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Elavil

Elavil is the medication of high quality, which is taken in treatment of depression. Elavil is acting by increasing the amounts of certain natural substances in the brain that are needed to maintain mental balance. It is tricyclic antidepressant.

Other names for this medication:

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Asendin, Norpramin, Sinequan, Anafranil, Surmontil , Asendin, Norpramin, Sinequan, Anafranil, Surmontil, Aventyl Hydrochloride, Tofranil-PM

 

Also known as:  Amitriptyline.

Description

Elavil target is the treatment of depression. Elavil is acting by increasing the amounts of certain natural substances in the brain that are needed to maintain mental balance. It is tricyclic antidepressant.

Generic name of Elavil is Amitriptyline.

Elavil is also known as Amitriptyline, Amitryptyline, Amidon, Amitryn, Tryptanol, Endep, Elatrol, Tryptizol, Trepiline, Laroxyl, Saroten, Triptyl, Amitrip.

Brand names of Elavil are Elavil, Endep, Vanatrip.

Dosage

Take Elavil tablets orally with water, with or without food.

Take Elavil for one to four times a day at the same time.

The treatment can be resulting after 4 weeks.

If you want to achieve most effective results do not stop taking Elavil suddenly.

Overdose

If you overdose Elavil and you don't feel good you should visit your doctor or health care provider immediately. Symptoms of Elavil overdosage: seizures, loss of consciousness for a period of time, seeing things or hearing voices that do not exist, agitation, feeling drowsy, rigid muscles, vomiting, high temperature, cold body temperature, problems concentrating, abnormal heartbeats, confusion.

Storage

Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F) away from moisture and heat. Throw away any unused medicine after the expiration date. Keep out of the reach of children.

Side effects

The most common side effects associated with Elavil are:

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Side effect occurrence does not only depend on medication you are taking, but also on your overall health and other factors.

Contraindications

Do not take Elavil if you are allergic to Elavil components.

Do not take Elavil if you are pregnant, planning to become pregnant, or are breast-feeding.

Be careful with Elavil if you suffer from or have a history of a history of heart attack, stroke, bipolar disorder (manic-depression), schizophrenia or other mental illness, diabetes, overactive thyroid, glaucoma, problems with urination, heart disease, seizures.

Be careful with Elavil if you are taking guanethidine (Ismelin), disulfiram (Antabuse), heart rhythm medications such as flecainide (Tambocor), propafenone (Rhythmol), quinidine (Cardioquin, Quinidex, Quinaglute), cimetidine (Tagamet).

Avoid alcohol.

Be careful! Taking Elavil you can become suicidal.

Be careful when you are driving or operating machinery.

Be careful with Elavil if you are going to have a surgery.

It can be dangerous to stop Elavil taking suddenly.

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The micellization behaviors of two amphiphilic drugs ((amitriptyline hydrochloride (AMT) and imipramine hydrochloride (IMP)) in presence of cationic surfactants (conventional as well as gemini) have been investigated conductometrically at four mole fractions and four temperatures. The critical micelle concentration (cmc) values come out to be lower than cmc(id) values (cmc(id) is the cmc value at ideal mixing state) indicating attractive interactions between the two components in mixed micelles. Micellar mole fractions of surfactants (X(1) and X(1)(M)), calculated by Rubingh and Motomura models, are always greater than X(1)(id) (micellar mole fraction at ideal mixing). The rigid structure of drugs decreases their contribution in mixed micelles as compared to that predicted by X(1)(id) values. Although α(1) (mole fraction of surfactant) is higher for DTAB than that of 12-4-12, the contribution of 12-4-12 is almost equal to that of DTAB. The interaction parameter (β) is negative at all temperatures and at all compositions indicating attractive interactions. Activity coefficients (f(1) and f(2)) are always less than unity suggesting nonideality in the systems. Thermodynamic parameters suggest dehydration of hydrophobic part of the drug at or above certain temperature which is different for the two drugs.

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Combination therapy is often used to increase the clinical utility of analgesic agents. The coadministration of two compounds may achieve analgesia at doses lower than those required for either compound alone, leading to enhanced pain relief and reduction of adverse effects. Herein, the authors describe the effect of coadministration of morphine and amitriptyline on cutaneous orofacial inflammatory pain in rats.

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We describe a gas chromatographic-chemical-ionization mass spectrometric procedure for determining concentrations of the tricyclic antidepressant drugs and their demethylated metabolites in plasma. The procedure requires 2.0 mL of plasma or serum and involves internal standard addition, extraction with a mixed organic solvent, and separation on a column packed with 0.5% potassium hydroxide and 2% Carbowax 20M. Between-assay and within-assay (n = 10) CVs were less than 11.0%. The procedure has been applied to several interesting cases, three of which are summarized.

