Amitriptyline Grindeks - Instructions For The Use Of Tablets, Reviews, Price

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Amitriptyline Grindeks

Amitriptyline Grindeks: instructions for use and reviews

1. 1. Release form and composition
2. 2. Pharmacological properties
3. 3. Indications for use
4. 4. Contraindications
5. 5. Method of application and dosage
6. 6. Side effects
7. 7. Overdose
8. 8. Special instructions
9. 9. Application during pregnancy and lactation
10. 10. Use in childhood
11. 11. In case of impaired renal function
12. 12. For violations of liver function
13. 13. Use in the elderly
14. 14. Drug interactions
15. 15. Analogs
16. 16. Terms and conditions of storage
17. 17. Terms of dispensing from pharmacies
18. 18. Reviews
19. 19. Price in pharmacies

Latin name: Amitriptyline Grindex

ATX code: N06AA09

Active ingredient: amitriptyline (Amitriptyline)

Manufacturer: JSC "Grindeks" (Latvia)

Description and photo update: 2019-10-07

Amitriptyline Grindeks is an antidepressant.

Release form and composition

Dosage form - film-coated tablets: round, biconvex, from light blue with a grayish tinge to blue (dosage 10 mg) or yellow (dosage 25 mg), at the site of the break - white or white with a yellowish tinge (in cell contour packs of 10 pcs., in a cardboard box 5 packs together with instructions for the use of Amitriptyline Grindeks).

Composition of 1 tablet:

• active substance: amitriptyline hydrochloride - 10 or 25 mg;
• auxiliary components: povidone (polyvinylpyrrolidone), corn starch, magnesium stearate, lactose monohydrate, silicon dioxide;
• film coating: tablets at a dosage of 10 mg - carnauba wax, Opadray II blue dye 85 F 20753 [indigo carmine (E 132), titanium dioxide (E 171), talc, macrogol PEG 3000, polyvinyl alcohol, quinoline yellow (E 104), dye crimson Ponso 4R (E 124)]; tablets at a dosage of 25 mg - carnauba wax, Opadray II yellow dye 85 F 22450 [indigo carmine (E 132), titanium dioxide (E 171), talc, macrogol PEG 3000, polyvinyl alcohol, quinoline yellow (E 104), sunset yellow dye (E 110)].

Pharmacological properties

Pharmacodynamics

Amitriptyline is a tricyclic antidepressant. It belongs to the group of non-selective inhibitors of neuronal uptake of monoamines. It has a pronounced thymoanaleptic and sedative effect.

The mechanism of the antidepressant action of Amitriptyline Grindeks is due to its ability to inhibit the reuptake of serotonin and norepinephrine by membranes of presynaptic neurons, which leads to an increase in the content of these neurotransmitters.

With prolonged use, amitriptyline reduces the functional activity of serotonin and beta-adrenergic receptors in the brain, normalizes serotonergic and adrenergic transmission, and also restores the balance of these systems, disturbed against the background of depressive conditions. In anxiety-depressive states, the drug reduces depressive manifestations, agitation and anxiety.

The antidepressant effect develops within 2-3 weeks after starting treatment with Amitriptyline Grindeks.

The drug also has m-anticholinergic blocking effect, causes blockade of α-adrenergic receptors and H ₁ -histamine receptors.

Pharmacokinetics

After oral administration from the gastrointestinal tract, the drug is absorbed quickly and to a high degree.

With _max (maximum plasma concentration) is achieved within 2-7.7 hours and is equal to 0.04-0.16 μg / ml. The bioavailability of amitriptyline is 30-60%, its main active metabolite nortriptyline is 46-70%, the effective therapeutic concentrations are 50-250 and 50-150 ng / ml, respectively.

In tissues, the concentration of amitriptyline is higher than in plasma. Plasma proteins bind 96%.

Amitriptyline and its main metabolite easily pass through histohematogenous barriers, including the blood-brain. The substance penetrates the placental barrier, as well as into breast milk, where it reaches the same concentrations as in blood plasma.

The drug is metabolized in the liver with the participation of isoenzymes CYP2C19 and CYP2D6. It is characterized by the effect of the first passage through the liver (by N-oxidation, demethylation and hydroxylation), as a result of which active (nortriptyline and 10-hydroxyamitriptyline) and inactive metabolites are formed.

