The bioavailability with oral amitriptyline. The maximum serum concentration reached an average of 4 h. Binding to plasma . Metabolism of amitriptyline is carried out by demethylation and hydroxylation. The main metabolite of amitriptyline is nortriptyline. The half-life of amitriptyline is an average of 25 hours (16 – 40 hours), the half nortriptyline – about 27 hours. The equilibrium trenbolone acetate results concentration is established in 1-2 weeks.Amitriptyline displayed mainly in the urine, and, in part, the feces. Amitriptyline and nortriptyline cross the placental barrier and small amounts are excreted in breast milk.
- Depression, especially with anxiety, agitation and sleep disorders. It is indicated for the treatment of: endogenous depression mono- and bipolar type, involution, masked and menopausal depression. It can be used with dysphoria and alcoholic depression, reactive depression and depressive neurosis. In the treatment of schizophrenic depression is used in combination with neuroleptics.
- Chronic pain disorders.
- Nocturnal enuresis.
Recent myocardial infarction, a violation of intracardiac conduction, acute poisoning with alcohol, barbiturates or opiates, angle-closure glaucoma, the application together with MAO inhibitors and within 2 weeks after their withdrawal, hypersensitivity to amitriptyline.
Precautions. Saroj should be administered with caution in patients with convulsive disorders, urinary retention, prostatic hypertrophy, severe liver disease, or cardiovascular system, hyperthyroidism.
By providing a sedative effect, can affect driving ability, and other mechanisms. Patients taking amitriptyline should be forewarned doctor about this aspect of the drug.
Saroj is not recommended during pregnancy and lactation.
Dosing and Administration
Treatment of depression
Adults: start treatment trenbolone acetate results (3 times a day for 25 mg). If necessary, the dose may be increased to 25 mg per day to 150 mg / day (less to 225 mg / day in hospitalized patients). After reaching expressed improvement daily dose may be reduced to the minimum effective, typically up to 50 – 100 mg / day. In the treatment of depression it is recommended to continue the use of antidepressants, including saroten after reaching more pronounced effect for 4-6 months. The maintenance doses that provide anti-relapse action Saroj can be taken long-term, up to several years.
Elderly: begin treatment Sarotenom be 30 mg per day (3 times a day 10 mg). The dose can gradually increase daily, if necessary up to 100 – 150 mg / day. After reaching expressed improvement daily dose should be gradually reduced to the minimum effective, typically up to 25 – 50 mg / day.
Children: Treatment Sarotenom children should only be done in a psychiatric hospital. The initial daily dose is determined taking into account the weight of the child, the rate of 1.5 mg / kg / day. The daily dose can be gradually increased to 1.5 mg / kg / day in a week to the maximum – 5 mg / kg / day.
Chronic pain disorders
Adults: start treatment should trenbolone acetate results be with the appointment of 25 mg at night. The dose may be increased to 100 mg at night if required.
Elderly: start treatment should be with the appointment of 10 mg at night. The dose may be increased up to 50 mg at bedtime if needed.
Children 7-12 years: 25 mg for 1 / 2-1 hour before bedtime. Children older than 12 years: 50 mg for 1 / 2-1 hour before bedtime.
Interaction with other drugs
Amitriptyline may increase the effects of alcohol, barbiturates and other substances that depress the central nervous system. The combined use with MAO inhibitors may result in hypertensive crisis.Because amitriptyline increases the effects of anticholinergic drugs, should avoid co-administration with them. Enhances the effect of sympathomimetics epinephrine, norepinephrine, and others., Therefore should not be used local anesthetics containing these substances, along with amitriptyline. It may reduce the antihypertensive effect of clonidine, guanethidine and betanidina. The joint appointment with neuroleptics should be borne in mind that tricyclic antidepressants and neuroleptics mutually inhibit the metabolism of each other, reducing the seizure threshold.
In an application with cimetidine may slow metabolism of amitriptyline, increasing its concentration in blood plasma and the development of toxicities.
Side effects associated with anticholinergic effects: dry and / or sweet and bitter taste in the mouth, nausea, vomiting, stomatitis, rarely – cholestatic jaundice; blurred vision, increased intraocular pressure, tachycardia, constipation and much less – urinary retention. There are usually at the beginning of treatment, and then, as a rule, are reduced. Since the cardiovascular system: tachycardia, arrhythmia, orthostatic hypotension, a violation of intracardiac conduction, recorded only on the ECG, but not manifested clinically. CNS: drowsiness, weakness, poor concentration, headaches, dizziness. These disorders often occur at the beginning of amitriptyline therapy reduced during treatment. Less often, especially when used high initial dose, may occur somnolence, confusion, state of confusion, agitation, hallucinations, extrapyramidal disorder, tremor and seizures, rare – anxiety. Allergic reactions: possible skin rash, itching. Other: trenbolone acetate results may cause nausea, increased sweating, weight gain, loss of libido. sustaject 250 sustaject