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At least 973 records · Page 54Linked to original sources
PubMed1982

Amitriptyline overdose: clinical effects on tricyclic antidepressant plasma levels.

Tricyclic antidepressant (TCA) plasma levels after amitriptyline overdose were reviewed in a retrospective study. Amount of drug taken correlated with total TCA levels. Plasma concentrations were higher in blacks than whites, but no association could be found between TCA levels and age or sex of patients. History of routine use of amitriptyline at the time of overdose did not predict TCA levels, but the one fatality could be shown on the basis of previous steady-state levels to be a slow metabolizer. Serious overdoses as documented by high plasma TCA levels were seen in all major diagnostic groups.

Adolescent↗
PubMed1982

ECG effects of comparable plasma concentrations of desipramine and amitriptyline.

To compare the electrocardiographic effects of therapeutic doses of desipramine and amitriptyline, weekly electrocardiograms (ECGs) were obtained from 46 depressed outpatients treated blindly for 3 weeks to a maximum of 200 mg/day. There was no difference in mean weekly plasma tricyclic antidepressant levels achieved for the two drugs. Compared to baseline measures, treatment with both drugs was associated with an increase in heart rate and a reduction in T wave amplitude, whereas prolongation of the QRS and QTc intervals was significant only for desipramine patients. Comparisons between drugs revealed a greater prolongation of QRS interval duration with desipramine treatment. Changes in ECG measures were not correlated with plasma tricyclic antidepressant levels. The absence of QRS interval prolongation among amitriptyline patients is additional evidence for the importance of distinguishing between the ECG effects of therapeutic and toxic doses of the tricyclic antidepressant.

Adult↗
PubMed1981

Uptake of 5-hydroxytryptamine by blood platelets incubated in plasma from rats and humans treated with amitriptyline and imipramine.

Blood platelets and [3H]-5HT ([3H]-5-hydroxytryptamine) were incubated in plasma samples taken from rats and humans treated with tricyclic antidepressants. The inhibition of 5-HT uptake detected in plasma was used as a bioassay of the drug concentration, and this was compared with gas chromatographic (GC) measurements of the same samples. With rats 5-HT uptake inhibition in plasma was studied one hour after five different doses of imipramine or amitriptyline i.p., and the time-course of uptake inhibition was studied from plasma samples taken 1, 2, 3 and 6 hours after injecting 10 mg/kg imipramine in to rats. Under long-term treatment, uptake inhibition was studied in samples taken from 20 patients treated with amitriptyline for 2 weeks or longer. In the samples with tricyclics, within the therapeutic range as detected by GC, the uptake inhibition was well over 50%. Bioassay based on uptake inhibition gave higher apparent results than did GC. The demethylated derivatives of the tricyclics, which were also measured by GC, did not explain the discrepancy. Thus, it is possible that other active metabolites formed in vivo also contribute to uptake inhibition.

Amitriptyline↗
PubMed1980

Cardiovascular effects of mianserin--a comparative study with amitriptyline and a placebo in healthy subjects.

The cardiovascular effects of a tricyclic (amitriptyline) and a tetracyclic (mianserin) antidepressant were compared with those of a placebo in a double-blind randomized group-comparative trial stratified for sex in 18 healthy volunteers. The dose of the test preparations was gradually increased to therapeutic level. Duration of treatment was 8 days. Neither test drug affected objective physical condition, intraocular pressure, blood variables or urinalysis, and the effect on blood pressure was found to be negligible. No impressive differences of untoward cardiac effects between the test preparations could be demonstrated. However, the prolongation of the pre-ejection period in amitriptyline-treated males, indicating a negative effect on myocardial contractility, and the reduction of the left ventricular end-systolic volume by mianserin, probably through increasing the ejection fraction, are observations of possible clinical relevance. They lend further support to the assumption that therapeutic doses of tricyclic antidepressants may produce untoward cardiac effects whereas the tetracyclic mianserin seems devoid of such unwanted properties.

Adolescent↗
PubMed1976

[Amitriptyline in psychiatric therapeutics. Apropos of 8 years of its use in hospital practice].