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Gas chromatography was used to determine plasma levels of amitriptyline, nortriptyline and their 10-hydroxy derivatives after conversion to the dehydro compounds by heating with acid. The primary amine 10-hydroxydesmethylnortriptyline is also dehydrated and the dehydro compound coincides on the chromatogram with dehydronortriptyline. Treatment of the extract with salicylaldehyde selectively removed the primary amine, which was determined by difference. Cis- and trans-hydroxydesmethylnortriptyline were isolated from urine by thin-layer chromatography and used to standardize the estimation. The stability of all the metabolites in plasma was investigated. Results are given for hydroxydesmethylnortriptyline levels in the plasma of 41 patients treated with amitriptyline.

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To review the tolerability and efficacy of amitriptyline in the management of depression.

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Actions on performance of dextropropoxyphene (DXP) alone and in combination with amitriptyline (AMI), indomethacin (IN), and placebo were compared in 15 patients with rheumatoid arthritis. The patients were on their prescribed maintenance regimen excluding analgesics. In four randomized test sessions at two-week intervals, they received double blind and crossover single oral doses of DXP 130 mg, IN 50 mg, DXP 65 mg + AMI 25 mg or placebo, each after two days' pretreatment with the same drug. Objective and subjective effects were measured at baseline and 2 and 4 hours after drug administration. DXP impaired critical flicker discrimination, symbol copying and body balance without modifying tracking, choice reactions or attention. It rendered the subjects elated, muzzy, mentally slow and calm. Actions of AMI + DXP were about the same. IN impaired body balance and critical flicker recognition. Plasma concentrations of DXP were moderate to high whilst those of IN and AMI were fairly low. We conclude that therapeutic doses of DXP and IN are relatively safe in regard to driving skills. Small doses of AMI may not enhance the mild psychomotor effects of DXP. Earlier single dose studies carried out with healthy volunteers might have overestimated the decremental effects of analgesics on psychomotor performance.

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A multi-centre controlled trial of amitriptyline, dothiepin and mianserin in the treatment of depressive illness was undertaken in psychiatric inpatients over the age of 65. Despite the co-operation of many of the leading practitioners in this field in Great Britain, it proved impossible to recruit sufficient patients for firm conclusions to be drawn. Forty-five patients were entered into the trial, 13 withdrew because of lack of improvement, 4 because of intercurrent physical illness, 3 because of adverse effects of trial medication and 2 because of lack of compliance. Only 11 of the 23 patients completing had a final score on the Hamilton Depression Rating Scale of 10 or less. No treatment showed a significant superiority over the others, nor was there any difference in tolerance.

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One-hundred and twenty patients with chronic pain, who had all failed to obtain relief with traditional medical treatment, were given a standard psychotropic drug mixture consisting of amitriptyline 25 mg and perphenazine 2 mg. Of those who completed 2 months of treatment, 33.68% were pain free, while 8.3% had unacceptable side-effects. The best results were obtained in patients with postherpetic neuralgia and postoperative scar pain.

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There is an art to prescribing medications to depressed patients. Both patient and therapist factors are important to a successful outcome with appropriate timing and prescribing of treatment. Two case reports are provided as examples. Specific strategies used by experienced clinicians are presented in the discussion.

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Dose-response association with QTc prolongation was identified for citalopram (adjusted beta 0.10 (SE 0.04), P<0.01), escitalopram (adjusted beta 0.58 (0.15), P<0.001), and amitriptyline (adjusted beta 0.11 (0.03), P<0.001), but not for other antidepressants examined. An association with QTc shortening was identified for bupropion (adjusted beta 0.02 (0.01) P<0.05). Within-subject paired observations supported the QTc prolonging effect of citalopram (10 mg to 20 mg, mean QTc increase 7.8 (SE 3.6) ms, adjusted P<0.05; and 20 mg to 40 mg, mean QTc increase 10.3 (4.0) ms, adjusted P<0.01).

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Palliative sedation (PS) is necessary in a significant percentage of patients dying on an acute palliative care unit (PCU). Common indications are terminal restlessness, pain and dyspnoea. On our PCU, terminal restlessness was the main indication for PS but pain was the most prevalent symptom during admission. Because delirium is often drug induced in terminal cancer patients and opioids are amongst the most frequently implicated drugs, we hypothesised that the underlying pain problem and its treatment might have been related to the need for sedation.

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We studied the effect of alaproclate [2-(4-chlorophenyl)-1,1-dimethyl 2-aminopropanoate] on the N-methyl-D-aspartate (NMDA)-induced changes in membrane potential and intracellular free Ca++ in cerebellar granule cells by using the fluorescent indicators DiBaC4(3) and fura-2, respectively. The NMDA-induced responses were blocked by the 5-hydroxytryptamine reuptake blocker alaproclate in a noncompetitive manner with an IC50 value of 0.3 microM. The effect of alaproclate was stereoselective because the S-(-)-enantiomer was more potent than the R-(+)-enantiomer. The inhibitory response was rapidly reversed if alaproclate was removed by perfusion. The same was the case with the reversible noncompetitive NMDA receptor antagonists dextromethorphan, dextrorphan, amitriptyline and desipramine. The inhibition caused by the noncompetitive antagonist dizolcipine could not be reversed by perfusion. The glycine-sensitivity of the NMDA response was unaffected by alaproclate, and high concentrations of glycine were unable to reverse the inhibition of alaproclate. Alaproclate also did not affect the sensitivity of the responses to Mg++. The results suggest that alaproclate, which has previously been in clinical trials for depressive illness, acts as a reversible noncompetitive antagonist of the NMDA receptor.

