Amitriptyline
(Elavil)
Common Drug Name
Amitriptyline
Common Brand Names
Elavil
Generic products are available.
Storage
Refrigerate oral suspension. Store other
forms at room temperature. Protect
injectable form from light and freezing.
Uses
Amitriptyline is a tricyclic antidepressant,
and should be used in combination with
behavior modification techniques.
Dogs: Used to treat anxiety disorders.
Cats: Used to treat anxiety disorders,
excessive grooming, and urine spraying.
Dose and Administration
Always follow the dosage instructions
provided by your veterinarian. If you have
difficulty giving the medication, contact
your veterinarian.
Give the oral form with food to decrease
the risk of side effects such as vomiting.
Amitriptyline in tablet form is very bitter,
and it may be difficult to give in pill form.
Compounding pharmacies can make an
oral liquid form or transdermal (topical)
gel, which may be easier to administer.
If using the transdermal gel, apply to the
skin as directed by your veterinarian.
If you miss a dose, give it as soon as you
remember. If it is almost time for the next
dose, skip the one you missed and go back
to the regular schedule. Do not give 2
doses at once.
Changes in dosage or discontinuation of
therapy should be done gradually.
This medication should only be given to
the pet for whom it was prescribed.
Possible Side Effects
Dogs: May see an increase in excitability
or sedation; lack of appetite, vomiting,
constipation, or diarrhea; increased
appetite and weight gain; increased water
consumption, caused by dry mouth;
abnormal heart rhythms, which may cause
weakness or collapse; bone marrow
suppression with anemia, causing
weakness and pale gums; or low platelets,
causing an increased tendency to bruise or
bleed.
Cats: May see drooling, sedation, urinary
retention, loss of appetite, vomiting,
constipation; increased appetite and
weight gain; increased water consumption,
caused by dry mouth; unkempt hair coat;
incoordination, disorientation; abnormal
heart rhythms, which may cause weakness
or collapse; or low platelets, causing an
increased tendency to bruise or bleed.
Cats being treated with the gel form may
develop a skin condition where it is applied
and possibly scratch the area. If this
occurs, contact your veterinarian.
Consult your veterinarian if you notice any
of these side effects.
If your pet experiences an allergic reaction
to the medication, signs may include facial
swelling, hives, scratching, sudden onset of
diarrhea, vomiting, shock, seizures, pale
gums, cold limbs, or coma. If you observe
any of these signs, contact your
veterinarian immediately.
Precautions
Do not use in animals hypersensitive
(allergic) to tricyclic antidepressants.
Use with extreme caution in animals with
seizure disorders/epilepsy, diabetes
mellitus, liver disease, or heart disease.
Consult with your veterinarian regarding
the physical examinations (including an
EKG) and laboratory testing necessary
prior to and during treatment with
amitriptyline.
Do not use in pregnant or lactating animals
(female animals nursing their young).
Human Precautions
Children are very sensitive to the seizureinducing
and heart effects of the
medication. Keep the medication out of
their reach.
Drug, Food, and Test Interactions
Consult your veterinarian before using
amitriptyline with vitamins, supplements,
ephedrine, monoamine oxidase inhibitors
(MAOIs) such as selegiline (deprenyl,
Anipryl) or amitraz (an ingredient in some
tick collars, and in Mitaban, a treatment for
mange), anticholinergic medications
(atropine), central nervous system (CNS)
depressants, or sympathomimetic agents
like phenylpropanolamine (Proin,
Cystolamine), methimazole, or other
antithyroid drugs, or cimetidine, since
interactions may occur.
May alter blood glucose levels.
Signs of Toxicity/Overdose
Can be very toxic, in overdoses, to humans
and pets. Large overdoses can cause death.
May see sedation; abnormal heart rhythms
and low blood pressure, which may cause
weakness or collapse; seizures; or coma.
If you know or suspect your pet has had an
overdose, or if you observe any of these
signs in your pet, contact your veterinarian
immediately.
Keep this and all other medications out of
the reach of children and pets.