A hundred and thirty patients have been treated with Amitriptylin in the "Clinique de Psychiatrie" in Marseille during the last eight years. The review of the hundred cases for which the information are the most detailed show that Amitriptylin remains one of the most powerful, manageable and well-tolerated anti-depressant drugs available at the present time. Its therapeutic indications are numerous, but the best ones are proceeding from depressed states with high anxious participation in subjects of less that 60 years of age.

Adjustment Disorders↗
PubMed1976

Mianserin versus amitriptyline. A double-blind-trial evaluated by the AMP system.

Amitriptyline and mianserin were compared in a double-blind trial. Most of the depressive symptoms were influenced by both drugs, though quantitative and qualitative differences became evident. Amitriptyline predominantly influenced anxiety, despair and suicidal tendencies, while mianserin was particularly effective in psychomotor inhibition and the reduction of vegitative complaints. Mianserin did not show anticholinergic side effects.

Amitriptyline↗
PubMed1994

The effect of amitriptyline, doxepin, fluvoxamine, and paroxetine treatment on heart rate variability.

A total of 32 unmedicated patients with episodes of major depression (DSM-III-R) and 32 normal control subjects matched for age and sex were tested for heart rate variability (R-R variation) while resting and during deep breathing. Compared with the group of healthy subjects, the depressed patients showed no abnormalities before therapy. The patients were randomly allocated for treatment with 150 mg of amitriptyline per day (N = 8), 150 mg of doxepin per day (N = 8), 150 mg of fluvoxamine per day (N = 8), and 20 mg of paroxetine per day (N = 8). During treatment with either amitriptyline or doxepin, the coefficients of variation at rest and during deep breathing, which are largely independent of heart rate, had significantly decreased after 14 days (p = 0.012), whereas patients treated with fluvoxamine or paroxetine showed no significant changes of heart rate variability parameters after 14 days. The implications of these findings are discussed.

Adult↗
PubMed1994

A multicenter double-blind trial of paroxetine versus amitriptyline in depressed inpatients.

The phenylpiperidine derivative paroxetine is a selective serotonin reuptake inhibitor. In a double-blind 6-week trial, paroxetine was compared with amitriptyline in hospitalized patients suffering from major depression (DSM-III). One hundred fifty-three patients were enrolled in the study in seven centers in Austria and Germany. Results showed similar efficacy of both drugs after 6 weeks. The differences between groups in Montgomery-Asberg Depression Rating Scale and Clinical Global Impression ratings did not reach statistical significance at any time. Side effects were distributed similarly but with a significantly higher incidence of anticholinergic effects in patients treated with amitriptyline (p < or = 0.001), whereas agitation and insomnia were registered more often in the paroxetine group. This study supports the antidepressive efficacy of paroxetine in a sample of severely depressed inpatients.

Adolescent↗
PubMed1994

Adult respiratory distress syndrome associated with amitriptyline overdose.

Adult respiratory distress syndrome (ARDS) from overdose of tricyclic antidepressants (TCA) has been rarely reported in the literature. We describe a case report of ARDS secondary to amitriptyline overdose. A 39-y-old comatose female was admitted to the emergency department after ingesting approximately 2 g of amitriptyline 1-12 h prior to arrival. Patient was intubated and physostigmine was administered. There was only minimal level of improvement in the patient's consciousness. Gastric lavage was followed by charcoal and magnesium citrate; no material was recovered from the stomach. The patient was transferred to the intensive care unit and placed on a ventilator. Chest radiographic study on day 2 of hospital admission revealed bilateral diffuse opacity typical of ARDS. In the intensive care unit the patient developed metabolic acidosis and hypotension, and they were treated aggressively. The patient's chest radiograph was normal after 5 d; she was discharged from the hospital after 12 d. Though there are few reports of ARDS secondary to TCA, clinicians should be aware of this potential.

Adult↗
PubMed1993

[Cardiovascular effects of amitriptyline in therapeutic dosages. Echocardiographic study].