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Low back pain (LBP) is responsible for more than 2.5 million visits to US emergency departments (EDs) annually. These patients are usually treated with nonsteroidal anti-inflammatory drugs, acetaminophen, opioids, or skeletal muscle relaxants, often in combination.

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In users of tricyclic antidepressants (TCAs) the risk of switching to another antidepressant was significantly higher in poor metabolizers (PMs:*4/*4) compared with extensive metabolizers (EMs:*1/*1), with an adjusted OR of 5.77 (95% CI 1.59, 21.03; P = 0.01). In SSRI users there was no significant difference (OR 0.91; 95% CI 0.20, 4.15; P = 0.90). Heterozygous patients did not have an increased risk of switching in both TCA and SSRI users. The mean TCA dose was significantly lower in PMs than in EMs at the third and fourth prescription (difference 0.11 DDD, P = 0.03). In SSRI users the difference in mean dose between PMs and EMs was significant at the third prescription (0.17 DDD; P = 0.02).

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Amitriptyline may be effective in the treatment of diarrhoea-predominant irritable bowel syndrome and at low dose is well tolerated.

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A pharmacokinetic analysis of a new antidepressant drug, mianserin (ORG GB-94), was undertaken in 4 male volunteers, each of whom received 15 mg mianserin on two occasions. Plasma levels peak at 2 h with a median level of 11.0 ng/ml, a median beta-phase half-life of 10.0 h, and a median apparent volume of distribution of 3.3 X 10(3) 1. EEG profile analysis shows mianserin to increase frequencies below 6 Hz, decrease those from 7.5 to 15 Hz, and increase frequencies above 18 Hz, a pattern similar to amitriptyline. Peak EEG effects range from 2 to 5 h with a pattern of measured changes that parallels plasma levels with varying latency. Decreases in vigilance measures and in critical flicker-fusion frequency show a similar time course. Mianserin is a putative thymoleptic on EEG profile analysis with high cerebral penetrance.

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Amitriptyline intoxication lowered cardiac output, peak left ventricular dP/dt, and mean arterial pressure (MAP). All doses of norepinephrine and the two higher doses of dopamine increased cardiac output, MAP, and peak left ventricular dP/dt during the intoxicated state. Both agents restored all variables to preintoxication values. Values obtained at the highest doses of the two drugs were not different for any variable.

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Many adverse drug reactions are caused by the cytochrome P450 (CYP) dependent activation of drugs into reactive metabolites. In order to reduce attrition due to metabolism-mediated toxicity and to improve safety of drug candidates, we developed two in vitro cell-based assays by combining an activating system (human CYP3A4) with target cells (HepG2 cells): in the first method we incubated microsomes containing cDNA-expressed CYP3A4 together with HepG2 cells; in the second approach HepG2 cells were transiently transfected with CYP3A4. In both assay systems, CYP3A4 catalyzed metabolism was found to be comparable to the high levels reported in hepatocytes. Both assay systems were used to study ten CYP3A4 substrates known for their potential to form metabolites that exhibit higher toxicity than the parent compounds. Several endpoints of toxicity were evaluated, and the measurement of MTT reduction and intracellular ATP levels were selected to assess cell viability. Results demonstrated that both assay systems are capable to metabolize the test compounds leading to increased toxicity, compared to their respective control systems. The co-incubation with the CYP3A4 inhibitor ketoconazole confirmed that the formation of reactive metabolites was CYP3A4 dependent. To further validate the functionality of the two assay systems, they were also used as a "detoxification system" using selected compounds that can be metabolized by CYP3A4 to metabolites less toxic than their parent compounds. These results show that both assay systems can be used to screen for metabolic activation, or de-activation, which may be useful as a rapid and relatively inexpensive in vitro assay for the prediction of CYP3A4 metabolism-mediated toxicity.

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All RCTs comparing fluoxetine with any other AD (including non-conventional agents such as hypericum) for patients with unipolar major depressive disorder (regardless of the diagnostic criteria used) were included. For trials that had a cross-over design only results from the first randomisation period were considered.

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We conclude that clinical response to antidepressive treatment precedes improvement of declarative memory. A low degree of impairment of declarative memory is associated with early complete remission of depression.