The drug is excreted from the body: 80% - by the kidneys (mainly in the form of glucuronides), the remaining amount - by the intestines.

T _½ (half-life) from blood plasma of amitriptyline is 10–26 hours, nortriptyline - 18–44 hours. Complete elimination of the drug from the blood occurs within 7–14 days.

In patients with renal insufficiency, the clearance of amitriptyline metabolites decreases, which may be associated with the accumulation of the drug.

Indications for use

Amitriptyline Grindeks is used to treat endogenous depression and other depressive disorders.

Contraindications

Absolute:

• paralytic ileus;
• pyloric stenosis;
• peptic ulcer of the stomach and duodenum in the acute stage;
• severe renal or hepatic impairment;
• arrhythmia;
• blockade of intracardiac conduction (regardless of the degree);
• heart failure;
• myocardial infarction (acute and recovery periods);
• hyperplasia of the prostate;
• atony of the bladder;
• angle-closure glaucoma;
• acute alcohol intoxication;
• lactase deficiency, lactose intolerance, glucose-galactose malabsorption;
• acute intoxication with psychoactive, hypnotic or analgesic drugs;
• age up to 18 years;
• period of breastfeeding;
• simultaneous use of monoamine oxidase (MAO) inhibitors and a period of at least 14 days after their cancellation;
• hypersensitivity to any component of the drug.

Relative (Amitriptyline Grindeks tablets should be used with caution, after assessing the benefits and risks):

• schizophrenia (the use of the drug can activate psychosis);
• bipolar disorder;
• epilepsy;
• flat anterior chamber of the eye and acute angle of the chamber of the eye;
• increased intraocular pressure;
• stroke;
• diseases of the cardiovascular system (arterial hypertension, angina pectoris);
• oppression of bone marrow hematopoiesis;
• abnormal liver or kidney function;
• chronic alcoholism;
• bronchial asthma;
• hypotension of the bladder;
• hyperthyroidism;
• elderly age;
• pregnancy (especially the third trimester).

Amitriptyline Grindeks, instructions for use: method and dosage

Amitriptyline Grindeks tablets should be taken orally: swallow whole (without chewing or biting) and drink plenty of water. It is recommended to take the drug during or immediately after a meal - this will reduce the irritant effect on the gastric mucosa.

Treatment always starts with a low dose and gradually increases it depending on the individual clinical picture, while taking an increased dose is optimal in the evening or before bedtime. When carrying out maintenance therapy, the daily dose of Amitriptyline Grindeks can be taken once, preferably at bedtime.

The recommended starting dose for adults is 25 mg 2 times a day. If the effect is insufficient, the dose is increased gradually - by 25 mg every other day. The average daily dose is 75 mg, if necessary, it is increased to 150 mg. In rare cases, in a hospital setting, a daily dose of 225-300 mg is allowed.

For elderly patients, the initial recommended dose is 10 mg 2-3 times a day. The dose should be increased gradually - every other day. The maximum daily dose is 50-100 mg. In some cases, the minimum effective daily dose in elderly patients may be 10-50 mg.

After achieving a persistent antidepressant effect (usually observed after 2-4 weeks of therapy), you can gradually reduce the daily dose to the minimum effective. However, if symptoms of depression appear, you should return to the previous therapeutic dose.

If after 3-4 weeks of treatment the patient's condition does not improve, the continuation of taking Amitriptyline Grindeks is considered inappropriate.

The recommended duration of treatment is at least 6 months (this duration allows, among other things, to prevent the recurrence of depression).

If it is necessary to cancel therapy, especially with long-term treatment in high doses, Amitriptyline Grindeks is stopped gradually to avoid the development of a withdrawal syndrome.

If you miss the next dose, you should not take a double dose once, you need to wait for the next dose.

