Tricyclic Antidepressant
TCA(Amitryptylin)
অন্যতম বহুল ব্যাবহারিত drug Amitryptylin (tryptin)
Commonly prescribe করা হয় যেসব conditions এ:
1.Depression (1st line ssri কিন্তু young patient সাথে insomnia এমন কেসে 1st line হিসেবে use করা যায়)
2.Neuropathic pain
3.Headache(Tension type /Migraine এর prophylaxis হিসেবে use করা হয়)
4.Anxiety
5.Resistant depression
6.Fibromyalgia
TCA মেইনলি যেসব সিম্পটম কে টার্গেট করে দেয়া হয়:
Depressed mood/symptoms of anxiety /somatic symptoms /chronic pain/insomnia
Usual dose:
150mg/day
Initial dose:
Tab.tryptin 25mg
0+0+1
1week পর পর 25mg করে বাড়ানো যায়।
সাধারণত রাতে দেয়া হয়। কিন্ত 75mg দিলে divided dose এ দেয়া ভাল।
কতদিন দেয়া যায়?
=অনেক দিন।No limitলিমিত। তবে সাধারণত upto symptoms subside.
off করলে taper করে off করতে হবে। না হলে withdrawal symptoms হবে।
50% dose reduction in 3 days then another 50% reduction in next 3 days.then off.
Side effect :
QT prolongation করে. intra ocuar pressure raised করে।
যাদের cardiac/arrhythmia or glucoma problem আছে TCA avoid করতে হবে।
Tablet 1:-Tryptin 25mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).
Indications of Tablet :-Tryptin 25mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).
Tryptin is indicated in-
- Depressive Illness: particularly where sedation is required.
- Nocturnal Enuresis in children.
- Prophylaxis of Migraine.
- Tension Headache.
- Chronic Pain.
Pharmacology of Tablet :-Tryptin 25mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).
The mechanism of action of this drug is not fully elucidated. It is suggested that amitriptyline inhibits the membrane pump mechanism responsible for the re-uptake of transmitter amines, such as norepinephrine and serotonin, thereby increasing their concentration at the synaptic clefts of the brain. These amines are important in regulating mood. The monoamine hypothesis in depression, one of the oldest hypotheses, postulates that deficiencies of serotonin (5-HT) and/or norepinephrine (NE) neurotransmission in the brain lead to depressive effects. This drug counteracts these mechanisms, and this may be the mechanism of amitriptyline in improving depressive symptoms. Whether its analgesic effects are related to its mood-altering activities or attributable to a different, less obvious pharmacological action (or a combination of both) is unknown.
Dosage & Administration of Tablet :-Tryptin 25mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).
Depression: Initially 75 mg (Elderly and Adolescents 30-75 mg) daily in divided doses or as a single dose at bedtime increased gradually as necessary to 150-200 mg; Child under 16 years not recommended for depression.
Nocturnal Enuresis: Child 7-10 years: 10-20 mg, 11-16 years: 25-50 mg at night; max. period of treatment (including gradual withdrawal) 3 months-full physical examination before the further course.
Prophylaxis of Migraine: 100 mg daily.
Tension Headache: 10-25 mg three times daily.
Interaction of Tablet :-Tryptin 25mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).
TCA enhances the sedative effect of alcohol and opioid analgesics. When TCA is used with Moxifloxacin or Terfenadine, it increases the risk of ventricular arrhythmias. Disulfirum and Cimetidine inhibit the metabolism of Tryptin. When TCA is used with diuretics, it enhances the risk of postural hypotension.
Contraindications of Tablet :-Tryptin 25mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).
Amitriptyline is contraindicated in myocardial infarction, arrythmias, particularly heart block of any degree, mania and severe liver disease. Initially, sedation may affect the ability to drive or operate machinery.
Side Effects of Tablet :-Tryptin 25mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).
- Anticholinergic: Excessive perspiration, dry mouth, blurred vision, hyperpyrexia, urinary retention and urinary tract dilatation.
- Cardiovascular reactions: Hypotension, syncope, postural hypotension, hypertension, tachycardia, palpitations, myocardial infarction, etc.
- CNS and Neuromuscular: Confusional states, disturbed concentration, disorientation, delusions, etc.
- Allergic: Skin rash, urticaria, photosensitization, etc.
- Haematological: Bone-marrow depression.
- Gastrointestinal: Nausea, epigastric distress, vomiting, anorexia, stomatitis, unpleasant taste, weight loss, diarrhoea, constipation, etc.
- Endocrine: Testicular swelling, gynaecomastia, breast enlargement, galactorrhoea, etc.
Pregnancy & Lactation of Tablet :-Tryptin 25mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).
Pregnancy Category C. Amitriptyline has been shown to cross the placenta. Amitriptyline should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the fetus. Amitriptyline is excreted into breast milk. Because of the potential for serious adverse reactions in nursing infants from Amitriptyline, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Therapeutic Class of Tablet :-Tryptin 25mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).
Tricyclic Anti-depressant
Digest medicine Raiyyan Tahsan Date:31-01-2025 Friday Time:-6-43-45 Pm
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