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Hidradenitis Supprurativa (HS) is a painful chronic follicular disease. Few papers have addressed pain control for this debilitating condition. Possible topical agents include tricyclic antidepressants, opioids, anticonvulsants, NSAIDs, NMDA receptor antagonists, local anesthetics and other agents. The first line agents for the topical treatment of the cutaneous pain of HS are diclonefac gel 1% and liposomal xylocaine 4% and 5% cream or 5% ointment. The chief advantage of topical xylocaine is that is quick acting i.e. immediate however with a limited duration of effect 1-2 hours. The use of topical ketamine, which blocks n-methyl-D-aspartate receptors in a non-competitive fashion, might be a useful tool for the treatment of HS pain. Topical doxepin, which available in a 5% commercially preparation (Zonalon®) , makes patients drowsy and is not useful for controlling the pain of HS . Doxepin is available in a 3% or 3.3% concentration (which causes less drowsiness) from compounding pharmacies and can be used in compounded analgesic preparations with positive effect. Topical doxepin is preferred over use of topical amitriptyline because topical doxepin is more effective. Nevertheless, topical amitriptyline increase of the tactile and mechanical nociceptive thresholds and can be used for topical pain control in compound mixture of analgesics . Gabapentin and pregablin can also be used compounded with other agents in topical analgesic preparations with positive topical anesthetic effect. Capsaicin is not useful for topical treatment of the pain of HS. Sometimes compounded of anesthetics medications such as ketamine 10%, bupivacaine 1%, diclofenac 3%, doxepin 3% or 3.3%, and gabapentin 6% can extend the duration of effect so that medication only needs to be used 2 or 3 times a day. Still in my experience the easiest to get and most patient requested agent is topical diclonefac 1% gel.

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Tricyclic antidepressants (for example, amitriptyline) and other types of antidepressants (for example, amoxapine and maprotiline) are competitive antagonists of muscarinic acetylcholine receptors, the predominant class of acetylcholine receptors in the brain. Some evidence suggests that this muscarinic receptor blockade in brain alleviates depression. However, all tricyclic antidepressants appear to be equally effective in treating depression despite having differences in their antimuscarinic potencies while having similar ranges of therapeutic blood levels. It is more likely that the antimuscarinic potency of antidepressants is related mainly to the frequency with which they cause such symptoms as blurred vision, dry mouth, and urinary retention. Information on the antimuscarinic potency and other receptor-blocking potencies of antidepressant agents can be helpful in minimizing or avoiding certain side effects when these drugs are given to patients.

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The efficacy of each antidepressant available has been found equal to that of amitriptyline in double-blind studies as far as mild to moderate depression is involved. However, it seems that some antidepressants are more effective than others in the treatment of severe types of depression (i.e., delusional depression and refractory depression). Following studies regarding the antinociceptive mechanisms of various antidepressants, we speculate that the involvement of the opioid system in the antidepressants' mechanism of action may be necessary, in order to prove effective in the treatment of severe depression. Among the antidepressants of the newer generations, that involvement occurs only with venlafaxine (a presynaptic drug which blocks the synaptosomal uptake of noradrenaline and serotonin and, to a lesser degree, of dopamine) and with mirtazapine (a postsynaptic drug which enhances noradrenergic and 5-HT1A-mediated serotonergic neurotransmission via antagonism of central alpha-auto- and hetero-adrenoreceptors). When mice were tested with a hotplate analgesia meter, both venlafaxine and mirtazapine induced a dose-dependent, naloxone-reversible antinociceptive effect following ip administration. Summing up the various interactions of venlafaxine and mirtazapine with opioid, noradrenergic and serotonergic agonists and antagonists, we found that the antinociceptive effect of venlafaxine is influenced by opioid receptor subtypes (mu-, kappa1- kappa3- and delta-opioid receptor subtypes) combined with the alpha2-adrenergic receptor, whereas the antinociceptive effect of mirtazapine mainly involves mu- and kappa3-opioid mechanisms. This opioid profile of the two drugs may be one of the explanations to their efficacy in severe depression, unlike the SSRIs and other antidepressants which lack opioid activity.

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A new method for the CE separation of nine tricyclic antidepressants (TCAs), viz. amitriptyline, clomipramine, desipramine, doxepin, fluphenazine, imipramine, nortriptyline, promazine, and thioridazine, is described. The capillary was statically coated with a layer of poly(N,N-dimethylacrylamide) (PDMA) to suppress the EOF, and beta-CD was used as an additive in the BGE solution. The optimal resolution of nine TCAs was obtained by using a 1% v/v PDMA-coated capillary and a BGE solution of 50 mM sodium phosphate buffer (pH 3.0) containing 0.5 mM beta-CD. Efficiencies were typically >10(5 )plates/m. Complete separation of nine TCAs could be achieved in about 28 min; the two diastereomers of doxepin and the two enantiomers of thioridazine could also be separated. The RSD values of migration time and peak area of the TCAs were in the ranges 0.5-0.8 and 3.3-4.9% (n = 10), respectively. In combination with a suitable sample clean-up technique, such as hollow fiber-based liquid phase microextraction (HF-LPME), the polymer-coated capillary can be employed for the CE-UV analysis of TCAs in human plasma.

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Analysis of routinely collected anonymised computerised patient records in 131 UK general practices (approximately 162,000 registered patients annually aged >or=65 years) providing data to the DIN-LINK database between 1994 and 2003. In each year, we identified patients prescribed drugs classified by the 2003 Beers criteria as potentially inappropriate for older people.