The authors studied the cardiovascular effects of amitriptyline at therapeutic plasma concentrations in 15 depressed patients (6 M. 9 F.) without cardiovascular disease both before treatment and after six months of therapy. The cardiovascular effects were evaluated by means of electrocardiographic and 2D-echocardiographic examinations in basal conditions and after hand-grip stress test. The effects of isometric hand-grip exercise (IHG) on left ventricular size and performance were studied non invasively in all patients at rest and after 3 min. of IHG at 30% of maximum contraction. Left ventricular internal diameter was measured at end-diastole and end-systole on LV echograms, and blood pressure was measured by sphygmomanometer. Our data confirmed the depressant effect of amitriptyline even on healthy myocardium, an effect that becomes manifest only at handgrip stress with a significant reduction of ejection fraction (form 70.6 to 66.4%; p < 0.001), while ECG and arterial blood pressure did not change throughout the study. This goes to show that treatment with tricyclic antidepressants always has a latent depressant effect on myocardial contractility that becomes clinically evident under stress, as well as in subjects with heart disease and in the elderly. Hence the need to monitor left ventricular function, as well as ECG and blood pressure, and to exercise great caution in prescribing tricyclic antidepressants to subjects with a history of myocardial failure.

Aged↗
PubMed1995

Effect of amitriptyline on blood glucose level in rabbits.

Effect of single graded doses of amitriptyline (4, 8 and 16, mg/kg, p.o.) were observed on blood glucose level in 18 h fasted albino rabbits. All the doses of Amitriptyline produced significant hyperglycemia at 4 h, which attained a peak at 24 h with 16 mg/kg dose and appears to be due to blockade of the uptake of monominergic transmitters across the axoplasmic membrane, It (16 mg/kg) also produced glucose intolerance during early hours probably due to interference with gastrin function.

Amitriptyline↗
PubMedDate not supplied

Effect of repeated amitriptyline administration to mice on the T lymphocyte proliferative activity and natural killer cell cytotoxicity.

The study examined the effect of repeated amitriptyline administration to mice on the proliferative activity of lymphocytes in response to mitogen stimulation and on the ability of natural killer (NK) cells to evoke lysis of YAC-1 tumor cells in vitro. A relatively short treatment (5 days) produced an increase in the NK activity, but no change in the T cell proliferative response to mitogens. After a 2-week treatment, a transient but significant decrease in the proliferative activity of splenocytes and in the NK activity was observed. Prolonged administration of that drug for more than 3 weeks produced a return to the control level of the NK activity and the T lymphocyte responsiveness to mitogens. The obtained results show that amitriptyline modifies the immune function, and that the observed effect depends crucially on the length of drug administration.

Amitriptyline↗
PubMed1995

The effects of imipramine, amitriptyline and clonidine administered by iontophoresis on the pain threshold.

We performed iontophoresis of aqueous solution of imipramine and amitriptyline, tricyclic antidepressant, and clonidine, an alpha 2 agonist, in a total of 30 healthy adult volunteers. Analgesic effects were compared among the 3 drugs by measurement of the pain threshold using a thermopainmeter. No significant changes in the pain threshold were observed with imipramine or amitriptyline. On the other hand, clonidine significantly increased the pain threshold, compared with the control value before iontophoresis. Although the effects of iontophoresis of clonidine were smaller than the previously reported effects of iontophoresis with other drugs, these effects seemed to be due to the action of clonidine itself not associated with electric stimulation. More marked effects may be obtained with changes in the conditions of iontophoresis.

Adrenergic alpha-Agonists↗
PubMed1995

Test-dependent relationship of the antidepressant and analgesic effects of amitriptyline.

Antidepressants have been found to be of value in the treatment of pain of various etiologies. Nevertheless, the data are conflicting as it is often difficult to distinguish between the analgesic and antidepressant action. The analgesic effect of acutely administered amitriptyline at doses of 2.5, 5, 10, 20 and 40 mg/kg was investigated in four nociceptive tests involving physical (hot plate and tail flick tests), or noxious chemical stimuli (acetic acid and formalin tests). Relationships were established between the analgesic actions and the antidepressant effect of acutely administered amitriptyline at doses of 2.5, 5, 10 and 20 mg/kg in the forced swimming test. The results demonstrated a relationship between the antidepressant effect and the analgesic action in the tail flick test, but not in the hot plate, acetic acid and formalin tests. Thus, the type of noxious stimulus may be a determining factor in the relationship between these two pharmacological actions.

