Abdominal pain or discomfort (in patients who have not responded to laxatives, loperamide, or antispasmodics)

Adult: Initially 5–10 mg daily, to be taken at night; increased in steps of 10 mg at least every 2 weeks as required; maximum 30 mg per day

Major depressive disorder (not recommended- increased risk of fatality in overdose)

Adult: Initially 50 mg daily in 2 divided doses, then increased in steps of 25 mg once daily on alternate days if required, maximum 150mg daily in 2 divided doses

Elderly: Initially 10–25 mg daily, increased if necessary up to 100–150 mg daily in 2 divided doses, dose increases dependent on individual patient response and tolerability—doses above 100mg should be used with caution

Major depressive disorder in patients with cardiovascular disease (not recommended increased risk of fatality in overdose)

Adult: Initially 10–25 mg daily, increased if necessary up to 100–150 mg daily in 2 divided doses, dose increases dependent on individual patient response and tolerability—doses above 100mg should be used with caution

Neuropathic pain, Migraine prophylaxis, Chronic tension type headache prophylaxis

Adult: Initially 10–25 mg daily, dose to be taken in the evening, then increased, if tolerated, in steps of 10–25 mg every 3–7 days in 1–2 divided doses; usual dose 25–75 mg daily, dose to be taken in the evening, doses above 100mg should be used with caution (doses above 75mg should be used with caution in the elderly and in patients with cardiovascular disease); maximum per dose 75 mg

Emotional lability in multiple sclerosis

Adult: Initially 10–25 mg daily; increased, if tolerated, in steps of 10–25 mg every 1–7 days; maximum 75 mg.

• Arrhythmias
• During manic phase of bipolar disorder
• Heart block immediate recovery period after myocardial infarction

Cardiovascular disease, Chronic constipation, Diabetes, Epilepsy, History of bipolar disorder, History of psychosis, Hyperthyroidism (risk of arrhythmias), Increased intra-ocular pressure, Patients with a significant risk of suicide, Phaeochromocytoma (risk of arrhythmias), prostatic hypertrophy, Pyloric stenosis, Susceptibility to angle closure glaucoma, Urinary retention

Cautions, Further Information

Treatment should be stopped if the patient enters a manic phase, elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants, glow initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.

Common or very common Anticholinergic syndrome, drowsiness, QT interval prolongation

Frequency not known Agranulocytosis, Alopecia, Anxiety, appetite abnormal, Arrhythmias, Asthenia, Bone marrow depression, Breast enlargement, Cardiac conduction disorders, Coma concentration impaired, Confusion, constipation, Delirium, Delusions, Diarrhoea, Dizziness,

Dry mouth, Dysarthria, Eosinophilia, Epigastric distress, face oedema, Galactorrhoea, Gynaecomastia, hallucination, Headache, Hepatic disorders, Hyperhidrosis hyperpyrexia, Hypertension, Hyponatraemia, hypotension, Leukopenia, Mood altered, Movement

Disorders, Mydriasis, Myocardial infarction, Nausea, neuroleptic malignant syndrome, Oral disorders, palpitations, Paralytic ileus, Peripheral neuropathy, photosensitivity reaction, Seizure, Sensation abnormal, Sexual dysfunction, SIADH, Skin reactions, Sleep disorders, Stroke, Sudden cardiac death, Suicidal behaviours, Syncope, Taste altered, Testicular swelling thrombocytopenia, Tinnitus, Tremor, Urinary disorders, urinary tract dilation, Vision disorders vomiting, Weight changes, Withdrawal syndrome.

Further Information

The risk of side effects is reduced by titrating slowly to the minimum effective dose (every 2–3 days), consider using a lower starting dose in elderly patient’s, overdose over dosage with amitriptyline is associated with relatively high rate of fatality, symptoms of over dosage may include dry mouth, coma of varying degree, hypotension, hypothermia, hyperreflexia, extensor plantar responses, convulsions, respiratory failure, cardiac conduction defects, and arrhythmias, dilated pupils and urinary retention also occur, for details on the management of poisoning, see tricyclic and related antidepressants.

Store in a cool and dry place

20×14 Tablets