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Milnacipran's binding and uptake inhibition profile more closely resembles that of the tricyclic antidepressants than that of duloxetine. Whether these differences observed in vitro manifest themselves in vivo is not clear.

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The cases of two borderline patients are presented, dexamethasone suppression test (DST) positive and refractory to many therapeutic interventions and treated successfully with high doses of amitriptyline (225 and 200 mg/day, respectively). During the therapeutic intervention, the psychopathological condition of the patients was evaluated using Hamilton's rating scale for depression and a constructed scale based on items 11, 12 and 13 (dysphoria, anger, sense of emptiness, boredom, anhedonia) of the diagnostic interview for borderline patients.

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A three-dimensional molecular template has been generated for substrates of human debrisoquine 4-hydroxylase cytochrome P450 (CYP2D6). This template defines the stereochemical requirements for CYP2D6 substrates in terms of the volume occupied and positions of key atoms. The modelling was based on the X-ray crystallographic coordinates of the location of the attacked C5 atom of camphor in relation to the haem in cytochrome P450 cam. Interactive molecular graphics combined with energy calculations were used to identify allowed conformers to superpose known CYP2D6 substrates to yield a molecular template. This model takes into account the site of attack of the known substrates and the requirement for a protonated nitrogen atom to interact with an anion site of the protein. A nitrogen-anion distance of between 2.5 and 4.5 A was allowed for the interaction. The substrates modelled were cardiovascular drugs (debrisoquine, sparteine, guanoxan and perhexiline), beta-adrenergic blocking agents (bufuralol and propranolol), tricyclic anti-depressants (desipramine, amitriptyline and nortriptyline) and other miscellaneous compounds (phenformin, methoxy-amphetamine, codeine and dextromethorphan). The template generated in this manner was then used to determine the likelihood that certain other compounds were substrates for CYP2D6. A carcinogenic protein pyrolysate product, 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP), did not fit the template and is therefore unlikely to be activated by this enzyme. A potent carcinogen in tobacco smoke, 4-(N-methyl-N-nitrosamino)-1-(3-pyridyl)-1-butanone (NNK), fitted the template but could not be modelled to form a favourable nitrogen-anion interaction. Experimental substrate competition studies also showed that NNK is unlikely to be a CYP2D6 substrate. It was also shown that the widely used drug for treatment of breast cancer, trans-1-(4-beta-dimethylaminoethoxyphenyl)-,2-diphenyl-1-ene (tamoxifen), did not fit the molecular template and is unlikely to be metabolized by CYP2D6. Coordinates of the template are available.

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Interstitial cystitis is associated with substantial costs and health care resource utilization.

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Psychomotor retardation, a general slowing of activity which is one of the central characteristics of depression, was investigated by measuring reaction time and movement duration in drawing tasks. Twenty depressive patients and 20 normal controls participated in two tasks in which either simple or more complex figures had to be copied as fast as possible on a digitizer. In general, patients needed more time to complete the drawing tasks than controls, and they performed them differently. Six patients, who could be tested before and after treatment, showed changes in drawing speed that correlated with clinical improvement. These results suggest that psychomotor retardation might be fruitfully studied by measuring the kinematic aspects of drawing and might provide objective parameters to measure progress in therapy.

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elavil drug classification 2016-09-08

One-hundred and twenty patients with chronic pain, who had all failed to obtain relief with traditional medical treatment, were given a standard psychotropic drug mixture consisting of amitriptyline buy elavil 25 mg and perphenazine 2 mg. Of those who completed 2 months of treatment, 33.68% were pain free, while 8.3% had unacceptable side-effects. The best results were obtained in patients with postherpetic neuralgia and postoperative scar pain.

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Sixty-five patients attending a pain relief clinic were randomly allocated to treatment for 5 weeks with amitriptyline alone, distigmine alone, amitriptyline and distigmine started together, or addition of distigmine to preexisting treatment with amitriptyline. Forty-eight patients successfully completed the trial; the most common cause for withdrawal was dry mouth in the amitriptyline-alone group. Two parameters were measured: Pain intensity was measured at the beginning and end of the treatment, and the saliva flow was measured at the beginning and the end of the treatment. At the end of 5 weeks, buy elavil treatment with a combination of amitriptyline (75 mg/day) and distigmine (10 mg/day) resulted in a 43% reduction of pain and no subjectively noticeable mouth dryness. Distigmine alone also decreased pain and increased saliva flow, sometimes to the point of discomfort, whereas amitriptyline alone, in this particular series, did not significantly reduce pain and produced unpleasant mouth dryness. The addition of distigmine to preexisting (and ineffective) amitriptyline treatment failed to relieve pain. We therefore conclude that a combination of amitriptyline and distigmine (both given ab initio) may be a useful therapy for chronic pain.

