Amitriptyline - Revision history

MDElliottMD: parser-claude: Amitriptyline MedTemplate refill, Top 300 stub upgrade

2026-05-23T06:52:54Z

parser-claude: Amitriptyline MedTemplate refill, Top 300 stub upgrade

← Older revision		Revision as of 06:52, 23 May 2026
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	{{MedTemplate		{{MedTemplate
	\| generic = Amitriptyline		\| generic = Amitriptyline (hydrochloride)
	\| brand = Elavil		\| brand = Elavil (US brand discontinued; generic widely available), Endep, Tryptizol
	\| structure =		\| structure =
	\| classes = TCA, Antidepressant		\| classes = [[:Category:Tricyclic antidepressants\|Tricyclic antidepressant (TCA)]], [[:Category:Antidepressants\|Antidepressant]], [[:Category:Migraine prophylactics\|Migraine prophylactic]], [[:Category:Neuropathic pain medicines\|Neuropathic pain medicine]]
	\| ~~mechanism~~ = ~~Serotonin and norepinephrine reuptake inhibitor~~; ~~anticholinergic~~		\| uses = <vote slug="major-depressive-disorder-amitriptyline-use">Major depressive disorder (FDA; historical; now usually reserved for treatment-refractory cases due to safety profile)</vote>, <vote slug="neuropathic-pain-amitriptyline-use">Neuropathic pain (off-label, often first-line)</vote>, <vote slug="migraine-prophylaxis-amitriptyline-use">Migraine prophylaxis (off-label, frequently first-line)</vote>, <vote slug="tension-headache-prophylaxis-use">Tension-type headache prophylaxis (off-label)</vote>, <vote slug="fibromyalgia-amitriptyline-use">Fibromyalgia (off-label)</vote>, <vote slug="irritable-bowel-syndrome-use">Irritable bowel syndrome (off-label)</vote>, <vote slug="nocturnal-enuresis-pediatric-use">Pediatric nocturnal enuresis (FDA, historical)</vote>
	\| ~~uses~~ =		\| starting_dose = Depression (rarely used now): 25-75 mg PO at bedtime, titrate to 150 mg/day. Neuropathic pain / migraine prophylaxis: 10-25 mg at bedtime, titrate by 10-25 mg weekly to 50-100 mg/day. Elderly: 10 mg at bedtime (Beers-list cautions apply)
	\| ~~starting_dose~~ =		\| preparations = Tablets 10, 25, 50, 75, 100, 150 mg
	\| ~~preparations~~ =		\| fda_max = 300 mg/day (historical hospitalized inpatient depression); 150 mg/day outpatient typical ceiling
	\| ~~fda_max~~ =		\| pill_id =
	\| routes =		\| routes = Oral
	\| onset =		\| onset = Sleep effect from first dose; analgesic and migraine-prophylaxis effect 1-4 weeks; antidepressant effect 4-6 weeks
	\| duration =		\| duration = 24 hours (HS dosing)
	\| halflife =		\| halflife = Amitriptyline 10-50 hours (highly variable); nortriptyline active metabolite 18-44 hours<ref name="elavil-label">FDA Prescribing Information, Elavil (amitriptyline hydrochloride), Merck/various, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/085966s095,085969s084,085968s096,085972s062,085974s075,085976s061,085971s072,085967s094lbl.pdf</ref>
	~~\| bioavailability =~~		\| bioavailability = ~50% (oral)<ref name="elavil-label" />
	~~\| pregnancy~~ =		\| pregnancy = Older agent with substantial use experience; observational signals not clearly causal.{{citation needed}}
	~~\| legal~~ =		\| legal = [[USLegal:Prescription only\|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults<ref name="elavil-label" />
	\| ~~intro =~~		\| mechanism = <vote slug="amitriptyline-mech-claim">Tricyclic antidepressant inhibiting both serotonin and norepinephrine reuptake (the antidepressant and analgesic mechanism), with substantial additional muscarinic-acetylcholine M1 antagonism, H1 antihistaminergic activity, and α1-adrenergic antagonism. These ancillary activities drive the sedation, weight gain, dry mouth, constipation, orthostatic hypotension, and the Beers-list anticholinergic-burden concerns in elderly patients.</vote> Active metabolite '''nortriptyline''' is itself a separately marketed TCA with somewhat less anticholinergic burden. CYP2D6 and CYP2C19 substrate; CPIC PGx guidance applies for dose individualization. TCAs are '''lethal in overdose''' from sodium-channel-blockade-induced cardiac arrhythmias (wide QRS, torsades, cardiac arrest), the primary reason TCAs have been displaced from first-line antidepressant use by the safer SSRI alternatives<ref name="cpic-tca">CPIC Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Tricyclic Antidepressants, 2016. https://cpicpgx.org/guidelines/guideline-for-tricyclic-antidepressants-and-cyp2d6-and-cyp2c19/</ref>.
	~~\| pharmacokinetics~~ =
	~~\| pharmacodynamics~~ =
	\| ~~indications~~ =
	\| ~~dosing~~ =
	\| ~~effects =~~
	~~\| interactions~~ = ~~<pharmaInteractions~~/>
	\| ~~pregnancy_details =~~
	~~\| monitoring~~ =
	~~\| counseling~~ =
	~~\| anecdotes =~~
	~~\| seealso =~~
	~~\| references~~ =
	}}		}}

