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Amitriptyline


Presentation

  • CVS has no specific diagnostic test and the diagnosis is based on history, clinical presentation and exclusion of other possible causes with similar presentation.[ncbi.nlm.nih.gov]
Death in Childhood
  • A single dose of cyclic antidepressants leads to death in childhood. Myocardial depression and ventricular arrhythmia are the severe side effects in cyclic antidepressant overdose.[ncbi.nlm.nih.gov]
Bronchorrhea
  • Cholinergic toxicity from physostigmine may include bronchospasm, bronchorrhea, bradycardia, asystole, diaphoresis, incontinence and seizures.[web.archive.org]
Increased Appetite
  • Although side effects, such as dry mouth, increased appetite and constipation may occur, consultation with the physician may help minimize the likelihood and severity of these effects. It can cause sedation and can be taken at night to help sleep.[headaches.org]
  • Some of the side effects of amitriptyline include (but aren’t limited to): Weight gain Increased appetite Dry mouth Drowsiness Headache Fatigue A drop in blood pressure upon standing Constipation Nausea Low libido Sexual performance problems Weakness[psyweb.com]
  • Possible side effects Side effect Frequency Consult your doctor Common Rare Only if severe In all cases Confusion x x Dry mouth x x Headache x x Nausea/ vomiting x x Weight gain/ increased appetite x x Heartburn x x Constipation x x Difficulty urinating[health24.com]
  • Amitriptyline may increase appetite, cause weight gain, or produce an unpleasant taste in the mouth. It may also cause diarrhea, vomiting, or heartburn. Taking this medication with food may decrease digestive side effects.[minddisorders.com]
Decreased Bowel Sounds
  • Symptoms and signs may include: blurred vision, confusion, restlessness, dizziness, hyporeflexes, dilated pupils, fever, rapid heart rate, decreased bowel sounds, dry mouth, inability to void, myoclonic jerks, seizures, respiratory depression, myoglobinuric[web.archive.org]
Chronic Abdominal Pain
  • Abstract A man with severe inflammatory bowel disease suffered from chronic abdominal pain and depression.[ncbi.nlm.nih.gov]
Blurred Vision
  • […] precipitate mania in patients with bipolar disorder Clinical worsening and suicidal ideation may occur despite medication in adolescents and young adults (18-24 years) Risk of anticholinergic side effects; may cause constipation, urinary retention, blurred[web.archive.org]
  • Common side effects of amitriptyline include dry mouth, loss of appetite, dizziness, drowsiness, and blurred vision. Other side effects may include trouble concentrating, nightmares, and a decreased sex drive.[everydayhealth.com]
  • The most common side effects of amitriptyline include drowsiness, weight gain, dry mouth, constipation, sedation, and blurred vision. In one study, about 60 percent of the patients reported gaining weight, with an average gain of almost 12 pounds.[consumerreports.org]
Diplopia
  • Diplopia was solved in time after anticholinergic medication cessation. During the recovery period, Fresnell prisms have been used in order to eliminate diplopia.[ncbi.nlm.nih.gov]
  • Quality of life is also important because patients may be confined to bed because of pain or may be pain free after receiving drugs but unable to walk due to ataxia, diplopia and drowsiness.[doi.org]
Visual Hallucination
  • Overdosage Manifestations High doses may cause temporary confusion, disturbed concentration, or transient visual hallucinations.[web.archive.org]
  • Other signs of overdose may include: impaired myocardial contractility, confusion, disturbed concentration, transient visual hallucinations, dilated pupils, disorders of ocular motility, agitation, hyperactive reflexes, polyradiculoneuropathy, stupor,[dailymed.nlm.nih.gov]
Globus Symptom
  • AIMS: To evaluate the effect of paroxetine and amitriptyline to prevent relapses in patients with globus, the simultaneous relationship between changes in UES pressure and improvement of globus symptoms were measured.[ncbi.nlm.nih.gov]
Polyuria
  • Nocturia, nocturnal polyuria, and sleep quality in the elderly. J Psychosom Res 2004; 56 :517–525 [ PubMed ] [ Google Scholar ] 15. Resnick HE, Redline S, Shahar E, et al.[ncbi.nlm.nih.gov]
Seizure
  • She was admitted to hospital because of lethargy and seizures. It was estimated that she took approximately 75 mg/kg of amitriptyline 2 h before admission. On examination she was comatose, had ventricular tachycardia and multifocal clonic seizures.[ncbi.nlm.nih.gov]
  • Seizures: Tricyclic antidepressants can lower the seizure threshold and should be used with caution in patients with a history of seizures or those who may be predisposed to seizures.[web.archive.org]
  • Seizures have been known to happen with tramadol and mixing it with dravocet can increase this but only in those who are prone to seizure.[wiki.answers.com]
Paresthesia
  • Patients who received amitriptyline or topiramate had higher rates of several adverse events than those receiving placebo, including fatigue (30% vs. 14%) and dry mouth (25% vs. 12%) in the amitriptyline group and paresthesia (31% vs. 8%) and weight loss[ncbi.nlm.nih.gov]
  • About this Medication Brand Name: Elavil (U.S. and Canada) Chemical Name: Amitriptyline (a-mee-trip-ti-leen) Usage in MS: Pain (Paresthesias) Generic Available: Yes Description Amitriptyline is a tricyclic antidepressant used to treat depression.[nationalmssociety.org]
  • […] regulation), hepatic/renal impairment, and the elderly Abrupt discontinuation or interruption of antidepressant therapy has been associated with a discontinuation syndrome, which may include vomiting, diarrhea, headaches, dizziness, chills, tremors, paresthesias[reference.medscape.com]
  • Occasionally: insomnia, dizziness, headache, paresthesia (numbness, tingling sensation, symptoms suggestive of peripheral neuropathy). Rarely: seizures.[web.archive.org]
Poor Coordination
  • . • weakness, poor concentration, disorientation, delusion, restlessness, pain, poor coordination, blurred vision, movement disorders (involuntary movements or decreased movements) • hypersensitivity inflammation of heart muscle, heart attack, stroke[drugs.com]

