Amitriptyline: Further information

Contraindications of amitriptyline

As with any other drug, amitriptyline must not be used under certain circumstances. This is the case, for example, if there is hypersensitivity to the active substance.

Interactions with other drugs

Before you start treatment with amitriptyline, please discuss with your doctor whether there may be interactions with other medications you are taking. Among other things, the following interactions can occur:

• The life-threatening  serotonin syndrome  can occur if MAO inhibitors are taken at the same time. Therefore, MAO inhibitors must not be combined with amitriptyline. Other antidepressants should also not be taken together with amitriptyline – this applies in particular to the active ingredients  fluoxetine  and fluvoxamine.
• If amitriptyline is used concomitantly with drugs that affect the QT interval, there is an increased risk of  cardiac arrhythmia .
• If coumarin-type blood coagulants are administered, the blood coagulation values ​​must be checked regularly by a doctor.

Reducing the effect of amitriptyline

If amitriptyline is taken at the same time, the following drugs and active ingredients may have an increased effect:

• painkillers, sleeping pills or tranquilizers
• Antihistamines , anticholinergics and direct sympathomimetics
• Certain antiarrhythmic drugs such as amiodarone or quinidine
• Certain drugs against  epilepsy  such as carbamazepine or phenytoin

At the same time, there may be a reduction in the effect of amitriptyline. Such a weakening of the effect can also be provoked by taking drugs with the active ingredients carbamazepine and phenytoin. Likewise, the concentration of the antidepressant in the blood can be reduced by drugs containing active ingredients from St. John’s wort, nicotine and hormonal contraceptives.

The active ingredient itself, on the other hand, weakens some antihypertensive drugs in their effect. Among other things, active ingredients of the clonidine or guanethidine type are affected. Taking the active ingredients cimetidine or methylphenidate at the same time can increase the effect and side effects of amitriptyline. This also applies to the simultaneous intake of neuroleptics and antiepileptics.

Amitriptyline in pregnancy

Amitriptyline should not be used during pregnancy unless absolutely necessary. Although there is little experience with the use of the active ingredient in pregnancy, animal experiments have shown that taking it causes harm to the fetus. Therefore, always clarify with your doctor in individual cases whether it can be taken during pregnancy.

The active ingredient should also not be taken while breastfeeding, as it can pass into breast milk. If treatment with amitriptyline is required during breastfeeding, breastfeeding should be stopped beforehand. Children under the age of 18 should not take amitriptyline, as there is insufficient experience.

amitriptyline and alcohol

Patients taking amitriptyline should refrain from drinking alcohol during treatment. Since the active ingredient has a sedative effect, it is also advisable to refrain from driving vehicles and other dangerous activities, at least for the first few days of treatment. The doctor should then make a decision on a case-by-case basis, taking into account the dosage and individual reactions.

More information

Please also note the following information when taking amitriptyline:

• Ingestion can increase the risk of  bone fractures  .
• Corneal damage can occur in contact lens wearers during treatment due to reduced lacrimal gland activity.
• Intense sunlight should be avoided as much as possible during treatment.
• The teeth should be examined regularly during long-term treatment, as there is an increased risk of developing caries.