| DRUG | SUPPLIED | DOSE | COMMENTS |
|---|---|---|---|
| AMITRIPTYLINE (Paeds) (Elavil) Mechanism of action: Tricyclic antidepressant. A tricyclic antidepressant with limited efficacy for treatment of depression in children and adolescents. Antidepressant effect may not occur for 2-6 weeks. Ref: 83, 389, 390, 391, 392 Last update: 2022-06-09 |
tablet: 10 mg, 25 mg | Adjunct to Analgesia for Chronic Pain: Initial: 0.1 mg/kg/dose PO QHS (max: 10 mg/dose). Increase if needed and as tolerated by 0.1 to 0.2 mg/kg/dose (max: 10 mg/dose) every 5-7 days to usual dose of 0.5 to 1 mg/kg/dose PO QHS (Usual max: 50 to 100 mg/dose). Migraine Prophylaxis: Initial: 0.1 to 0.25 mg/kg/dose PO QHS (max: 10 mg/dose). Increase as needed and tolerated every 2 wks by 0.1 to 0.25 mg/kg/dose up to 1 mg/kg/dose or 75 mg/dose PO QHS. Maximum: 2 mg/kg/day or 150 mg /day. Adults: Initial: 25-50 mg PO QHS. Maintenance: 150-300 mg PO QHS. |
Analgesic effects are usually seen in 1-2 weeks. When used for analgesia, if there is no response at dose of 10 to 15 mg/day, patient is unlikely to respond to higher dose. Baseline ECG to exclude prolonged QT prior to initiating therapy. Monitor therapy with heart rate, BP and ECG as needed. Side Effects include: sedation, confusion, weakness, fatigue, tremor, sweating, headache, anticholinergic effects, cardiovascular effects (including hypotension, tachycardia and arrhythmias at higher plasma levels), decreased seizure threshold. May discolour urine blue/green. Do not suddenly stop long-term treatment due to risk of discontinuation syndrome (flu-like symptoms, dizziness, mood changes, "electric-shock" sensations). Is it recommended to taper dose by ~25%/week. Many drug interactions via cytochrome p450 system. Contraindicated if MAO inhibitors used within 14 days. Assess patient carefully and limit prescribed quantities if necessary - potential for significant toxicity of tricyclic antidepressants in overdose. Standard Prescription: amitriptyline __mg PO __(frequency)(__mg/kg/day) |