate, Mitryp, Tadamit and Tryptomer.
  • Amitriptyline was originally developed by Merck in 1960.
  • Primarily AstraZeneca pharmaceutical is responsible for the manufacturing and distribution of Amitriptyline under brand name Elavil.
  • Generic variations of the drug also manufactured by various pharmaceutical companies such as Sanofi-Aventis, Bristol myers squibb, Sandoz pharmaceuticals and Watson laboratories.

Amitriptyline

What is the source of the drug (natural or synthetic)?

  • Amitriptyline is a synthetic (man-made) first generation tricyclic antidepressant

Why Amitriptyline prescribed

  • Amitriptyline plays a key role in the treatment of Major depressive disorder.
  • It is used in the treatment of Anxiety, Psychosis, Bipolar disorder and Attention deficit hyperactivity disorder.
  • It is prescribed for Migraine prophylaxis, Neuropathic pain disorder, Nocturnal enuresis, Fibromyalgia and Insomnia.
  • It is also used for the treatment of Irritable bowel syndrome.
  • It may be used as an anticholinergic drug to treat early stage Parkinson’s disease.
  • Amitriptyline is also exercised for the treatment of Post-traumatic stress disorder.

Pharmacophore structure: Information about the chemical structure of the drug

Amitriptyline chemically belongs to the class of organic compounds which are known as Dibenzocycloheptanes characterized by dibenzocycloheptane moiety which is consist of two benzene ring connected by a cycloheptane ring. The detailed chemical classification of Amitriptyline is described below:

Kingdom Organic compounds
Super Class Benzenoides
Class Dibenzocycloheptanes
Sub Class Not available
Direct Parent Dibenzocycloheptanes

Chemical information of the drug

  • Amitriptyline is a derivative of Dibenzocycloheptanediene and available as monohydrochloric salt which potentiates the inhibition of serotonin and norepinephrine reuptake.
  • It is a synthetic pharmaceutical Aromatic homopolycyclic compounds with a molecular formula C20H23N.
  • The molecular weight of the Amitriptyline is 403 g/mol.
  • Chemically, Amitriptyline is dimethyl(3-{tricyclo[9.4.0.0³,⁸]pentadeca-1(15),3,5,7, 11,13-hexaen-2-ylidene}propyl)amine.
  • Amitriptyline is odourless, almost white powder or colourless minute crystal and has water solubility of 0045 mg/mL.
  • Amitriptyline is freely soluble in alcohol and Methylene chloride.
  • The melting point of Amitriptyline is 187-189.5°

Amitriptyline dosage

  • Amitriptyline is available in tablet form for oral administration as well as in oral suspensions form for intramuscular use.
  • Amitriptyline tablets contain Amitriptyline HCl as active ingredient and supplied in different strength of 10mg, 25mg, 50mg, 75mg, 100mg and 150mg.

10 mg: blue in color, round, film-coated tablet debossed with “Elavil” on one side and “40” on another side.

  • Inactive ingredients: calcium phosphate, cellulose, colloidal silicon dioxide, lactose, magnesium stearate, hydroxypropyl cellulose, hydroxypropyl methylcellulose, starch, stearic acid, talk, titanium dioxide and FD&C Blue 1.

25 mg: yellow in color, round, film-coated tablet debossed with “Elavil” on one side and “45” on another side.

  • Inactive ingredients:cellulose, calcium phosphate, colloidal silicon dioxide, lactose, magnesium stearate, hydroxypropyl cellulose, hydroxypropyl methylcellulose, starch, stearic acid, talk, titanium dioxide,  D&C Yellow 10, FD&C Yellow 6 and FD&C Blue 1.

50 mg: beige in color, round, film-coated tablet debossed with “Elavil” on one side and “41” on another side.

  • Inactive ingredients: lactose, hydroxypropyl cellulose, cellulose, calcium phosphate, colloidal silicon dioxide, magnesium stearate, hydroxypropyl methylcellulose, starch, stearic acid, talk, titanium dioxide, D&C Yellow 10, FD&C Yellow 6 and iron oxide.

75 mg: orange in color, round, film-coated tablet debossed with “Elavil” on one side and “42” on another side.

  • Inactive ingredients: lactose, hydroxypropyl cellulose, cellulose, calcium phosphate, colloidal silicon dioxide, magnesium stearate, hydroxypropyl talk, methylcellulose, starch, stearic acid, titanium dioxide and FD&C Yellow 6.