			== References ==
			<references />

	[[Category:Tricyclic ~~Antidepressants (TCAs)~~]]		[[Category:Tricyclic antidepressants]]
	[[Category:Antidepressants]]		[[Category:Antidepressants]]
			[[Category:Migraine prophylactics]]
			[[Category:Neuropathic pain medicines]]

MediaWiki default: Assign pharmacological categories from List_of_CNS-active_medicines

2026-05-14T15:06:48Z

Assign pharmacological categories from List_of_CNS-active_medicines

← Older revision		Revision as of 15:06, 14 May 2026
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	}}		}}


			[[Category:Tricyclic Antidepressants (TCAs)]]
	[[Category:Antidepressants]]		[[Category:Antidepressants]]

MDElliottMD: Pharmacopedia: add

2026-05-14T03:30:41Z

Pharmacopedia: add <pharmaInteractions/>

← Older revision		Revision as of 03:30, 14 May 2026
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	\| dosing =		\| dosing =
	\| effects =		\| effects =
	\| interactions =		\| interactions = <pharmaInteractions/>
	\| pregnancy_details =		\| pregnancy_details =
	\| monitoring =		\| monitoring =

MDElliottMD: Pharmacopedia: remove contraindications parameter

2026-05-14T02:40:23Z

Pharmacopedia: remove contraindications parameter

← Older revision		Revision as of 02:40, 14 May 2026
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	\| dosing =		\| dosing =
	\| effects =		\| effects =
	~~\| contraindications =~~
	\| interactions =		\| interactions =
	\| pregnancy_details =		\| pregnancy_details =

MDElliottMD: Added empty fda_max parameter to MedTemplate call

2026-05-13T02:32:37Z

Added empty fda_max parameter to MedTemplate call

← Older revision		Revision as of 02:32, 13 May 2026
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	\| starting_dose =		\| starting_dose =
	\| preparations =		\| preparations =
			\| fda_max =
	\| routes =		\| routes =
	\| onset =		\| onset =
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	[[Category:Antidepressants]]		[[Category:Antidepressants]]

MDElliottMD: Expand stub to full MedTemplate parameter set

2026-05-13T01:00:00Z

Expand stub to full MedTemplate parameter set

@@ Line 1: / Line 1: @@
 {{MedTemplate
-| generic           = Amitriptyline
+| generic            = Amitriptyline
-| brand             = Elavil
+| brand              = Elavil
-| classes           = TCA, Antidepressant
+| structure          =
-| mechanism         = Serotonin and norepinephrine reuptake inhibitor; anticholinergic
+| classes            = TCA, Antidepressant
 }}
 [[Category:Antidepressants]]

MDElliottMD: Auto-created stub

2026-05-13T00:00:00Z

Auto-created stub

New page

{{MedTemplate
| generic = Amitriptyline
| brand = Elavil
| classes = TCA, Antidepressant
| mechanism = Serotonin and norepinephrine reuptake inhibitor; anticholinergic
}}
[[Category:Antidepressants]]