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Safety in overdose should be considered in risk-benefit and cost-benefit considerations of antidepressants. A switch in prescribing, from drugs with a high number of deaths per million prescriptions to drugs with a low number, could reduce the numbers of deaths from overdose. Although this form of suicide prevention can be implemented easily and buy elavil immediately, its introduction needs to be considered against the higher costs of some of the newer drugs.

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Thirty-eight studies were selected. Eighteen were excluded. Eleven preventive drugs were compared with placebo in a total of 15 studies. Drug-drug comparisons were made in just six studies. For only four drugs (L-5-hydroxytryptophan [L-5HTP], flunarizine, clonidine, and propranolol) were two or more studies selected. For only six drugs (trazodone, L-5HTP, propranolol, flunarizine, papaverine, and nimodipine) were data reported for effect on frequency. For no individual drug were comparable data reported in more than one study, thus meta-analysis was not possible. Two placebo-controlled studies showed a beneficial effect on the primary outcome measure, headache frequency. They were for the drugs propranolol and flunarizine. The propranolol study reported a dichotomous outcome (proportion of children responding), and it was possible to calculate a number-needed-to-treat to produce a two-thirds reduction in headache frequency (NNT = 1.5 buy elavil , 95%CI 1.15 to 2.1). The flunarizine study produced a SMD of 1.51 (95% confidence interval, -2.21 to -0.82), which was statistically significant in favour of flunarizine (p < 0.001). Nimodipine, timolol, papaverine, pizotifen, trazodone, L-5HTP, clonidine, metoclopramide, and domperidone showed no efficacy in reduction of frequency of attacks. The available studies on cyproheptadine, phenobarbitone, phenytoin, amitriptyline, carbamazepine, metoprolol, and piracetam were excluded for various reasons.

elavil cost 2017-11-23

1. Debate exists as to the nature of antidepressant-induced antinociception. It is unclear whether antidepressants are inherently antinociceptive, are able to potentiate opioid antinociception or both. We have used the acetic acid induced abdominal constriction assay in mice to investigate antidepressant-induced antinociception. 2. All the antidepressants tested (s.c.) produced dose-dependent protection against acetic acid-induced abdominal constriction. Similarly, morphine and aspirin were also effective antinociceptive agents in this nociceptive assay. 3. Opioid antagonists, naloxone (0.5 mg kg(-1), s.c.) and naltrindole (1 mg kg(-1), s.c.), shifted the dose-response relationships to the right for each of the antidepressant agents (dothiepin, amitriptyline, sibutramine, (+)-oxaprotiline and paroxetine). In this context the naloxone dose-ratios were 1.95, 3.90, 2.32, 4.50 and 2.65, with naltrindole dose-ratios of 4.36, 17.00, 4.28, 11.48 and 2.65 were obtained, respectively. Naloxone also shifted the morphine dose-response relationship to the right, by a factor of 2.62, whilst naltrindole had no effect upon morphine antinociception. Aspirin antinociception remained unaffected by both opioid antagonists. 4. The enkephalin catabolism inhibitor acetorphan, by itself, produced no activity in this test at a dose of 10 mg kg(-1) (s.c.). However, at higher doses, acetorphan produced a linear dose-response relationship against acetic acid-induced abdominal constriction. 5. When acetorphan was administered before either the antidepressants or morphine, there was a clear potentiation of the antidepressant- or morphine-induced antinociception. However, acetorphan had no effect on aspirin antinociception. 6. Since neither of the opioid antagonists were able to attenuate, nor was acetorphan able to potentiate, aspirin antinociception, we concluded buy elavil that the mechanism of antidepressant-induced antinociception is different from that of the non-steroidal anti-inflammatory drugs. 7. These data are consistent with the view that antidepressants may induce endogenous opioid peptide release, as shown by the acetorphan study. In this context, the ability of naltrindole to displace the antidepressant dose-response relationship to the right without affecting morphine antinociception, implicates the delta-opioid receptor and endogenous opioid peptides in antidepressant-induced antinociception.

elavil anxiety medication 2016-11-11

Both duloxetine and amitriptyline demonstrated similar efficacy in PDN. A large, multicentric buy elavil clinical trial in other populations could possibly demonstrate the superiority of either drug.

elavil usual dosage 2016-09-23

A 44-year-old African American woman with systemic lupus erythematosus developed thrombocytopenia. Splenic sequestration was suspected, but the rise in platelets after splenectomy was temporary. Bacterial and viral etiologies were ruled out, since thrombocytopenia continued 6 months after splenectomy. Her medications acetaminophen, amitriptyline, amlodipine, beta-antagonists, and diphenhydramine were suspected. Nadolol and labetalol were started immediately prior to splenectomy. Six months after splenectomy, the woman was hospitalized for pneumonia; the platelet count was 50 x 10(3)/mm(3). Nadolol was discontinued on day 2. Within 24 hours, the platelet count rose to 128 x 10(3)/mm(3) and exceeded 200 x 10(3)/mm(3) by day 7. Labetalol was discontinued on day buy elavil 8, but no additional significant rise occurred. The patient developed thrombocytopenia one year later when placed on nadolol and famotidine during admission for a gastrointestinal bleed. The platelet count decreased during the admission. Both drugs were discontinued after the last platelet count (100 x 10(3)/mm(3)). The platelet count had normalized by the follow-up visit 16 days later and remained normal until the patient's death almost a year later.

