Amitriptyline

Chemical name

3-(10,11-Дигидро-5Н-дибенз [a,d]циклогептен-5-илиде н)-N,N-диметил-1-про panamin (as hydrochloride or embonate)

Gross

C20-H23-N

Characteristics

Tricyclic antidepressant. The white crystalline powder and odourless, it is readily soluble in water.

Of drugs

Drugs, the antidepressant, anxiolytic, sedative, antidizuricescoe. Ingibiruet reverse takeover neiromediatorov (norarenalina, serotonin and others) presinapticakimi nerve endings neuronal is monoaminov accumulation in the synaptic junctions and reinforces postsinapticescuu impulsaciu. With long-term use reduces the functional activity (desencitization) beta-adrainergicakih and serotonin receptors in the brain, normalizes and adrenergic serotoninergicescuu transfer, restores balance to the system breached the depressed conditions. Does m-holino- and gistaminove receptors Zns.bystro and well absorbed from the digestive tract. Bioavailability amitriptilina at different ways of representing 30-60%, it metabolita - nortriptilina - 46-70%. C_max in blood after taking into achieved through 2,0-7,7 hours Therapeutic concentrations in the blood of amitriptilina, 50-250 ng / ml for nortriptilina - 50-150 ng / J In sossoudistom with 95% associated with the squirrels. Easy is as nortriptilin through gistogematicalkie barriers, including GEB, placental, enters the breast milk. T_1/2 is 10-26 hrs, the nortriptilina-44 p.m. The liver is biotransformation (demethylation, gidrauxilirovnie, N-okislenie), and is active-nortriptilin, 10-gidroksi-amitriptilin and inactive metabolites. Write memory (mainly in the form of metabolites) in a few Dnei.pri тревожно-депрессивны�� Conditions reduces concern ajitatia and depressive manifestations. Antidepressive Effects develops over two weeks after the start of treatment. The sudden halt after receiving long-term care insurance to the syndrome of "setting aside".

Indications

Depression (endogenous, inwaluie, rocket-propelled, neurotic, and organic brain damage, medication), stress syndrome, shizofrenicescie psychosis, тревожно-депрессивны�� of different genesis, mixed emotional disorder, a breach of conduct, psychogenic anorexia, night enourez (therapy), severe pain neurogennogo nature.

Pregnancy and lactation

Contraindicated in pregnancy. At the time of treatment should stop breastfeeding.

Contraindications

Hypersensitivity, glaucoma, epilepsy, giperplazia prostate, atony bladder paralysis occlusion bowel pilorostenoz, myocardial infarctions history, the use of MAO inhibitors in the preceding two weeks, pregnancy, breast-feeding, child age (up to 6 years).

Side-Effects

The blockade peripheral m-holinoretseptorov : dry mouth, the delay urination, constipation, impaired vision, ccomodation reinforced Potootdelenie.so the circulatory system : tachycardia, ortostatical gipotenzia, pressure increase, the conductivity, ECG changes (especially Micro). From the central nervous system : drowsiness, dizziness, Tremor.allergicakie reactions : skin rash, etc.

Patient interaction

Incompatible with MAO inhibitors. Potenziruet effect compounds oppressive central nervous system (including sedatives, tranquilizers, alcohol), simpatomimetikov, противопаркинсоничес ких funds weakens, and gipotenziveh protivosudorozhnykh drugs. Inductive mikrosomalnogo oxidation (barbiturates, carbamazepine) reduce, and increases zimetidin concentration in plasma.

Overdosing

Symptoms : hallucinations, convulsions, deliri, coma, the heart conductivity, arrythmia, jeludockove adults, hypothermia and Dr.lechenie : washing stomach reception suspension activated charcoal, laxatives, the maintenance of body temperature and monitoring of the cardiovascular system, at least 5 days; With heavy holinoliticakih symptoms (gipotenzia, incredible, coma), 0.5-2.0 g fizostigmina in / m or / 386/1989 Haemodialysis and big diurez ineffective.

Precautions

Admission amitriptilina possible no earlier than 14 days after the lifting of MAO inhibitors. Older children and recommended lower doses. Nor should appoint mania patients and patients with suicidal tendencies. Be wary when using IBS, aritmiah, heart failure. During treatment should avoid alcohol, as well as to abstain from activities requiring greater attention and reaction speed.

Dosing and Administration

The inside is not liquid, after delivery, adult primary-dose to 25 mg 2-4 times a day. The maximum dose for outpatient treatment, up to 150 mg / day in the hospital up to 300 mg / day in elderly patients, up to 100 mg / Sut.v / m or / in (enter slowly) in the dose of 20-40 mg four times a day. Injections gradually replace reception inside. The course of treatment no more than 6-8 Mes.detam as antidepressant : from 6 to 12 years, 10 to 30 mg or 5 mg / kg / day Batches in adolescence - to 10 mg three times a day (if necessary up to 100 mg / day) for the treatment of night enoureza children up to 6 years old to 10 mg per night, and 6-10 years in the 10 to 20 mg / day, 11 to 16 years in the 25-50 mg / sut.

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