100 mg: mauve in color, round, film-coated tablet debossed with “Elavil” on one side and “43” on another side.

  • Inactive ingredients: hydroxypropyl cellulose, hydroxypropyl methylcellulose, cellulose, calcium phosphate, lactose, colloidal silicon dioxide, magnesium stearate, starch, stearic acid, talk, titanium dioxide, FD&C Blue 2 and FD&C Red 40.

150 mg: blue in color, capsule shaped, film-coated tablet debossed with “Elavil” on one side and “47” on another side.

  • Inactive ingredients: calcium phosphate, colloidal silicon dioxide, lactose, hydroxypropyl cellulose, cellulose, magnesium stearate, hydroxypropyl methylcellulose, starch, stearic acid, talk, titanium dioxide, FD&C Blue 2 and FD&C Yellow 6.
  • Amitriptyline solution is a clear, colourless suspension and available in strength of 10 mg/mL for intramuscular administration in 10 ml vials.
  • Amitriptyline solution contains Amitriptyline HCl as active ingredient while dextrose and water as an inactive ingredients. It also contains methylparaben and propylparaben as preservative agents.

How Amitriptyline works

  • Amitriptyline, a dibenzocycloheptane, is metabilised into active nortriptyline.
  • Nortriptyline inhibits the serotonin and norepinephrine reuptake by inhibiting the serotonin and norepinephrine reuptake transporters.
  • Serotonin is a monoamine neurotransmitter while norepinephrine (noradrenaline) is catecholamine which has multiple roles including those as a neurotransmitter and hormone.
  • Amitriptyline inhibits the membrane pump mechanism which is responsible for the uptake of serotonin and norepinephrine in serotonergic and adrenergic neurons.
  • Pharmacologically this action may potentiate or extend neuronal activity since reuptake of these biogenic amines is significant physiologically in terminating transmitting activity.
  • This interference with the reuptake of serotonin or norepinephrin is thought by some to emphasize the antidepressant activity of Amitriptyline.

Recommended doses of Amitriptyline

  • The prescribed dose of Amitriptyline varies depending upon the age and diseased state of the patient.

Adult dose

  • Depression:

Oral

  • Initial dose: 25-100mg daily in 3-4 divided doses orally.
  • Maintenance dose: 25-150mg daily in 3-4 divided doses orally (maximum 300 mg daily).

Intramuscular

  • 20-30mg up to 4 times daily.
  • Migraine prophylaxis:
  • 10 mg orally once a day at bedtime.
  • Dysthymia:

Oral

  • Initial dose: 75 mg daily in single or divided dose.
  • Maintenance dose: 150 to 300 mg daily in single or divided dose.

Intramuscular

  • 20 to 30 mg daily up to 4 times.
  • Post traumatic stress disorder:

Oral

  • Initial dose: 75 mg daily in single or divided dose.
  • Maintenance dose: 150 to 300 mg daily in single or divided dose.

Intramuscular

  • 20 to 30 mg daily up to 4 times.
  • Somatoform pain disorder:

Oral

  • Initial dose: 75 mg daily in single or divided dose.
  • Maintenance dose: 150 to 300 mg daily in single or divided dose.

Intramuscular

  • 20 to 30 mg daily up to 4 times.

Geriatric dose

  • Depression:

Oral

  • 10 mg thrice in a day and 20 mg at bedtime orally.

Intramuscular

  • 20 to 30 mg daily up to 4 times.

Paediatric dose:

  • Depression:

9 to 12 years

  • Initial dose: 1 mg/kg in 3 divided doses daily.
  • Maintenance dose: 1 to 5 mg/kg in 3 divided doses daily.

12 to 18 years

  • Oral
  • Initial dose: 25 to 50 mg daily in 3-4 divided doses.
  • Maintenance dose: 20 to 200 mg daily in divided doses.
  • Intramuscular
  • 20 to 30 mg daily up to 4 times.
  • Migraine prophylaxis:
  • 6 to 12 years: 0.25 to 1.50 mg/kg once a day at bedtime orally.
  • 12 to 18 years:

Initial dose: 25 mg twice a day orally.

Maintenance dose: 50 to 200 mg in divided doses daily.

  • Urinary incontinence:
  • 2 to 6 years: 10 mg at bedtime orally.
  • In patients of hepatic impairment, caution should be exercised.

When should I discontinue, withhold or modify the dose of Amitriptyline?

