General Info:

ACTIONS

ELAVIL is an antidepressant with sedative effects. Its mechanism of action in man is not known. It is not a monoamine oxidase inhibitor and it does not act primarily by stimulation of the central nervous system.

Amitriptyline inhibits the membrane pump mechanism responsible for uptake of norepinephrine and serotonin in adrenergic and serotonergic neurons. Pharmacologically this action may potentiate or prolong neuronal activity since reuptake of these biogenic amines is important physiologically in terminating transmitting activity. This interference with the reuptake of norepinephrine and/or serotonin is believed by some to underlie the antidepressant activity of Amitriptyline.

INDICATIONS

For the relief of symptoms of depression. Endogenous depression is more likely to be alleviated than are other depressive states.

CONTRAINDICATIONS

ELAVIL is contraindicated in patients who have shown prior hypersensitivity to it. It should not be given concomitantly with monoamine oxidase inhibitors. Hyperpyretic crises, severe convulsions, and deaths have occurred in patients receiving tricyclic antidepressant and monoamine oxidase inhibiting drugs simultaneously When it is desired to replace a monoamine oxidase inhibitor with ELAVIL, a minimum of 14 days should be allowed to elapse after the former is discontinued. ELAVIL should then be initiated cautiously with gradual increase in dosage until optimum response is achieved.
ELAVIL should not be given with Cisapride due to the potential for increaded QT interval and increased risk for arrhythmia.
This drug is not recommended for use during the acute recovery phase following myocardial infarction.

WARNINGS

ELAVIL may block the antihypertensive action of guanethidine or similarly acting compounds. It should be used with caution in patients with a history of seizures and, because of its atropine-like action, in patients with a history of urinary retention, angle-closure glaucoma or increased intraocular pressure. In patients with angle-closure glaucoma, even average doses may precipitate an attack. Patients with cardiovascular disorders should be watched closely. Tricyclic antidepressant drugs, including ELAVIL, particularly when given in high doses, have been reported to produce arrhythmias, sinus tachycardia, and prolongation of the conduction time. Myocardial infarction and stroke have been reported with drugs of this class.
Close supervision is required when ELAVIL is given to hyperthyroid patients or those receiving thyroid medication.
ELAVIL may enhance the response to alcohol and the effects of barbiturates and other CNS depressants. in patients who may use alcohol excessively, it should be borne in mind that the potentiation may increase the danger inherent in any suicide attempt or overdosage. Delirium has been reported with concurrent administration of Amitriptyline and disulfiram.