Side effects

Gradation of the side effects described below: very frequent -> 1/10, frequent - from> 1/100 to 1/1000 to 1/10 000 to <1/1000, very rare - <1/10 000:

• on the part of the psyche: very often - disorientation, confusion (in elderly patients, it can manifest itself with excitement, anxiety, elements of hallucinatory delusional disorders); infrequently - nightmares, insomnia, mania, hypomania, weakened cognitive abilities, anxiety; rarely - aggressiveness, hallucinations (in patients with schizophrenia), delirium (in the elderly); very rarely (including after the end of therapy) - suicidal thoughts and behavior;
• from the nervous system: very often - dizziness, tremors, headache, drowsiness; often - paresthesia, taste disturbance, decreased concentration of attention, extrapyramidal symptoms (slow speech, akathisia, ataxia, tardive dyskinesia, dystonic reactions, parkinsonism); infrequently - convulsions;
• on the part of the cardiovascular system: very often - orthostatic hypotension, tachycardia, palpitations; often - a decrease in blood pressure (BP), atrioventricular (AV) blockade, violation of intraventricular conduction [changes in the parameters of the electrocardiogram (ECG): signs of bundle branch blockade, expansion of the QRS complex, increase in QT and PQ intervals, nonspecific changes in the ST interval or T wave, including in patients without heart disease]; infrequently - increased blood pressure, arrhythmia; rarely - myocardial infarction;
• from the digestive system: very often - nausea, dry mouth, constipation; often - a burning sensation in the mouth, inflammation of the oral cavity, gum atrophy, dental caries; infrequently - diarrhea, swelling of the tongue, vomiting; rarely - an increase in the salivary glands, intestinal obstruction, impaired liver function, cholestatic jaundice, hepatitis;
• on the part of metabolism: very often - increased appetite, weight gain; rarely - decreased appetite; very rarely - syndrome of inadequate hypersecretion of antidiuretic hormone;
• from the urinary system: often - urinary retention;
• on the part of the reproductive system: very often - strengthening or weakening of sexual desire; often in men - erectile dysfunction and impotence; rarely in men - delayed ejaculation, testicular edema, gynecomastia; rarely in women - loss of the ability to achieve orgasm, delayed orgasm, galactorrhea;
• on the part of the hematopoietic organs: rarely - thrombocytopenia, leukopenia, eosinophilia, agranulocytosis, inhibition of bone marrow functions;
• from the senses: very often - violation of accommodation, decreased visual acuity; often - mydriasis; infrequently - increased intraocular pressure, tinnitus; rarely - loss of the ability to accommodate, aggravation of narrow-angle glaucoma in the elderly;
• on the part of the skin: very often - hyperhidrosis; infrequently - urticaria, skin rash, angioedema; rarely - photosensitivity reactions, alopecia;
• laboratory indicators: rarely - deviation from the norm of liver function tests, increased activity of hepatic transaminases and alkaline phosphatase.

Some of these adverse reactions (decreased concentration, tremors, decreased libido, constipation, headache) can also be symptoms of depression. Typically, these symptoms diminish or disappear completely as the depressed patient improves.

Post-marketing studies reported on the development of lupus-like syndrome (migratory arthritis, positive rheumatoid factor, the appearance of antinuclear antibodies), but the relationship of its occurrence with the use of Amitriptyline Grindeks has not been established.

Epidemiological studies, carried out mainly in patients over 50 years of age, revealed an increased risk of bone fractures during therapy with selective serotonin reuptake inhibitors and tricyclic antidepressants. The mechanism of action that increases this risk is unknown.

In case of abrupt cessation of therapy, withdrawal syndrome may occur: malaise, headache, unusual dreams, sleep disturbances, irritability, restlessness, agitation, poor general health, diarrhea, nausea, vomiting. These disorders are not symptoms of drug dependence.

Overdose

Symptoms of an Amitriptyline Grindeks overdose may occur suddenly or develop slowly. In the first hours, hallucinations, agitation or drowsiness are usually observed and symptoms due to the anticholinergic action of amitriptyline, such as dry mucous membranes, urinary retention, mydriasis, weakening of intestinal motility, tachycardia. In some patients, body temperature rises, convulsions appear. In the future, it is possible to suppress the functions of the central nervous system (CNS), impairment of consciousness (up to coma), and respiratory failure. Ataxia, hypokalemia, metabolic acidosis are also possible.