elavil 25mg reviews 2015-04-13

There has been an overall decrease in the annual incidence of antidepressant users in older adults over the last buy elavil 16 years, with a marked decline in new amitriptyline use and an increase in the incidence of newer agents.

elavil tablet 2016-01-29

Amitriptyline and topiramate combination may be beneficial for patients with migraine and comorbid depression, particularly in terms of buy elavil side effects and associated displeasure due to monotherapy.

elavil medication 2016-09-26

An examination of 68 patients with neurotic and psychopathic states detected the existence of significant connections between the method of treatment and reverse development of the symptomatology. The author used sets clinical scales and methods of statistical canonic, regressional and dispersional analysis. The most effective appeared to be autogenic training and aminazine. The effectiveness of aminazine was most distinctly seen in arresting hysterical characterological disturbances. The action of autogenic training in combination with amytriptiline was more effective in buy elavil the treatment of insomnia and psychopathic disorders of the inhibitive type.

elavil generic name 2016-12-26

To assess the effects of tricyclic and related drugs on nocturnal enuresis in children, and to compare them buy elavil with other interventions.

elavil maoi drugs 2017-01-27

We have reported that atropine, the prototype of muscarinic anticholinergic drugs, elicits a dose-dependent increase in core temperature of heat-stressed rats. In the present study, we have quantified the effects of other anticholinergic drugs on increments in core temperature and have derived the following potencies relative to atropine: imipramine 0.004, amitriptyline 0.02, chlorpromazine 0.1, atropine 1, L-hyoscyamine 2, atropine methyl nitrate 4, and scopolamine 16. Additionally, we quantified the efficacy of carbamates to reduce the elevated heating rate of atropinized rats as a measure of anticholinesterase efficiency. The results buy elavil indicated the following relative potencies: neostigmine 8, physostigmine 2, and pyridostigmine 1. We have concluded that alterations in core temperature responses to exposure to hot environments may be a useful and sensitive bioassay for anticholinergic and anticholinesterase efficacy.

elavil generic form 2016-09-03

A retrospective cohort study was conducted using the GPRD. The study included patients with MDD, aged [18-70], with a new prescription for amitriptyline, citalopram, escitalopram, fluoxetine, paroxetine, sertraline or venlafaxine between January 1, 2001 and September 30, 2003 and having no antidepressant prescription in the 6 months preceding index date. Switching of antidepressant treatment was defined as a prescription of a different antidepressant among all available marketed antidepressant treatment at this buy elavil time (no restriction of compound) from 1 month before up to 2 months after the calculated end of the previous antidepressant treatment. Survival analysis techniques were used to describe switching of antidepressant and time to switch. Profiles of switchers were described and by-treatment analyses performed.

elavil low dose 2016-08-28

A new high-performance liquid chromatographic method for the determination of amitriptyline and its metabolites, nortriptyline, 10-hydroxynortriptyline and 10-hydroxyamitriptyline, in plasma is described which uses direct injection and a column-switching valve. The buy elavil method is based on the enrichment of drugs on a reversed-phase concentration column, packed with Corasil RP. The enriched drugs were then separated, using back-flush mode on a bonded-phase CN column using an isocratic acetonitrile-acetate buffer (60:40, v/v) mobile phase. The validation of the method showed excellent sensitivity, precision and reproducibility. The limit of detection, using a 250-microliter direct injection of plasma, was between 5 and 10 ng/ml for each of the four drugs. The mean coefficient of variation for intra- and inter-assay was better than 5%. The method showed obvious advantages over conventional extraction procedures in terms of speed and ease of sample handling. The method has been successfully applied to the samples from patients receiving oral doses of amitriptyline.

elavil 25 mg 2015-06-25

PubMed, SCOPUS Cymbalta Capsule Picture , and EMBASE were searched up to December 2012 for relevant publications using the terms fat emulsion, lipid emulsion, Intralipid, Liposyn, Medialipide, Medialipid, lipid rescue, ILE, IVLE, IFE, IVFE, or lipid and intoxication, overdose, poisoning, toxicity, resuscitation, antidote, and rescue that were limited to reports in humans aged 18 years or younger.

elavil reviews depression 2017-09-10

The literature search identified several case reports and case series, as well as 3 small placebo-controlled studies (2 complete, 1 brief report) and 1 comparative trial against the Imodium Dosing TCA amitriptyline. The designs and dosing regimens differed between studies.

elavil 20 mg 2016-04-23

The study population consisted of 800 residents (average age, 84.7 years; range, 65 to 105 years) from 12 intermediate-care facilities in Massachusetts. Patient characteristics and actual medication use were documented during a 1-month observation period. Neuropsychological and functional testing Omnicef Missed Dose was performed on all residents receiving psychoactive medications. Constipation was assessed by measuring the frequency of laxative use.