Monday, January 25, 2010
Some questions which you ask to your doctor 2
Q: Dear Dr. Mike, A friend of mine has told me she has heard of a "new" medication for use on dogs with thunderstorm fears. I am familiar only with acepromazine and other tranquilizers which must be given 30 to 60 minutes before the storm. She said it is called something like "eltriplomean" or at least sounds like that. I cannot find anything on the internet because I am probably mis-spelling it. She said it has to be given to the dog daily for it to build up an immunity in its system over a 4 to 6 week period. Sounds quite strange to me, but if there is such a drug available, might be worth using for owners with dogs with this problem during the summer months. I have a boarding kennel and have probably a dozen or so dogs during the summer who have this phobia. We have always treated with tranquilizers the owners bring from their own vets. Are you familiar with anything like this? Thanks, Betsey
A: You are probably referring to amitriptyline (Elavil Rx) which is used in conjunction with diazepam (Valium Rx) or other anti-anxiety medications for thunderstorm phobias. It is used daily during the thunderstorm season and when storms actually occur diazepam is given as well, if needed. We have used this combination and it works better than most things for thunderstorms but it is not effective in all dogs. My guess is that it is helpful enough to satisfy the client in about 50 to 60% of thunderstorm phobia cases.
Some questions which you ask to your doctor 1
Q: Dear Dr. Mike, First off let me say that your column has been a valuable source of information, as well as interesting reading. We have a 7 month old mixed breed dog "Angel" which we adopted from our local animal shelter. She has good overall health, only vet visits have been for vaccinations, spaying, and allergies. However, we have always had a problem with separation anxiety which has gotten worse over the last month. Originally , her behavior would include crying, whining, barking and occassional property destruction when we left her alone. Lately, however, she not only exhibits her prior behaviors, but she now salivates excessively when we leave. We took her to our vet and explained the symptoms and they concurred that she is suffering from separation anxiety. They gave us training suggestions similar to tthe ones you have in your column and also prescribed Elavil. My question is: What, if any are the side effects of this medication in dogs. Our vet didn't have much information on that and the pharmacist was useless. Any information would be helpful. Thank you so very much. Lisa
A: Lisa- The most common side effect of amitriptylline (Elavil Rx) is sedation. Some dogs also experience "dry mouth" effects from a decrease in salivation and sometimes increase their drinking, which may be an effort to combat this effect. Low blood pressure (hypotension) is possible when using amitriptylline, as well. In severe instances, this could lead to symptoms like fainting when getting up or after exercise. Constipation and urine retention have been seen in some pets on amitriptylline. Serious side effects include seizure induction and blockage of conduction in the heart but these seem to pretty rare. I have not seen either one of these effects and we have used amitriptylline for several years in our clinic.
Friday, January 1, 2010
How Supplied
Tablets: Elavil comes in 10 mg, 25 mg, 50 mg, 75 mg,100 mg,150 mg.
Injection: Elavil, 10 mg/ml, is a clear, colorless solution, and is supplied in 10 ml vials.
Dosage
HOW TO USE THIS MEDICINE:
After you begin using this medicine, several weeks can cross before you smell full advantage.
* Follow directions to use this medicine given by your doctor.
* Keep this medicine to the temperature of room, far from heat and from light.
* Continue taking this medicine even if you better feel.
* Do not lack doses. If you miss a dose of this medicine, take it as soon as possible. If it is almost the time for your following dose, skip the missed dose and go back to your programme of regular proportion. Do not take 2 doses immediately. If you take 1 dose every day at bedtime, do not take dose missed next morning.
Oral Proportion: Proportion should be would throw at a low level and would augment progressively, by noting carefully clinical answer and any obviousness of intolerance.
For the external Sick: 75 mgs of amitriptyline one day in the divided doses are satisfactory usually. At the need, it can be augmented in a total of 150 mgs a day. Increase is late made preferably the doses hour of the bedtime and/or of afternoon. A sedative effect can be obvious before the effect of antidepressant is noted, but an adequate therapeutic effect can take 30 well days to develop. An alternate method to throw therapy in the external sick must begin with 50 - 100 mgs amitriptyline at bedtime. It can be augmented by 25 or 50 mgs as essentials in the dose hour of the bedtime in a total of 150 mgs a day.