  • The usual dosing of the drug may vary depending upon the efficiency and side effects of the drug in a particular individual.
  • Do not use the medicine if you are hypersensitive or allergic to any of the ingredients of Amitriptyline.
  • Use of Amitriptylin is withheld in case of myocardial infarction.
  • Amitriptyline should not be used with monoamine oxidase inhibitors such as Tranylcypromine, Iscarboxazid, Phenelzine and Selegiline.
  • Amitriptyline is contraindicated with the use of antihistamines, quinidine, Phenobarbital, other antidepressants, medications of irregular heartbeats (Propafenone and Flecainide), anxiety, asthma, urinary problems and mental illness.
  • Use of Amitriptyline may also be contraindicated with the selective serotonin reuptake inhinitor such as Sertraline, Fluvoxamine, Paroxetine and Fluoxetine. Fluoxentine inhibits the CYP 2D6 which involve in the metabolism of the Amitriptyline.
  • It is also not recommended for the treatment of depression in patients under age of 12 years.
  • Geriatric patients cannot tolerate higher dose of Amitriptyline. Hence, low dose should be exercised.
  • Consult with your doctor if you are having surgery, including dental surgery.

What are the pharmacokinetic properties of the drug?

  • Pharmacokinetic studies suggested that after oral administration, Amitriptyline is absorbed rapidly and has a bio-availability of approximately 30-60% due to first pass metabolism.
  • Following absorption the majority (90%) of the drug is bound to plasma and tissue proteins.
  • It has been observed that following a dose of maximum (or peak) plasma concentration (~62ng/ml) is achieved in 4 hours in the fasted state.
  • Amitriptyline is metabolized in liver primarily by cytochrome P450 3A4 (CYP3A4) and P450 2C19 (CYP2C19) and demethylated into its primary active metabolite nortriptyline.
  • Nortriptyline further metabolised by CYP 2D6 into E-10-hydroxynortriptyline.
  • The average median half-life of Amitriptyline is 15 hours (ranges from 10 to 50).
  • Amitriptyline and its metabolites are mainly excreted in the urine as glucuronides and sulphate conjugate with small amount of uncharged drug. 25-50% dose is excreted in urine as inactive metabolites.
  • A little amount of the drug also excreted in feces through biliary elimination.
  • The average steady state volume of distribution of the Amitriptyline is approximately 11-18 L/kg.

Which pregnancy category (A; B; C; D; X) has been assigned to Amitriptyline?

  • The Amitriptyline is classified by US FDA pregnancy category: C
  • Due to lack of adequate and well-controlled studies the use of Amitriptyline in pregnant women is contraindicated and recommended only when benefit justifies the risk.
  • Laboratory animal studies have revealed that the Amitriptyline produces a variety of adverse effect in fetus. It may cause congenital malformation including limb reduction defects.
  • Studies support that the Amitriptyline and its active metabolite nortriptyline excreted into human milk in small amounts (135-152ng/mL). Therefore, breast feeding is not recommended.
  • Despite these facts caution should be exercised when taking Amitriptyline.

How to take Amitriptyline works

  • Amitriptyline tablet is taken by mouth with or without food.
  • Amitriptyline tablets do not chew, split or crush. Whole tablet should be swallowed.
  • The Amitriptyline medication should be used in divided doses (2-4 times in a day).
  • Amitriptyline medication should not be stopped suddenly. Your doctor possibly reduces the dose gradually.
  • It is also recommended to take drug at almost the same time every day.
  • Follow the instructions carefully as directed on prescription leaflet and take Amitriptyline exactly as directed.
  • Do not change the dose of the drug as prescribed by your doctor. Since, the dosage is based on patient medical condition, treatment responses and usage with other drugs.

How to store the drug?

  • Amitriptyline is stored at 25°C (77°F) and excursion permitted to 15-30°C (59-86°F).
  • Store the medicine away from light and moisture.
  • Medicine should not be stored in the bathroom.
  • The drug should be kept away from children and pets.

How to dispose the medicine?

  • Throw away unused and opened, outdated or no longer used container.
  • Also dispose the old medicine after the expiration date.
  • Amitriptyline should not be dispose in the household garbage, sink or in wastewater.
  • Consult your pharmacist or local waste disposal company for proper disposal.

Does Amitriptyline has approval from government / FDA /or any other related agencies?

  • Amitriptyline was approved in April, 1961 by U.S. Food and Drug Administration for the treatment of major depressive disorder.

Other uses of the drug                                                           

  • Amitriptyline may also be used to treat the eating disorders and post-herpetic neuralgia.
  • Amitriptyline may also be used for other uses not listed here. It is advisable to ask your doctor or pharmacist for more information.