The following disorders of the cardiovascular system may occur: arterial hypotension, arrhythmia (ventricular tachyarrhythmia, ventricular fibrillation and flutter), heart failure, cardiogenic shock. Characteristic changes on the ECG are: ST segment depression, lengthening of the QT and PR interval, flattening or inversion of the T wave, expansion of the QRS complex, varying degrees of intracardiac conduction blockade, which can cause cardiac arrest. A case of lethal arrhythmia occurred 56 hours after taking an excessive dose of the drug.

Overdose reactions can vary significantly from patient to patient. Children are particularly prone to the development of seizures and cardiotoxic events. In adults, moderate and severe intoxication occurs when taking 500 mg of amitriptyline, taking a dose of about 1000 mg is fatal.

In case of taking an excessive dose of Amitriptyline Grindeks, the patient should be immediately taken to the hospital. The first therapeutic measures are gastric lavage and the intake of activated charcoal (20-30 g every 4-6 hours during the first 1-2 days after poisoning). The patient should be under constant close supervision, even in seemingly uncomplicated cases. Shows control of the level of consciousness, blood pressure, respiration and heart rate (HR), gas and electrolyte content in the blood. To avoid respiratory arrest, ensure airway patency through mechanical ventilation. ECG monitoring should continue for 3-5 days.

With ventricular arrhythmias, widening of the QRS complex, and heart failure, a shift in the blood pH level to the alkaline side (for example, hyperventilation or sodium solution) and rapid administration of hypertonic sodium chloride solution (100-200 mmol Na ⁺) can be effective. In case of ventricular arrhythmias, traditional antiarrhythmic drugs can be prescribed, for example, lidocaine (1–1.5 mg / kg) intravenously with further infusion at a rate of 1–3 mg / min. Defibrillation and cardioversion are used if required. Circulatory insufficiency is corrected by the introduction of plasma substitutes, in severe cases - by dobutamine infusions (with an initial rate of 0.002-0.003 mg / min with a further increase in the dose depending on the severity of the effect).

For metabolic acidosis, standard therapy is performed. Excitement and convulsions are stopped with diazepam.

Dialysis is ineffective because the concentration of amitriptyline in the blood is low.

special instructions

Prior to the appointment of Amitriptyline Grindeks and periodically during treatment, blood pressure should be monitored (with labile or low blood pressure, the decrease can occur to a greater extent), with prolonged therapy - the functions of the cardiovascular system and liver.

In high doses, the drug increases the risk of severe arterial hypotension and cardiac arrhythmias. In patients with heart disease, these conditions can occur with usual doses.

The risk of a drop in blood pressure and the development of arrhythmias increases with the simultaneous use of local or general anesthetics.

The likelihood of developing cardiac arrhythmias increases in patients with thyrotoxicosis and patients receiving thyroid hormones, therefore, antidepressant treatment should be carried out with caution.

During the period of taking amitriptyline, the use of alcoholic beverages should be excluded.

Patients taking Amitriptyline Grindeks should be careful when abruptly changing the lying position or sitting to an upright position.

There are known cases of the development of agranulocytosis during therapy, therefore, it is recommended to monitor peripheral blood parameters, especially with an increase in body temperature, tonsillitis or flu-like symptoms.

In the treatment of the depressive component of schizophrenia, amitriptyline can aggravate psychotic symptoms, therefore it is advisable to prescribe it in conjunction with antipsychotics.

Amitriptyline Grindeks, due to the anticholinergic effect, can reduce lacrimation and relatively increase the amount of mucus in the lacrimal fluid, which may damage the corneal epithelium in persons who use contact lenses.

Other m-anticholinergics, when used simultaneously, can enhance the m-anticholinergic effect of Amitriptyline Grindeks.

In high doses (more than 150 mg per day), an antidepressant reduces the threshold of seizure activity, which increases the risk of developing epileptic seizures in predisposed patients and patients with other risk factors, such as brain damage of any etiology, simultaneous use of antipsychotics, a period of ethanol withdrawal (with chronic alcoholism), withdrawal of drugs with an anticonvulsant effect (for example, benzodiazepines).