Hospitalised Patients: is possible demand 100 mgs a day initially. It can be progressively augmented in 200 mgs a day at the need. A small number of hospitalised patients needs probably of until 300 mgs a day.
Youthful and rather old patients: In general, lower proportions are recommended for these patients. Ten mgs 3 times a day with 20 mgs at bedtime can be satisfactory in the youthful and rather old patients who do not tolerate higher proportions.
Intramuscular Proportion: Initially, 20 - 30 mgs (2 - 3 millilitres) four times a day. When amitriptyline HCL injection is managed intramusculairement, effects can appear faster than with the oral administration. When amitriptyline HCL injection is used for initial therapy in the patients unable or not much disposed to take amitriptyline HCL tablets, tablets should replace injection as soon as possible.
Maintenance: the proportion of ordinary maintenance of amitriptyline HCL is 50 - 100 mgs a day. In some patients 40 mgs a day am sufficient. For the therapy of maintenance complete daily proportion can be given in a simple dose preferably at bedtime. When satisfactory improvement was attained, proportion should be reduced to the lowest quantity which will support the relief of symptoms. It is appropriate to continue the therapy of maintenance 3 months or longer to diminish the possibility of relapse.
Usage at the Children: In view of the inexperience with the use of this medicament at the children, are not currently recommended for the patients less than 12 years of age.
After you begin using this medicine, several weeks can cross before you smell full advantage.
* Follow directions to use this medicine given by your doctor.
* Keep this medicine to the temperature of room, far from heat and from light.
* Continue taking this medicine even if you better feel.
* Do not lack doses. If you miss a dose of this medicine, take it as soon as possible. If it is almost the time for your following dose, skip the missed dose and go back to your programme of regular proportion. Do not take 2 doses immediately. If you take 1 dose every day at bedtime, do not take dose missed next morning.
Oral Proportion: Proportion should be would throw at a low level and would augment progressively, by noting carefully clinical answer and any obviousness of intolerance.
For the external Sick: 75 mgs of amitriptyline one day in the divided doses are satisfactory usually. At the need, it can be augmented in a total of 150 mgs a day. Increase is late made preferably the doses hour of the bedtime and/or of afternoon. A sedative effect can be obvious before the effect of antidepressant is noted, but an adequate therapeutic effect can take 30 well days to develop. An alternate method to throw therapy in the external sick must begin with 50 - 100 mgs amitriptyline at bedtime. It can be augmented by 25 or 50 mgs as essentials in the dose hour of the bedtime in a total of 150 mgs a day.
Hospitalised Patients: is possible demand 100 mgs a day initially. It can be progressively augmented in 200 mgs a day at the need. A small number of hospitalised patients needs probably of until 300 mgs a day.
Youthful and rather old patients: In general, lower proportions are recommended for these patients. Ten mgs 3 times a day with 20 mgs at bedtime can be satisfactory in the youthful and rather old patients who do not tolerate higher proportions.
Intramuscular Proportion: Initially, 20 - 30 mgs (2 - 3 millilitres) four times a day. When amitriptyline HCL injection is managed intramusculairement, effects can appear faster than with the oral administration. When amitriptyline HCL injection is used for initial therapy in the patients unable or not much disposed to take amitriptyline HCL tablets, tablets should replace injection as soon as possible.
Maintenance: the proportion of ordinary maintenance of amitriptyline HCL is 50 - 100 mgs a day. In some patients 40 mgs a day am sufficient. For the therapy of maintenance complete daily proportion can be given in a simple dose preferably at bedtime. When satisfactory improvement was attained, proportion should be reduced to the lowest quantity which will support the relief of symptoms. It is appropriate to continue the therapy of maintenance 3 months or longer to diminish the possibility of relapse.
Usage at the Children: In view of the inexperience with the use of this medicament at the children, are not currently recommended for the patients less than 12 years of age.