Workup

Hyponatremia
  • The incidence of hyponatremia was more in pediatric patients and severe poisoning groups (38.8 and 53.4%, respectively).[ncbi.nlm.nih.gov]
  • Common Electrocardiogram abnormal, electrocardiogram QT prolonged, electrocardiogram QRS complex prolonged, hyponatremia. Uncommon Intraocular pressure increased. Rare Weight decreased.[medicines.org.uk]
Wide QRS Complex
  • She was in comatose, had generalized tonic clonic seizure, ventricular tachycardia, and wide QRS complexes.[ncbi.nlm.nih.gov]
Torsades De Pointes
  • Haloperidol-induced torsade de pointes. Ann Pharmacother. 1999; 33:1046-50. Kriwisky M, Perry GY, Tarchitsky D et al. Haloperidol-induced torsades de pointes. Chest. 1990; 98:482-4. Dineen S, Withrow K, Voronovitch L et al.[web.archive.org]
  • Preclinical research demonstrated that the drug prolonged the Q-Tc interval in a non-dose-dependent manner. [69] In small-sample premarketing trials, few cases of Q-Tc interval prolongation, torsades de pointes, and SCD were reported.[medscape.com]
  • Cardiac symptoms : Arrhythmias (ventricular tachyarrhythmias, torsade de pointes, ventricular fibrillation).[medicines.org.uk]
  • An effect on cardiac conduction similar to that of quinidine may be seen with slowing of conduction, prolongation of the QRS complex and QT intervals, right bundle branch and AV block, ventricular tachyarrhythmias (including torsades de pointes and fibrillation[rxmed.com]
T Wave Abnormality
  • Afterward, she became conscious, though, in electrocardiography, ST/T wave abnormality persisted. So that, we tapered sodium bicarbonate infusion slowly and stopped it later.[ncbi.nlm.nih.gov]
Electrocardiogram Change
  • Some of the more major problems that can arise include coma, convulsions, severely low blood pressure, hypothermia, a dangerously high heart rate and electrocardiogram changes.[macromass.com]
  • Electrocardiogram changes and therapeutic desipramine and 2-hydroxy-desipramine concentrations in elderly depressives. Br. J. Psychiatry 148: 676–679. Google Scholar Kutcher, S. P., Shulman, K. I., and Reed, K. (1986b).[doi.org]

