Elavil Cats and Dogs

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.

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.

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.

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.

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.

Drug Interactions

Amitriptyline can block the antihypertensive action of guanethidine or similarly active compounds.

When amitriptyline HCL is given with the agents anticholinergic medicaments or sympathomimetic, by including epinephrine combined with local anaesthetics, close surveillance and careful adaptation of proportions are demanded. Hyperpyrexia was announced when amitriptyline HCL is managed with the agents anticholinergic or with medicaments neuroleptic, particularly during hot time. Ileus paralytic can occur in the taking patients tricyclic antidepressants in the combination with medicaments of anticholinergic-type.

They announce that Cimetidine reduces the hepatic metabolism of some antidepressants tricyclic, by postponing elimination so and by augmenting permanent concentration of these medicaments. Clinically significant effects were announced with antidepressants tricyclic when used concomitantly with cimetidine. Increase in the plasma levels of antidepressants tricyclic and in frequency and strictness of side effects, particularly anticholinergic, was announced when cimetidine was added to the regime of medicament. The suspension of cimetidine in good - the accepting controlled patients tricyclic antidepressants and cimetidine can diminish plasma levels and effectiveness of antidepressants.

Caution is recommended if the patients accept big doses of ethchlorvynol concurrently. Transitional frenzy was announced in the patients that 75 - 150 mgs from Amitriptyline were treated with a gramme of ethchlorvynol and.

Amitriptyline can improve the answer to the alcohol and to the effects of barbiturates and of other DÉPRESSEURS CNS. Frenzy was announced with the simultaneous administration of amitriptyline and of disulfiram.

BEFORE USING THIS MEDICINE: INFORM YOUR DOCTOR OR CHEMIST Of all prescript and of medicine redouble which you take. It includes carbamazepine, cimetidine, dicumarol, clonidine, mibefradil, paroxetine, tramadol, other medicines for depression or emotional riot and medicines for seizures. Inform your doctor of other medical conditions by including diseases of the heart, allergies, a pregnancy, or a feeding of the breast.

Precautions

The schizophrenic patients can develop symptoms augmented by psychosis; the patients with the paranoid symptomatology can have an exaggeration of such symptoms. The depressed patients, particularly those with known manic-depressive illness, can know a change in habit or in hypohabit. In these circumstances the dose of amitriptyline can be reduced or a tranquillizer importing such as perphenazine can be concurrently managed.

The possibility of suicide in the depressed patients stays until significant delivery occurs. The potentially suicidal patients should have no access to big quantities of this medicament. Prescripts should be written for the smallest accomplishable quantity.

The simultaneous administration of Amitriptyline and of electroshock therapy can augment chances linked to such therapy. Such treatment should be limited to the patients for whom it is essential.

When possible, the medicament should be stopped several days before the elective surgery.

Both elevation and fall of levels of glycemia were announced. Amitriptyline should be used with caution in the patients with the weak function of liver.

Warnings

Amitriptyline can block the antihypertensive action of guanethidine or similarly active compounds.

It should be used with caution in the patients with a history of seizures and, because of its atropine - as action, in the patients with a history of urinary retention, glaucoma of closing of assemblage or augmented intraoculaire pressure. In the patients with the glaucoma of closing of assemblage, the even medium doses can throw an attack.

Should be look one nearly at the patients with cardiovascular riot. They announced that medicaments of antidepressant of Tricyclic, by including amitriptyline, particularly when given in high doses, produce arrhythmias, sinus tachycardia and the extension of the time of conduction. Heart attack of Myocardial and blow were announced with medicaments of this class.

Close surveillance is demanded when amitriptyline is given to the patients of hyperthyroid or those who accept the treatment of thyroid.

Amitriptyline can improve the answer to the alcohol and to the effects of barbiturates and of other DÉPRESSEURS CNS. In the patients who can use some alcohol exceedingly, he should be kept in the head that the potentiation can augment inherent danger in any suicide attempt or excessive dose. Frenzy was announced with the simultaneous administration of amitriptyline and of disulfiram.

Usage in the Pregnancy

They showed that Amitriptyline crosses the afterbirth. Although a causative report is not established, there were some reports of disadvantageous events, by including effects of CNS, deformities of member, or delay of development, in the babies whose mothers had taken amitriptyline during the pregnancy. Amitriptyline should be used during the pregnancy only if the potential advantage to the mother justifies potential risk in the foetus.

Because of potential for serious disadvantageous reactions in the babies male nurses of amitriptyline, a decision should be made if it is necessary to stop care male nurses or to stop the medicament, by taking into account the importance of the medicament to the mother.

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.

Contraindications

Amitriptyline is against pointing out in the patients who showed prior hypersensitivity there.

It should not be given concomitantly with the monoamine oxidase of inhibitors. Crises of Hyperpyretic, strict convulsions and the dead occurred in the accepting patients tricyclic the antidepressant and the oxidase monoamine inhibiting it of medicaments at the same time. When it is wanted to replace an oxidase monoamine the inhibitor with amitriptyline, they should allow that a minimum of 14 days passes after that one is stopped. Amitriptyline should then be thrown carefully with gradual increase in proportion until optimum answer is accomplished.

This medicament is not recommended for use during the stage of sharp recovery further to myocardial heart attack.

Indications and Usage

For the relief of symptoms of depression. Endogenous depression will be better relieved than other depressive states are. Amitriptyline, because of the sedative action, also has value in fact to relieve the element of concern of depression.

As with other antidepressants tricyclic, amitriptyline (Elavil, Endep) is possible throw episodes hypomanic in the patients with depression bipolar. These medicaments are not pointed out in light depressive states and depressive reactions.

Pharmacology

Amitriptyline (Elavil) is an antidepressant with sedative effects. His mechanism of action in the man is not known. It is not an oxidase monoamine the inhibitor and he does not act principally by the stimulation of the central nervous system.

Amitriptyline inhibits the mechanism of membranous pomp responsible for the consumption of norepinephrine and of serotonin in neurons adrénergiques and serotonergic. This interference with the reconsommation of norepinephrine and/or serotonin is believed by some it underlies the activity of antidepressant of amitriptyline.

Description

Amitriptyline (Elavil) is a tricyclic antidepressant used to treat depression. He can also be used to treat chronic pain and other conditions as determined by your doctor.