Amitriptyline↗
PubMedDate not supplied

[Effects of amitriptyline on the contractile function of the myocardium. Dobutrex in the role of a positive inotropic agent].

Study of the effect of a tricyclic antidepressant amitriptyline on an isolated papillary muscle of the rat left ventricle showed a decrease of the contractility due to depression of the potential of action and the slow calcium channels, as well as decreased rate and prolongation of contraction caused by impairment of calcium reabsorption from the sarcoplasma. Injection of dobutrex after amitriptyline has a positive inotropic effect by completely removing the disorders in the time parameters of contraction.

Amitriptyline↗
PubMed1998

The anti-allodynic effects of amitriptyline, gabapentin, and lidocaine in a rat model of neuropathic pain.

UNLABELLED: The management of patients with neuropathic pain is challenging. There are only a few reports regarding the acute effects of the commonly used adjuvant drugs amitriptyline (AMI), gabapentin (GBP), and lidocaine (LDC) on neuropathic pain behaviors in animal models. Thus, the purpose of this study was to investigate the acute effects of AMI, GBP, and LDC on behavioral signs of mechanical allodynia and the site of action of these drugs using a rat model of neuropathic pain. Under general anesthesia with halothane, neuropathic injury was produced in rats by tightly ligating the left L5 and L6 spinal nerves. In Experiment 1, baseline mechanical allodynia data were recorded, and the animals were randomly divided into five groups: Group 1 received saline intraperitoneally (IP), Group 2 received AMI (1.5 mg/kg IP); Group 3 received GBP (50 mg/kg IP), Group 4 received an IV saline infusion for 10 min, and Group 5 received LDC (10-mg/kg IV infusion) for 10 min. Measurements of mechanical allodynia were repeated 0.5, 1, 2, and 4 h and 1, 3, and 7 days after treatment. In Experiment 2, rats were prepared similarly to the first experiment, and a single unit activity of continuous discharges of injured afferent fibers was recorded from the left L5 fascicles before and until 1 h after treatment. All animals developed neuropathic pain behavior within 7 days after surgery. All three tested drugs were effective in increasing the threshold for mechanical allodynia as early as 30 min after treatment, and the effect lasted for at least 1 h. Furthermore, AMI and LDC reduced the rate of continuing discharges of injured afferent fibers, whereas GBP did not influence these discharges. Our findings clearly demonstrate an attenuation of neuropathic pain behavior in rats treated with AMI, GBP, or LDC. Finally, the site of action of LDC seems to be primarily in the periphery, and that of GBP is exclusively central, whereas that of AMI seems to have both peripheral and central components. IMPLICATIONS: In the present study, we examined the effectiveness of three drugs commonly used for the treatment of neuropathic pain. Systemic injections of amitriptyline, gabapentin, or lidocaine produced pain-relieving effects in this established model for neuropathic pain in rats, which supports their clinical use in managing patients with neuropathic pain syndromes.

Acetates↗
PubMedDate not supplied

[Study of mechanisms of action of amitriptyline and acupuncture using nociceptive flexor reflex in patients with chronic forms of headache].

The nociceptive flexor reflex (NFR, R3) was tried for quantitative assessment of pain in patients with various forms of primary and secondary headaches. Amitriptyline and acupuncture elevated the threshold of R3-reflex emergence, though the threshold of subjective pain sensitivity increased only in response to amitriptyline. NFR is adequate for assessing anesthesia efficacy and investigating the mechanisms of action of analgesics in patients with headache.

Acupuncture Analgesia↗
PubMed1999

Amitriptyline-induced erythema annulare centrifugum.

A case of amitriptyline-induced superficial erythema annulare centrifugum (EAC) is reported. Its singular characteristics are prominent epidermal manifestations, with clinical and histologic vesiculation, associated with vacuolar degeneration at the dermoepidermal junction; numerous arciform lesions, accompanied by diffuse erythema on rechallenge; quick change, more rapid than that usually described for EAC; and a short course, in contrast with the usual chronic evolution of EAC. To our knowledge, this is the first reported case of EAC associated with amitriptyline intake.

Amitriptyline↗