elavil pills 2017-12-07

We selected randomised controlled trials (RCTs) and quasi-RCTs, performed in any healthcare setting, with included participants over 18 years of age, with or without IAD. We included trials comparing the (cost) effectiveness of topical skin care products such as skin cleansers, Pediatric Zyrtec Dosage moisturisers, and skin protectants of different compositions and skin care procedures aiming to prevent and treat IAD.

elavil 300 mg 2016-07-25

Ninety alcoholic patients with the secondary affective disorders (anxiety, depression) were divided into four groups. Patients in the first group received GABAB receptor ligands (baclofen), those in the second group, diazepam, those in the third group, amitriptyline and those in the fourth group, placebo. The results of clinical, psychological (tests of Spielberger, Zung and MMPI), and electrophysiological (superslow omega-potential) investigations showed that baclofen is an effective drug for affective disturbances in alcoholic patients, with efficacy superior to placebo and equal to diazepam and amitriptyline. At the same time baclofen does not have the side-effects and complications of the latter. Significant changes in platelet MAOB activity and the dopamine, serotonin and GABA concentrations in blood after treatment were not found in the four patient groups. The peripheral matabolism of GABA and monoamines do not seem to be related to the development of secondary Vermox Dosage Adults affective disorders in alcoholic patients. This investigation encourages the search for drugs acting on the affective psychopathology of GABAB receptor ligands.

elavil overdose charcoal 2015-08-13

Captopril, as well as amitriptyline, was shown to enhance apomorphine-induced stereotype in mice. At doses, which failed to modify the effect of apomorphine, both substances reversed the inhibitory action of sulpiride and haloperidol on stereotypical behaviour. Treatment with Zanaflex Drug Class captopril (25 mg/kg) did not modify the open-field behaviour, but significantly reduced the immobility in the forced swim test (20 mg/kg) Dopaminergic link was suggested to be involved in the CNS effect of captopril.

elavil drug interactions 2015-06-22

There are no prospective, multicenter, double-blind, placebo-controlled, randomized pharmacologic trials for the treatment of pain-predominant functional gastrointestinal disorders in children. The aim of this study was to evaluate the efficacy of amitriptyline in Zoloft Y Alcohol children with pain-predominant functional gastrointestinal disorders.

elavil reviews 2017-11-29

The acidic drugs caffeine, tolbutamide and naproxen did not bind appreciably to the microsomal membrane. Phenytoin, a lipophilic weak acid which is mainly unionized at pH 7. 4, was bound to a small extent (fu(mic) = 0.88) and the binding did not depend on drug concentration over the range used. The three weak bases amiodarone, amitriptyline and nortriptyline all bound extensively to the microsomal membrane. The binding was saturable for nortriptyline and amitriptyline. Bmax and KD values for nortriptyline at 1 mg ml-1 microsomal protein were 382 +/- 54 microM and 147 +/- 44 microM, respectively, and for amitriptyline were 375 +/- 23 microM and 178 +/- 33 microM, respectively. Bmax, but not KD, varied approximately proportionately with the microsome concentration. When KD is much less than the Km for a reaction, the apparent Km based on total drug can be corrected by multiplying by fu(mic). When the substrate concentration used in a kinetic study is similar to or greater than the KD (Km >/= KD), simulations predict complex effects on the reaction kinetics. When expressed in terms of total drug concentrations, sigmoidal reaction velocity vs substrate concentration plots and curved Eadie Hofstee plots are predicted.

elavil 150 mg 2017-10-05

Light scattering has proved to be useful in characterizing colloidal systems. We have studied the interaction between an amphiphilic drug, amitriptyline hydrochloride (AMT), and neutral polymers, polyvinylpyrrolidone (PVP) and poly(ethylene glycol) (PEG), using the dynamic light scattering (DLS) technique. AMT was found to interact with PVP more strongly than PEG. A large decrease of the size of aggregates upon increase of AMT concentration indicates a successive collapse of the polymer conformation. The partial negatively charged oxygen atoms, present in the amide group of PVP, were believed to be responsible for the collapse while interacting with the cationic head group of AMT. Presence of NaBr in the solution enhanced the effect markedly and made the AMT-PVP aggregates more compact. The PEG aggregates also showed a similar behavior, although less pronounced than the PVP. The results obtained in the present investigations may be helpful to design the drug delivery systems for the antidepressant drugs as the higher concentration of these drugs is harmful for the human body. Likewise, as the results have shown that on increasing the temperature there is a decrease in the extent of interaction; this may be helpful for the controlled release formulations.

elavil migraine dosage 2016-11-19

The awareness of general practitioners of selected adverse drug interactions has been assessed. The drugs studied included adrenergic neurone blockers, warfarin, antidiabetic agents, and monoamine oxidase inhibitors. The findings must be interpreted with caution but they suggest that there is a clear need to improve the effectiveness of communication of information about adverse drug interactions if unnecessary iatrogenic disease is to be avoided.