Common brand names: Elavil
Description: Amitriptyline is classified as a tricyclic antidepressant.
Dental uses: While its primary medical use is in the treatment of depression, amitriptyline also is effective in treating certain types of chronic pain, including pain around the temporomandibular joint and various types of neuropathic pains involving abnormalities of nerves in the face and mouth. Amitriptyline also improves sleep, which is beneficial to the chronic-pain sufferer.
Dosages for dental purposes: When prescribing chronic pain medications like amitriptyline, the axiom “start low and go slow” applies, to reduce side effects. The typical starting dose of amitriptyline for chronic facial pain may be as low as 10 mg at bedtime, with a gradual increase in the dose until the desired effect are achieved.
Concerns and possible side effects: While amitriptyline is considered a mood elevator, drowsiness is a common side effect. Some patients may be able to take amitripityline only at bedtime and not during the day, thereby reducing the incidence of this common side effect. Patients who experience drowsiness should not operate dangerous machinery or drive automobiles.
Other common side effects include dry mouth, constipation and dizziness on standing. Patients with narrow-angle glaucoma (increased eye pressure) should not take amitriptyline, because amitriptyline may precipitate an acute glaucoma attack in these individuals. Patients should not drink alcohol when taking amitriptyline, because the combination can lead to increased drowsiness and even unconsciousness. Certain drugs can cause amitriptyline to accumulate, leading to more side effects. These include the ulcer medications cimetidine (Tagamet) and omeprazole (Prilosec), the antifungal agents ketoconazole (Nizoral) and fluconazole (Diflucan), and the antidepressants fluoxitene (Prozac) and paroxitene (Paxil). This list is not complete, and it continues to grow. These interactions can be serious, so it is imperative to inform your dentist of all medications you are taking.
Patients taking amitriptyline or other tricyclic antidepressants (imipramine, desipramine) for medical reasons also should inform their dentist. This is because the epinephrine and levonordefrin found in many dental local anesthetic solutions sometimes interact adversely with tricyclic antidepressants, causing increases in blood pressure and disturbances in heart rhythm. Experts recommend that local anesthetic solutions containing levonordefrin not be used in patients taking tricyclic antidepressants. Epinephrine can be used in these patients, but the maximum dose should be reduced.

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