In patients with the depressive phase of bipolar disorder, the drug can cause the development of manic or hypomanic states. In this case, a temporary dose reduction is required until the relief of these disorders, after which the treatment can be resumed at low doses. Some patients require the cancellation of Amitriptyline Grindeks.

In combination with electroconvulsive therapy, the drug can only be prescribed with close medical supervision.

Treatment should be suspended before elective surgery. If emergency surgery is required, the anesthesiologist should be warned about taking an antidepressant.

In predisposed individuals and the elderly, Amitriptyline Grindeks can cause drug psychosis (more often at night). After discontinuation of therapy for several days, the violation disappears.

The drug can cause paralytic intestinal obstruction. The most prone to this is the elderly, immobilized and patients with chronic constipation.

Amitriptyline Grindeks is able to alter glucose and insulin tolerance, therefore, patients with diabetes mellitus may require correction of antidiabetic therapy. It should be borne in mind that depressive states can also affect glucose metabolism.

There are known cases of hyperpyrexia (fever with an extremely high body temperature above 41 ° C) in patients receiving tricyclic antidepressants in combination with antipsychotics or anticholinergics, especially in hot weather.

The tablets contain dyes that can provoke the development of allergic reactions.

Taking an antidepressant can be accompanied by dry mouth, which can cause changes in the oral mucosa, a burning sensation, the development of inflammation and dental caries. It is necessary to warn the dentist about taking Amitriptyline Grindeks and to be monitored regularly. The need for riboflavin may increase.

It is recommended to avoid the simultaneous use of hypnotics and antipsychotics. If the combination is clinically justified, extreme caution should be exercised.

Suicidal thoughts and attempts

Any depression in itself is associated with an increased risk of suicide, which persists until significant remission and may spontaneously occur throughout the course of treatment. The antidepressant effect of Amitriptyline Grindeks develops after a few weeks of regular administration of the drug, therefore, all patients should be closely monitored in order to identify changes or violations of behavior and suicidal tendencies in time.

With severe depression, the risk of suicidal actions is highest, therefore, at the initial stage of therapy, it may be advisable to prescribe Amitriptyline Grindeks in combination with antipsychotics or drugs from the benzodiazepine group. More careful monitoring is required.

Patients with a history of suicidal thoughts / attempts should be closely monitored. In such cases, proxies (guardians) should be instructed to store the drug and dispense it to the patient to prevent abuse.

There was an increased likelihood of suicide in patients under 24 years of age with antidepressant therapy. The appointment of Amitriptyline Grindeks is possible only after a thorough assessment of the expected benefits of treatment and the possible risk of suicide. In short-term studies, this risk was not increased in people over 24 years old, and in people over 65 years old, it decreased slightly.

Influence on the ability to drive vehicles and complex mechanisms

During the entire period of taking Amitriptyline Grindeks, it is prohibited to drive vehicles and engage in other potentially hazardous activities, which require quick reactions and increased concentration of attention.

Application during pregnancy and lactation

Experimental studies have shown that amitriptyline has an adverse effect on the fetus. However, strictly controlled clinical trials have not been conducted. In this regard, Amitriptyline Grindeks is used during pregnancy only in cases where the expected benefit from antidepressant therapy is definitely higher than the potential risk.

In the third trimester of pregnancy, the drug cannot be prescribed, except in cases of absolute necessity. In high doses, tricyclic antidepressants can have a negative effect on the newborn, including impairment of neurological functions and behavior. Drowsiness and urinary retention have been reported in newborns whose mothers received the drug immediately before delivery.

In cases where a woman in the third trimester takes Amitriptyline Grindeks, the drug should be gradually canceled, starting to reduce the dose at least 7 weeks before the expected date of birth, this will avoid the development of withdrawal syndrome in the newborn child (shortness of breath, drowsiness, increased nervous irritability, intestinal colic, decrease or increase in blood pressure, spasticity, tremor).

Amitriptyline is excreted in mother's milk and may cause drowsiness in the baby. If treatment with the drug during lactation is necessary for the mother, breastfeeding should be discontinued.

Pediatric use

Amitriptyline Grindeks is not recommended for use in pediatric patients, since the efficacy and safety in children and adolescents under 18 have not been established.

