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Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z


Amitriptyline and nortriptyline

What are amitriptyline and nortriptyline?

Amitriptyline and nortriptyline are tricyclic medicines that were once widely used as antidepressants before being replaced by newer antidepressant medications with better side effect profiles. Other uses of amitriptyline and nortriptyline include the treatment of insomnia, enuresis and chronic pain syndromes such as fibromyalgia.

The tricyclic antidepressants are finding a place in the treatment of chronic pain and itch associated with some dermatological conditions.

What are amitriptyline and nortriptyline used for?

Amitriptyline and nortriptyline are useful in reducing the symptoms of chronic pain in the following skin conditions:

Pain arising from these conditions is defined as sympathetically maintained pain (SMP). The pain is usually described as having a burning sensation and is often in response to stimuli that does not ordinarily cause pain. This pain originates from the nervous system. Amitriptyline appears to be effective in reducing this type of neuropathic pain in doses lower than those used to treat depression.

Tricyclic medications may reduce the pain of chronic ulcers including:

Amitriptyline and nortriptyline are sometimes successfully prescribed for pruritus (itch), especially when this is of neuropathic origin:

Tricyclic medication has some antihistamine H1 blocking activity and may be useful in the treatment of urticaria even when conventional antihistamines have failed.

Dosage of tricyclic medications

Patients are usually started on a low dose of 5-10mg daily, taken at night to minimise side effects. This is gradually increased to a maximum daily dose of 50-150 mg, depending on the response and tolerability of side effects by the patient. Patients need to be warned that pain/itch relief is not immediate as it may take several weeks for the drug to become fully effective.

Side effects of tricyclic medications

The side effects of amitriptyline and nortriptyline include:

These effects may occur in up to 50% of patients and elderly patients are at greater risk. Intolerance of these effects often leads to discontinuation of the drug. Other tricyclic antidepressants such as desipramine and nortriptyline may be better tolerated than amitriptyline.

It may be dangerous to take a tricyclic medicine with a monoamine oxidase inhibitor (MAOI) antidepressant medication or within 14 days of discontinuing a MAOI. Adverse effects are likely to be worse with alcohol.

Tricyclic medications may not be suitable for people with certain medical conditions or taking certain medications such as anticholinergic agents. Tell your doctor if you have had any of the following health problems:

It may be wise to under an electrocardiograph prior to treatment and have this repeated after a few weeks on amitriptyline. Amitriptyline and nortriptyline are dangerous in overdose.

Related information

On DermNet NZ:

Other websites:

Author: Vanessa Ngan, staff writer

Note:

The New Zealand approved datasheet is the official source of information for this prescription medicine, including approved uses and risk information. Check the New Zealand datasheet on the Medsafe website.

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If you have any concerns with your skin or its treatment, see a dermatologist for advice.