Following is information on contraindications to the use of amitriptyline in general, pregnancy & amp; Breastfeeding and children. Please note that the contraindications may vary depending on the dosage form of a drug (eg tablet, syringe, ointment).
When should Amitriptyline not be used?
The active substance must not be used in:
- Hypersensitivity to amitriptyline or other tricyclic and tetracyclic antidepressants
- concomitant use of MAO inhibitors (antidepressants)
- Poisoning with sleeping pills, analgesics, psychotropic drugs or alcohol
- Patients with delirium
- untreated narrow angle glaucoma (cataract) (if injected)
- benign prostate enlargement with residual urine formation and / or urinary retention
- Narrowing of the gastric outlet (pyloric stenosis) or septic blockage
- Irritant conduction disturbances to the heart muscle or blockages in the cardiac conduction system with a heartbeat slowdown
- Potassium deficiency or simultaneous treatment with medications (such as dehydrators) that cause potassium deficiency.
Amitriptyline may only be prescribed at:
- after careful medical benefit / risk assessment
- benign prostate enlargement without residual urine formation
- severe impairment of liver or kidney function
- tendency to epileptic seizures
- Disorders of blood formation
- mental disorders due to a brain organic cause
- elderly patients.
Special care must be taken in these groups of patients and regular medical check-ups must be carried out.
If you experience manic phases (with extremely high mood and overdriven drive) when using amitriptyline, the active ingredient must be discontinued immediately. This also applies if additional depressive symptoms recur during treatment, especially in the course of schizophrenia (schizophrenia).
What should you watch out for during pregnancy and lactation?
So far, there is no evidence that amitriptyline could harm the unborn child. For safety’s sake, the use in pregnancy, especially in the first three months, nevertheless only for compelling reasons and after careful medical risk-benefit assessment. If amitriptyline is used at the end of pregnancy, the neonate must be monitored for the effects of the drug during the first few months.
Since amitriptyline passes into breast milk, the active substance should not be used during breast-feeding. If necessary, it must be weaned before treatment with amitriptyline.
What should be considered in children?
Children and adolescents under the age of 18 should not take the active substance as there is insufficient experience in this group of patients. If the doctor considers the use of the drug in younger patients to be necessary, the application must be made only after a strict benefit-risk balance and under his control.
Warnings and Precautions
- Regular medical blood pressure monitoring is advisable in patients with high blood pressure and labile circulatory conditions as there may be high blood pressure drops during treatment.
- Cardiac monitoring and ECG check-ups are recommended for patients with cardiovascular disease.
- Regular medical checkup on liver enzymes should be performed in patients with liver disease.
- Regular medical check-up of kidney function is recommended especially in elderly patients.
- Regular medical blood tests should be taken, as blood cell changes can occur.
- Medical checks, especially in cases of fever and influenza-like infections, are necessary throughout the treatment period.
- Regular medical check-up of the teeth is important as dental caries has been increasingly observed in long-term use.
- During treatment with the drug, medical EEG checks of brain activity should be performed at regular intervals.
- Severe depressive patients and especially young adults under the age of 30 are always suicidal until therapy improves.
- The sudden discontinuation of long-term high-dose therapy should be avoided, otherwise it may lead to adverse reactions (restlessness, anxiety, sweating, dizziness, vomiting, diarrhea, headache, sleep disorders).
- If a manic (exacerbated) upset or symptoms of schizophrenia occur, the drug should be discontinued immediately.
- If you have a tendency to epilepsy and brain damage, the medication can cause seizures.
- Special care should be taken in patients with hyperthyroidism or when administering thyroid hormones, as unwanted cardiac-damaging effects can be exacerbated.
- Before an operation, the anesthetist should be informed about the treatment with the drug.
- Corneal damage may occur to contact lens wearers due to decreased lacrimal gland activity.
- Intense sunlight should be avoided during treatment with the drug.
- The antidepressant effect of the drug is mitigated by nicotine (smoking).
- Alcohol increases the drug’s cushioning effect and increases the ability to react.
- The treatment of children and adolescents under the age of 18 with the drug is only permitted in exceptional cases.
- The medicine may increase the risk of bone fractures.
- Responsiveness is particularly affected during the first days of treatment. In this context, the ability to drive and use machines is severely limited. The steering of vehicles should therefore be avoided in the first days of treatment.
Sometimes medications release allergic reactions.
If you notice any signs of allergic reaction, tell your doctor or pharmacist immediately.