Overdose
High doses can cause temporary confusion, upset concentration, or transitional visual hallucinations. Excessive dose can cause drowsiness, hypothermia, tachycardia other anomalies and arrhythmic, such as the block of branch of packet, the obviousness of ECG of weak, congestive conduction the heart failure, riot of motility ocular, convulsions, strict low blood pressure, stupour, coma, polyradiculoneuropathy and constipation. Other symptoms can be agitation, hyperactive reflexes, rigidity of muscle, vomiting, hyperpyrexia, or whatever of the listing under Adverse effects.
Treatment
All patients suspected of having taken an excessive dose should be accepted in a hospital as soon as possible. The treatment is symptomatic and all-helping. Empty so quickly stomach as possible by emesis coherent by gastric washing on the arrival in the hospital. Further to gastric washing, the charcoal speeded up can be managed. ECG should be taken and fact to watch near cardiac function instituted if there is a sign of anomaly. Support an opened airline and an adequate liquid consumption; regulate the temperature of body.
They announce that the intravenous administration of 1-3 mgs of physostigmine salicylate reverses the symptoms of poisoning of antidepressant tricyclic. Since physostigmine is fast transformed by metabolism, the proportion of physostigmine should be repeated as demanded particularly if the signs of threat of life such as arrhythmias, convulsions and deep coma reproduce or keep after the initial proportion of physostigmine. Since physostigmine it can itself be toxic, is not recommended for the use of routine.
Anticonvulsants can be given to control convulsions. Amitriptyline augments dépresseuse CNS action, but the action anticonvulsant of barbiturates; therefore, an anaesthetic of inhalation, diazepam, or paraldehyde is recommended for the control of convulsions.
As excessive dose is often deliberate, the patients can try the suicide by other means during the stage of recovery. The dead by deliberate or accidental excessive dose occurred with this class of medicaments.
Treatment
All patients suspected of having taken an excessive dose should be accepted in a hospital as soon as possible. The treatment is symptomatic and all-helping. Empty so quickly stomach as possible by emesis coherent by gastric washing on the arrival in the hospital. Further to gastric washing, the charcoal speeded up can be managed. ECG should be taken and fact to watch near cardiac function instituted if there is a sign of anomaly. Support an opened airline and an adequate liquid consumption; regulate the temperature of body.
They announce that the intravenous administration of 1-3 mgs of physostigmine salicylate reverses the symptoms of poisoning of antidepressant tricyclic. Since physostigmine is fast transformed by metabolism, the proportion of physostigmine should be repeated as demanded particularly if the signs of threat of life such as arrhythmias, convulsions and deep coma reproduce or keep after the initial proportion of physostigmine. Since physostigmine it can itself be toxic, is not recommended for the use of routine.
Anticonvulsants can be given to control convulsions. Amitriptyline augments dépresseuse CNS action, but the action anticonvulsant of barbiturates; therefore, an anaesthetic of inhalation, diazepam, or paraldehyde is recommended for the control of convulsions.
As excessive dose is often deliberate, the patients can try the suicide by other means during the stage of recovery. The dead by deliberate or accidental excessive dose occurred with this class of medicaments.
Adverse Reactions
NOTE: some of noted disadvantageous reactions were not specifically announced below with the use of amitriptyline. However, because of close pharmacologic similarities among the tricyclics, reactions should be considered by prescribing amitriptyline. In every category following disadvantageous reactions are listed in the order of the diminishing strictness.
Cardiovascular: heart attack of Myocardial; blow; the changes of nonspecific ECG and changes in conduction AV; block of the heart; arrhythmias; low blood pressure, particularly orthostatic low blood pressure; blackout; hypertension; tachycardia; palpitation.
CNS and Neuromuscular: Coma; seizures; hallucinations; phantasms; states of confusional; bewilderment; lack of coordination; ataxie; shakings; neuropathie peripheral; numbness, fact to tickle and paresthesias of ends; the symptoms of extrapyramidal by including abnormal involuntary movements and late dyskinesia; dysarthria; upset concentration; glow; concern; insomnia; agitation; nightmares; drowsiness; vertigo; weakness; tiredness; trouble of head; the syndrome of inconvenient ADH (the antidiuretic hormone) the secretion; tinnitus; modification in the drawings of EEG.
