Amitriptyline (Tryptizol): what is it and what is it used for?

Amitriptyline is an antidepressant and analgesic widely used for the treatment and prevention of various disorders. Let’s see what it is used for and why.

Amitriptyline is a tricyclic antidepressant and analgesic. It was discovered in 1960 and is also marketed as Tryptizol ® or Deprelio ®. It is on the World Health Organization’s list of essential medicines. (WHO), for its effectiveness and safety.

Unlike other tricyclic antidepressants, amitriptyline It has similar efficacy to selective serotonin reuptake inhibitors (SSRIs).. This is why it is one of the most used antidepressants of its group.

What is amitriptyline used for?

Amitriptyline is approved and indicated for the treatment and prevention of several different disorders:

Treatment of major depressive disorder in adults. Treatment of neuropathic pain in adults. For example, in cases of fibromyalgia or postherpetic neuralgia. Prophylaxis of chronic tension headache in adults. Prophylaxis of migraine in adults. Treatment of nocturnal enuresis in children from 6 years of age. Only when no other treatment has worked and there is no pathological cause.

Sometimes, it is also used to treat some eating disorders. And, in some cases, in persistent hiccups.

As with most psychotropic drugs, it is recommended to start treatment with low doses. After, The dose can be increased progressively depending on the patient’s tolerance and clinical response.. When discontinuing the medication, it should be done in the same way: lowering the dose gradually.

It is administered orally until in three or four daily doses. It is recommended that the shots are always taken at the same time, in addition to always following the instructions that the specialist considers appropriate for each case.

Mechanism of action

As a tricyclic antidepressant, Its mechanism of action is the inhibition of the reuptake of norepinephrine and serotonin in the nerve endings.. This enhances the action of these neurotransmitters in the brain and improves depressive states.

In addition, Amitriptyline also blocks sodium, potassium, and NMDA ion channels. –N-methyl-D-aspartate-. This explains its effect on neuropathic pain and in the prevention of chronic tension headache and migraine. It has great affinity for alpha-adrenergic, muscarinic M1 and histamine H1 receptors. It is more sedative and has more anticholinergic properties than other tricyclic antidepressants..

Its antidepressant and analgesic therapeutic action takes between two and four weeks to establish itself. However, its sedative action is quite fast and intense. Adverse effects may begin to appear from the first dose.

Amitriptyline is very well absorbed from the digestive tract. After administration, it is metabolized to nortriptyline. This is an active metabolite that also has antidepressant action. It is a more potent inhibitor of noradrenaline reuptake than serotonin.

Side effects and contraindications

Amitriptyline may cause adverse effects similar to other tricyclic antidepressants. However, the anticholinergic symptoms are more striking. Some side effects are, for example:

drowsiness, tremor, dizziness, headache, lethargy, speech disorder, aggression, palpitations, tachycardia, orthostatic hypotension, hyperhidrosis (excessive sweat production), weight gain, dry mouth, difficulty urinating, alterations in ocular accommodation.

With high doses, arrhythmias and severe hypotension are likely. However, they can also occur with normal doses in patients who have a cardiovascular history. This includes patients with heart blockage, rhythm disorders, or coronary artery insufficiency.

How to deal with side effects

In general, when a significant adverse effect occurs, it is important to consult a doctor as soon as possible. If the symptoms are mild, there are some measures that can be taken.

Constipation: Eat foods rich in fiber, such as cereals, fresh fruits and vegetables. Drink several glasses of water or other non-alcoholic beverages every day. Doing some exercise may also help. Dizziness: It is recommended to drink plenty of water or other non-alcoholic beverages. Do not get up too quickly after sitting or lying down. Dry mouth: chewing sugarless gum or sugarless candy. Difficulty urinating: relax when urinating and do not force the flow of urine. Talk to your doctor urgently if you cannot urinate at all.Dolores head: rest and drink plenty of fluids. Don’t drink too much alcohol. Talk to your doctor if your headaches last more than a week or are severe.

Contraindications

Combined use with MAOI antidepressants is totally contraindicated. -monoamine oxidase inhibitors-. Serotonin syndrome may occur. However, many other drugs also interfere with the metabolism and action of amitriptyline.

For its part, amitriptyline It is not recommended during pregnancy, unless your doctor considers it clearly necessary. and only after careful consideration of benefit and risk.

If you have taken this medicine during the latter part of pregnancy, your newborn may have withdrawal symptoms such as irritability, increased muscle tension, tremor, irregular breathing, poor sucking, loud crying, urinary retention, and constipation.

The consumption of alcoholic beverages is not recommended during treatment with amitriptyline., since it can increase its sedative effect. Likewise, if you experience the side effects of drowsiness and dizziness, it is best not to work with heavy tools or machinery.

Who should not take amitriptyline

It is not recommended to use this medication in people with heart problems, because one of the most common side effects of using amitriptyline is irregular heartbeat. In severe cases, amitriptyline has been linked to a condition called QT prolongation, which could cause seizures, fainting, and, in fatal cases, death.

The same occurs if you have epilepsy, glaucoma, a history of allergic reactions to tricyclic antidepressants and angina (chest pains).

An effective medication for specific conditions

Amitriptyline can be very useful in some contexts. In any case, remember that only a specialist doctor can prescribe this medication according to your particular situation. For example, in the case of depressive disorders, there is a wide variety of drugs that can be useful and with a very different adverse effect profile.