With impaired renal function

Amitriptyline Grindeks is contraindicated in severe renal failure. For mild and moderate renal impairment, it should be used with caution, no dosage adjustment is needed.

For violations of liver function

Amitriptyline Grindeks is contraindicated in severe hepatic failure. In case of mild and moderate violations of liver function, it should be used with caution, it is recommended to periodically determine the concentration of the drug in the blood serum.

Use in the elderly

Treatment of elderly patients should be carried out under intensive monitoring of ECG, blood pressure and heart rate. On the ECG, minor changes are permissible (moderate expansion of the QRS complex, nonspecific changes in the T wave or ST interval). Therapy should be started with a minimum dose and increased gradually to prevent the development of hypomania, delirious disorders, or other complications.

Drug interactions

When Amitriptyline Grindeks is combined with other antidepressants (including other classes), there is a synergistic effect, therefore, when combined, serious side effects may develop, including serotonin syndrome. If it is necessary to transfer a patient from one psychotropic drug to another, it is recommended to maintain a free period from admission.

Amitriptyline enhances the effect on the central nervous system of the following drugs: neuroleptics, narcotic and central analgesics, anesthetics, anticonvulsants, hypnotics and sedatives, ethanol. With alcohol consumption, it is also possible to develop a hypotensive effect and respiratory depression.

Amitriptyline, like other tricyclic antidepressants, is metabolized in the liver with the participation of the CYP2D6 isoenzyme of the cytochrome P _{450 system}. Also, isoenzymes CYP3A and CYP2C19 are involved in the metabolism of the drug.

The isoenzyme CYP2D6 can inhibit various psychotropic drugs, including serotonin reuptake inhibitors (with the exception of citalopram, which is a very weak inhibitor), antipsychotics, β-blockers, antiarrhythmic drugs (esmolol, propafenone, phenytoin, amiodarone, they are capable of procainamide) inhibit the metabolism of amitriptyline and significantly increase its plasma concentration.

Amitriptyline Grindeks is contraindicated for use in combination with MAO inhibitors, since in this case the risk of developing serotonin syndrome increases (spasms with excitement, myoclonus, an increase in the frequency of periods of hyperpyrexia, hypertensive crises, delirium, severe convulsions, coma, death). Amitriptyline can be started no earlier than 2 weeks after the cancellation of irreversible non-selective MAO inhibitors, at least one day after the end of the reversible inhibitor moclobemide. MAO inhibitors are allowed to be taken at least 2 weeks after the cancellation of Amitriptyline Grindeks. In all cases, drug treatment should begin with small doses with a gradual increase, depending on the effect.

Combinations not recommended:

• antifungal agents (terbinafine, fluconazole, etc.): the concentration of amitriptyline in the blood serum increases, which leads to an increase in its toxicity, manifested, inter alia, by fainting, flutter and ventricular fibrillation;
• sympathomimetics (ephedrine, dopamine, adrenaline, norepinephrine, phenylephrine), including in the form of nasal drops: their effect on the cardiovascular system is enhanced;
• lithium carbonate: its toxicity increases, which is manifested by tremors, tonic-clonic seizures, hallucinations, mismatched thinking, difficulty remembering, the development of neuroleptic malignant syndrome;
• adrenergic blockers (reserpine, clonidine, methyldopa, betanidine, guanethidine): their antihypertensive action may be weakened;
• M-anticholinergics (for example, atropine, biperiden, antiparkinsonian drugs, phenothiazine derivatives, blockers of H ₁ -histamine receptors): their negative effect on the central nervous system, organs of vision, bladder and intestines is enhanced. Phenothiazine derivatives, in addition, increase the risk of developing neuroleptic malignant syndrome;
• drugs that can prolong the QT interval, such as sotalol, chloral hydrate, antiarrhythmics (eg, quinidine), some antipsychotics (pimozide, sertindole), H ₁ -histamine receptor blockers (eg terfenadine, astemizole), anesthetics (droperidol, isoflurane): the risk of developing ventricular arrhythmias increases.