Treatment

  • After 6 week treatment, 71.7% of paroxetine group (33/46) were calculated as treatment response, significantly higher than that in amitriptyline group (46.2%, 24/52) and lansoprazole group (14.0%, 7/50).[ncbi.nlm.nih.gov]

Prognosis

  • All adult patients were discharged with good prognosis. In pediatric age group, one patient was discharged with severe neurological sequelae and one patient died.[ncbi.nlm.nih.gov]
  • The prognosis with postherpetic neuralgia. Pain 1991; 46: 195–9 PubMed CrossRef Google Scholar 47. de Moragas JM, Kierland RR. The outcome of patients with herpes zoster. Arch Dermatol 1957; 75: 193–6 CrossRef Google Scholar 48.[doi.org]
  • These patients with autonomic dysfunction may have slower resolution of their symptoms that may take several years and the prognosis is worse than in postviral gastroparesis without autonomic disorders ( 20, 21 ).[gi.org]
  • Assessing Psychiatric Comorbidity Anxiety and depression are highly prevalent in patients who have CDH 7 and, when present, may negatively influence prognosis. All patients who have CDH should be screened for psychiatric comorbidity.[aafp.org]
  • These patients with autonomic dysfunction may have slower resolution of their symptoms that may take several years and the prognosis is worse than in postviral gastroparesis without autonomic disorders (20,21).[web.archive.org]

Etiology

  • OBJECTIVE: A neuropathic etiology has been suggested for patients with chronic laryngopharyngitis symptoms without visible structural pathology.[ncbi.nlm.nih.gov]
  • Postsurgical gastroparesis (PSG), often with vagotomy or vagus nerve injury, represents the third most common etiology of gastroparesis.[web.archive.org]
  • View Article PubMed Google Scholar Couch JR, Bearss C, Verhulst S: Importance of maternal heredity in the etiology of migraine.[doi.org]

Epidemiology

  • The epidemiology of headache in Germany: a nation wide survey of a representative sample on the basis of the headache classification of the Inter national Headache Society. Cephalalgia. 1994;14:97–106. ... 2. Rasmussen BK. Epidemiology of headache.[web.archive.org]
  • Painful diabetic polyneuropathy: epidemiology, pain description, and quality of life. Diabetes Res Clin Pract 2000; 47 :123–128 [ PubMed ] [ Google Scholar ] 4. O’Connor AB.[ncbi.nlm.nih.gov]
  • Class effects Epidemiological studies, mainly conducted in patients 50 years of age and older, show an increased risk of bone fractures in patients receiving SSRIs and TCAs. The mechanism leading to this increased risk is unknown.[medicines.org.uk]
  • The epidemiology and impact of gastroparesis are reviewed elsewhere ( 2 ).[gi.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology of itch in lichen amyloidosis may involve both cutaneous and neural components and amitriptyline is known to be useful for neuropathic itch.[ncbi.nlm.nih.gov]
  • Daniel Segelcke and Karl Messlinger, Putative role of 5-HT2B receptors in migraine pathophysiology, Cephalalgia, 37, 4, (365), (2017). T. S. Gan’shina, A. A. Gorbunov, A. V. Gnezdilova, A. I. Turilova, L. M. Kostochka, B. M. Pyatin, N. I.[doi.org]
  • Pathophysiology Although tension-type headaches are common, the pathophysiology and likely mechanism remain unclear.[aafp.org]

Prevention

  • Preventive medication therapy is suggested for 5 or more headaches per month.[ncbi.nlm.nih.gov]
  • ‘For example, the anti-depressant drug amitriptyline has been shown to help prevent some chronic headaches when taken in small doses (lower than that used to treat depression) before going to bed every night.’[oxforddictionaries.com]

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