Amitriptyline

Amitriptyline - a tricyclic antidepressant with sedative properties.When given at night it will help to promote sleep. It may take up to 4 weeks before any beneficial antidepressant effect is seen.

Uses:
Depression in patients requiring long-term ICU stay, particularly where
sedation is required
Difficulty with sleep
Neuropathic pain (unlicensed indication)

Contraindications:
Recent myocardial infarction
Arrhythmia
Heart block
Severe liver disease

Administration:
• Oral: depression 25–75 mg nocte
Neuropathic pain 10–25 mg at night, increased if necessary up to 75mg daily

How not to use amitriptyline:
During the daytime (disturbs the normal sleep pattern)

Adverse effects:
Antimuscarinic effects (dry mouth, blurred vision, urinary retention)
Arrhythmias
Postural hypotension
Confusion
Hyponatraemia

Cautions:
Cardiac disease (risk of arrhythmias)
Hepatic failure
Acute angle glaucoma
Avoid long-term use if patient represents a suicide risk
Concurrent use of MAOI
Additive CNS depression with other sedative agents
May potentiate direct-acting sympathomimetic drugs
Prostatic hypertrophy–urinary retention (unless patient’s bladder
catheterized)

Organ failure:
CNS: sedative effects increased
Hepatic: sedative effects increased