Combinations requiring caution:

• sucralfate: absorption of amitriptyline decreases and, as a result, its antidepressant effect may decrease;
• inducers of microsomal liver enzymes (oral contraceptives, barbiturates, rifampicin, nicotine, phenytoin, rifampicin, carbamazepine): the metabolism of amitriptyline increases, its concentration in the blood decreases, which weakens the antidepressant effect;
• blockers of slow calcium channels, methylphenidate, cimetidine: the plasma concentration of amitriptyline increases, which is fraught with increased toxicity;
• antipsychotics: there is a mutual suppression of metabolism, as a result of which a decrease in the seizure threshold and the development of seizures is possible (a dose adjustment of both drugs may be required);
• drugs affecting the activity of cytochrome P ₄₅₀ isoenzymes: a change in the metabolism of amitriptyline is possible, which causes significant fluctuations in its concentration in blood plasma;
• drugs that depress the central nervous system (strong analgesics, sedatives and hypnotics): inhibition of central nervous system functions may increase. Their combined use with amitriptyline should be avoided. If the appointment is necessary, special care is required;
• fluvoxamine, fluoxetine: the plasma concentration of amitriptyline increases (if necessary, its dose should be reduced by 50%);
• estrogen-containing oral contraceptives: increases the bioavailability of amitriptyline;
• disulfiram and other acetaldehydrogenase inhibitors: high risk of developing delirium;
• phenytoin: the risk of inhibiting its metabolism and increasing toxic effects (tremor, hyperreflexia, ataxia, nystagmus) increases. When taken together, the plasma concentration of phenytoin and the therapeutic effect of amitriptyline should be monitored, if necessary, the dose of the latter should be increased;
• valproic acid: the clearance of amitriptyline from blood plasma decreases, which is fraught with an increase in the concentration of both amitriptyline itself and its metabolite nortriptyline (their content in the blood should be monitored, if necessary, the dose of Amitriptyline Grindeks should be reduced);
• anticoagulants (coumarin derivatives): their effect may be enhanced;
• St. John's wort preparations: decrease the C _max and AUC (area under the concentration-time curve) of amitriptyline by about 20% (when using this combination, the concentration of amitriptyline should be carefully monitored and its dose adjusted);
• thyroid hormones: there is a mutual strengthening of the effects of both drugs, including side effects (stimulating effect on the central nervous system, development of cardiac arrhythmias);
• medicines for the treatment of thyrotoxicosis: the risk of developing agranulocytosis increases;
• glucocorticosteroids: may increase the depression caused by them;
• hematotoxic drugs: possibly increased hematotoxicity;
• cocaine: the risk of developing cardiac arrhythmias increases.

Analogs

The analogs of Amitriptyline Grindeks are: Adepress, Azafen MV, Alventa, Pram, Aleval, Aktaparoxetine, Asentra, Valdoxan, Velaxin, Duloxenta, Dapfix, Ixel, Clomipramine, Melipramine, Noxibel, Paxil, Paroxetteron, Serftco, Rem, Rem Fevarin, Fluoxetine, Citalopram, Eisipe, Elicea, Ephevelon, etc.

Terms and conditions of storage

Store in a dry, dark place, out of reach of children, at a temperature not exceeding 25 ° C.

Shelf life is 4 years.

Terms of dispensing from pharmacies

Dispensed by prescription.

Reviews of Amitriptyline Grindeks

According to reviews, Amitriptyline Grindeks is an effective antidepressant and sedative. However, to achieve the desired therapeutic effect, the drug must be taken for a long time, since the effect develops only 3 weeks after the start of the drug. Separately, they note the small size of the tablets (easy to swallow) and the budgetary cost in comparison with most similar products.

At the same time, there are reports of the development of side effects in the form of drowsiness, lethargy, headaches, dizziness, and weakness. For many, these disorders disappeared as treatment continued, but in some patients the symptoms persisted even when taking the drug at night, so they had to see a doctor to change therapy.

The price of Amitriptyline Grindeks in pharmacies

The approximate price of Amitriptyline Grindeks at a dosage of 10 mg is 46–55 rubles. per pack of 50 tablets. You can buy tablets in a dosage of 25 mg (50 pieces per pack) for 48–57 rubles.

Maria Kulkes Medical journalist About the author

Education: First Moscow State Medical University named after I. M. Sechenov, specialty "General Medicine".

Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!