What special dietary precautions should I follow?

  • Take diet as prescribed by your doctor otherwise follow usual diet.
  • Alcohol consumption can also enhance some side effects of the drug such as drowsiness.

What special precautions should I follow/ what should I avoid while using Amitriptyline?

  • Before taking Amitriptyline, tell your doctor about your medical history preferentially if you have any kind of heart, liver disease or kidney disease.
  • Take advice to your medical health provider if you have any other kind of eye disorder, enlarged prostate, overactive thyroid gland and diabetes.
  • Use of alcohol or alcoholic beverages should be avoided.
  • Consult with your doctor and pharmacist if you are taking any prescription and non-prescription medications or herbal products.
  • Avoid using machinery requiring alertness or clear vision as well as driving because the use of Amitriptyline may make you drowsy.
  • Amitriptyline medication should used with caution in those individuals which are of 65 years or older.
  • Consult your doctor in case of any query.

Amitriptyline side effects

In addition to the associated benefits, Amitriptyline also is accompanied with the side effects some of which are more common, others less common whereas some are more serious. It is always recommended to consult a doctor if you encounter any of the side effects.

Amitriptyline may cause some serious side-effect which requires immediate medical attention are as follows:

  • Crushing chest pain
  • Dizziness or faintness
  • Fainting
  • Jaw, neck, and back muscle spasms
  • Rapid, pounding, or irregular heartbeat
  • Seizures
  • Severe skin rash or hives
  • Slow or difficult speech
  • Swelling of the face and tongue
  • Uncontrollable shaking of a part of the body
  • Unusual bleeding or bruising
  • Weakness or numbness of an arm or a leg
  • Yellowing of the skin or eyes

There are some adverse effects that fade away while consuming the drug with time. These symptoms do not require any medical attention, but if these symptoms persist immediately contact to your doctor.

  • Blurred vision
  • Changes in appetite or weight
  • Changes in sex drive or ability
  • Confusion
  • Constipation
  • Difficulty urinating
  • Drowsiness
  • Dry mouth
  • Excessive sweating
  • Headaches
  • Nausea
  • Nightmares
  • Pain, burning, or tingling in the hands or feet
  • Unsteadiness
  • Vomiting
  • Weakness or tiredness

Beside these, Amitriptyline may associate with other symptoms such as hypomania, tremors, serotonin syndrome and syndrome resembling neuroleptic malignant syndrome.

What should I do in case of overdose?

  • If you overdose the drug contact with your doctor or pharmacist for symptomatic and supportive measures.
  • Symptoms of Amitriptyline overdose may include:
    • Confusion
    • Dilated pupils
    • Drowsiness
    • Hypothermia
    • Irregular heartbeat
    • Loss of consciousness for a period of time
    • Rigid muscle
    • Vomiting

What should I do in case of missed a dose?

  • Take a missed dose as soon as possible.
  • To make up the missed dose, do not take extra medicine.
  • Avoid taking the missed dose if it is about time for your next dose.

Does Amitriptyline have any interaction with other drugs?

Amitriptyline may interact with other medications, vitamins or herbs. Care should be taken when you are taking these drugs together. This interaction can be harmful or prevent the drug from working well.

Some drugs when given concomitantly with Amitriptyline can cause serious side effects. These drugs and Amitriptyline should not be taken simultaneously. Examples of these drugs include:

  • Drugs Metabolized by P450 2D6: Coadministration of  tricyclic antidepressants including  Amitriptyline with drugs that inhibit cytochrome P450 2D6 require lower doses of both the drugs than either of the drug taken individually. The drugs responsible for inhibition of cytochrome P450 2D6 include drugs that are not metabolized by the enzyme (quinidine; cimetidine) and other drugs that are substrates for P450 2D6 (many other antidepressants, phenothiazines, and the Type 1C antiarrhythmics propafenone and flecainide). Besides, withdrawl of one of these inhibitor drugs from the co-therapy require administration of antidepressant at increased dosage. Close monitoring of the plasma levels is required when these drugs are co-administered. An individual who is given a fixed dose of tricyclic depressant (TCA) may become abruptly toxic when given inhibition drugs in concomitant therapy.
  • Monoamine oxidase inhibitors: Monoamine oxidase inhibitors (MAOIs) including phenelzine, tranylcypromine, selegiline when co-administered with Amitriptyline can result in seizures or even death. It is recommended to take an MAOI within 2 weeks after stopping Amitriptyline.
  • Diuretics or Vasodilators: depressed patients with left ventricular impairment and/or in patients taking other drugs like diuretics or vasodilators when coadministered with Amitriptyline develop severe orthostatic hypotension.
  • Anticholinergic drugs/ Neuroleptic drugs: Concomitant use of anticholinergic drugs including diphenhydramine, loratadine, oxybutynin, solifenacin, and olanzapine with tricyclic antidepressant like Amitriptyline result in increased risk of side effects. Amitriptyline (TCA) when coadministered with neuroleptic drugs like clozapine, risperidone, and haloperidol causes increased risk of side effects. Coadministration of Amitriptyline with anticholinergic agents or sympathomimetic drugs, including epinephrine requires careful adjustment of dosages of the drugs. Hyperpyrexia occurs during concurrent use of Amitriptyline with anticholinergic agents or with neuroleptic drugs.  Paralytic ileus may result in patients who take tricyclic antidepressants in combination with anticholinergic-type drugs.
  • Quinidine and Cimetidine: Amitriptyline and Quinidine/Cimetidine combination often increased the risk of increased side effect due to increase accumulation of Amitriptyline in body.
  • Cisapride: It has been reported that Amitriptyline in combination with cisapride can increase the risk of irregular heart rhythm.

Besides this, some drugs such as Fluoxetine, Sertraline and Paroxetine when used in combination with Amitriptyline potentiate the toxic side effects of Amitriptyline.

Does Amitriptyline have any interaction with diseases?

It has been observed that following medical conditions (disease) may interact with Amitriptyline:

  • Hypersensitivity:  Amitriptyline is not recommended in case of people who are allergic or hypersensitive to Amitriptyline, other tricyclic antidepressants or any of the other ingredients.
  • Anticholinergic Effects (Glaucoma/Intraocular Hypertension, Urinary Retention, Gastrointestinal Obstruction): Antidepressants including Amitriptyline are associated with anticholinergic activity, to which elderly population are very sensitive. Therapy involving antidepressants should be administered very cautiously in patients with preexisting conditions that can become worse by anticholinergic activity as in case of untreated intraocular hypertension; urinary retention/ obstruction; gastrointestinal obstructive disorders; and angle-closure glaucoma, or uncontrolled primary open-angle glaucoma.
  • Cardiovascular Disease, Hyperthyroidism, Cerebrovascular Disease, Myocardial Infarction, Hypotension, Dehydration: Tricyclic and tetracyclic antidepressants (TCAs) such as Amitriptyline may result in the development of reflex tachycardia (increased heart rate in response to some stimulus conveyed through the cardiac nerves), orthostatic hypotension (form of low blood pressure that happens when you stand up from sitting or lying down), syncope (temporary loss of consciousness caused by a fall in blood pressure), and dizziness. Severe hypotension in some cases can cause sudden death. TCAs Therapy should be started with high caution in patients suffering with hyperthyroidism, a history of cerebrovascular or cardiovascular disease, or a predisposition to hypotension and not recommended during the recovery phase after myocardial infarction. Adverse cardiovascular effects associated with TCAs include thrombosis, tachycardia, heart block, hypertension, myocardial infarction, arrhythmias, strokes, ECG abnormalities, and congestive heart failure.
  • Pheochromocytoma (tumor of adrenal glands): Administration of Amitriptyline (Tricyclic and tetracyclic antidepressants) may enhance the effects associated with circulating catecholamines such as increased sympathetic activity that can cause severe increase in blood pressure leading to stroke in patients with pheochromocytoma or other tumors of the adrenal medulla.
  • Seizure Disorders (CNS Disorder): Amitriptyline may elicit seizures in a dose-dependent manner with smaller doses leading to low incidence in patients without a predisposition to seizures.  It is therefore recommended to cautiously administer Amitriptyline therapy in patients with a history of seizures or other predisposing factors, including CNS abnormalities, head trauma, and alcoholism.
  • Bone Marrow Suppression: The use of Amitriptyline (TCAs) can result in bone marrow suppression. Some of the associated effects with the use of the drug include anemia, leukopenia, thrombocytopenia, eosinophilia, agranulocytosis, and pancytopenia. Close monitoring of the patients with preexisting bone marrow suppression or blood dyscrasias and on Amitriptyline therapy is required to check for further decreases in blood counts.
  • Diabetes:  Administration of tricyclic and tetracyclic antidepressants (TCAs) such as Amitriptyline can cause a change in the blood sugar levels. It is usually suggested to monitor for the dramatic change of the blood glucose upon administration of the drug in patients with diabetes especially during dose modification or increase in dose.
  • Renal/Liver Disease: Tricyclic and tetracyclic antidepressants (TCAs) including Amitriptyline or metabolites are principally metabolized in the liver and excreted through the kidney. Drug therapy with TCAs should be initiated with caution in patients with renal or hepatic dysfunction as it may lead to drug accumulation and harmful effects. Schizophrenia/Bipolar Disorder/Mania: Amitriptyline (TCAs) may enhance psychosis (mental disorder characterized by thinking and emotions that are so impaired) in patients of schizophrenia (a brain disorder in which people interpret reality in an abnormal manner) patients. Administration of the drug in depressed patients with bipolar disorder (mental illness characterized by periods of depression and periods of elevated mood) may also result in a shift from depression to mania (abnormally elevated mood state) or hypomania. Caution should be taken while recommending the use of Amitriptyline (TCAs) therapy in patients with schizophrenia, bipolar disorder, or a history of mania.
  • Tardive Dyskinesia: TCAs including Amitriptyline possess anticholinergic activity that can lead to more severe tardive dyskinesia (neurological disorder characterized by involuntary movements of the face and jaw) or induce the suppressed symptoms. Close monitoring of the patients with tardive dyskinesia requiring TCAs therapy is required to check for the worsening of the condition.