Anticholinergic: ileus paralytic; hyperpyrexia; urinary retention; widening of urinary expanse; constipation; vague vision, trouble of accommodation, augmented ocular pressure, the mydriasis; mouth dries.
Allergic: redness of Skin; urticaria; photosensitization; the edema of face and of language.
Hematologic: the depression of Bone marrow by including agranulocytosis, leukopenia, thrombocytopenia; purpura; eosinophilia.
Gastrointestinal: Seldom hepatitis (by including the changed function of liver and turns it yellow); nausea; distress of epigastric; vomiting; anorexia; stomatitis; particular taste; diarrhoeia; swelling of parotid; black language.
Endocrine: the swelling of Testicular and gynecomastia in the male; the enlargement of chest and galactorrhea in the female; augmented or weak libido; impotence; elevation and fall of levels of glycemia.
Of other one: Loss of hair; edema; weighty benefit or loss; urinary frequency; augmented perspiration.
Symptoms of deprivation: After the extended administration, brusque suspension of treatment can produce nausea, trouble of head and Malaysia. They announced that the gradual reduction of proportion produces, in the course of two weeks, the transitional symptoms by including petulance, agitation and trouble of sleep and the dream. These symptoms are not indicative of tendency. Rare cases were announced of habit or hypohabit occurring in the course of 2-7 days further to suspension of chronic therapy with antidepressants tricyclic.
Unknown Causative Report: Other reactions, announced in the circumstances where a causative report could not be established, are listed to serve of it made to alert information to the doctors:
Body on the whole: Lupus - As the syndrome (migratory arthritis, positive ANA and rheumatoid factor).
Liqueur: hepatic failure, ageusia.
Cardiovascular: heart attack of Myocardial; blow; the changes of nonspecific ECG and changes in conduction AV; block of the heart; arrhythmias; low blood pressure, particularly orthostatic low blood pressure; blackout; hypertension; tachycardia; palpitation.
CNS and Neuromuscular: Coma; seizures; hallucinations; phantasms; states of confusional; bewilderment; lack of coordination; ataxie; shakings; neuropathie peripheral; numbness, fact to tickle and paresthesias of ends; the symptoms of extrapyramidal by including abnormal involuntary movements and late dyskinesia; dysarthria; upset concentration; glow; concern; insomnia; agitation; nightmares; drowsiness; vertigo; weakness; tiredness; trouble of head; the syndrome of inconvenient ADH (the antidiuretic hormone) the secretion; tinnitus; modification in the drawings of EEG.
Anticholinergic: ileus paralytic; hyperpyrexia; urinary retention; widening of urinary expanse; constipation; vague vision, trouble of accommodation, augmented ocular pressure, the mydriasis; mouth dries.
Allergic: redness of Skin; urticaria; photosensitization; the edema of face and of language.
Hematologic: the depression of Bone marrow by including agranulocytosis, leukopenia, thrombocytopenia; purpura; eosinophilia.
Gastrointestinal: Seldom hepatitis (by including the changed function of liver and turns it yellow); nausea; distress of epigastric; vomiting; anorexia; stomatitis; particular taste; diarrhoeia; swelling of parotid; black language.
Endocrine: the swelling of Testicular and gynecomastia in the male; the enlargement of chest and galactorrhea in the female; augmented or weak libido; impotence; elevation and fall of levels of glycemia.
Of other one: Loss of hair; edema; weighty benefit or loss; urinary frequency; augmented perspiration.
Symptoms of deprivation: After the extended administration, brusque suspension of treatment can produce nausea, trouble of head and Malaysia. They announced that the gradual reduction of proportion produces, in the course of two weeks, the transitional symptoms by including petulance, agitation and trouble of sleep and the dream. These symptoms are not indicative of tendency. Rare cases were announced of habit or hypohabit occurring in the course of 2-7 days further to suspension of chronic therapy with antidepressants tricyclic.
Unknown Causative Report: Other reactions, announced in the circumstances where a causative report could not be established, are listed to serve of it made to alert information to the doctors:
Body on the whole: Lupus - As the syndrome (migratory arthritis, positive ANA and rheumatoid factor).
Liqueur: hepatic failure, ageusia.
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