Where can I get more information?

Your pharmacist or health care provider can provide more information about Amitriptyline.

Clinical research and current scenario of the drug

  • Clinical trials suggest the effectiveness of Amitriptyline in treatment of patients with post-herpetic neuralgia and painful diabetic neuropathy, neurogenic pain syndromes that do not respond to narcotic analgesics.
  • Studies also demonstrate Amitriptyline use in the treatment of chronic non-malignant pain.
  • Experimental data suggests that single dose of Amitriptyline (20 mg/kg) is sufficient to produce the analgesic effect independent of its antidepressant properties.
  • Controlled clinical data indicate the role of Amitriptyline in reducing the severity of post-herpetic neuralgia and that Amitriptyline at a dose of 75 mg is sufficient for treatment of postherpetic neuralgia and providing significant pain relief.
  • Clinical study suggests the efficacy of Amitriptyline at a dose of 25 mg in treatment of patients with fibromyalgia and improving fatigue, sleep difficulties, and pain on awakening.
  • Experimental data demonstrate the safety and effectiveness of Amitriptyline (with maximum dosage 100 mg) for treating interstitial cystitis and improving urgency intensity, pain, and functional bladder capacity.
  • Short-term clinical studies suggest no increase in the risk of suicidality with antidepressants including Amitriptyline in comparison to placebo in adults with age >24.
  • No studies are available regarding the safety and effectiveness of Amitriptyline in the pediatric population.

References from chemical, biological and toxicological databases

  • Amitriptyline. Wikipedia. https://en.wikipedia.org/wiki/Amitriptyline
  • DrugBank: Amitriptyline. www.drugbank.ca/drugs/DB00321
  • Amitriptyline | C20H23N | ChemSpider. http://www.chemspider.com/Chemical-Structure.2075.html
  • Amitriptyline pubmed health. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0008944/
  • Amitriptyline: MedlinePlus Drug Information. https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682388.html
  • http://www.ncbi.nlm.nih.gov/pubmed/12804503
  • Amitriptyline for neuropathic pain and fibromyalgia in adults. http://www.ncbi.nlm.nih.gov/pubmed/23235657
  • Amitriptyline. A review of its pharmacological properties and therapeutic use in chronic pain states. http://www.ncbi.nlm.nih.gov/pubmed/8736630
  • Long-term results of amitriptyline treatment for interstitial cystitis. http://www.ncbi.nlm.nih.gov/pubmed/16217303
  • Effectiveness of amitriptyline versus cough suppressants in the treatment of chronic cough resulting from postviral vagal neuropathy. http://www.ncbi.nlm.nih.gov/pubmed/17146380
  • Amitriptyline for the treatment of depression. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0050333/
  • Amitriptyline for neuropathic pain in adults. http://www.ncbi.nlm.nih.gov/pubmed/26146793
  • Amitriptyline. A review of its pharmacological properties and therapeutic use in chronic pain states. http://www.ncbi.nlm.nih.gov/pubmed/8736630
  1. “Amlodipine“
  2. “Can losartan and propranolol be taken together?“