Overview
Elavil is a brand name for Amitriptyline, a tricyclic antidepressant (TCA.) It is a heterocyclic antidepressant - a class of drugs that inhibits the nerve cells' ability reuptake norepinephrine and serotonin and brings the levels of these neurotransmitters back up to normal. Elavil is very sedating.

Elavil effects may be felt after one to two weeks though some patients may take longer to feel its effects depending on the dosage and the patient. Elavil may improve sleep patterns earlier than other symptoms.

Why is this drug prescribed?
Elavil is used primarily to treat major depression (both psychotic and endogenous), especially depression associated with a sleep disturbance. Because of its sedative effects, it may be useful in treating anxiety associated with depression. Elavil should not be used for bipolar disorder (manic depression) as it may precipitate a manic episode.

Elavil may also be prescribed to treat:

1. nerve pain (neurogenic pain)
2. chronic, severe pain and pain syndromes such as ciguatera, posttherpetic neuralgia, neuropathic, and vulvodynia
3. agitation
4. chronic hiccups
5. fish (ciguatera) poisoning
6. anorexia
7. bulimia associated with depression
8. insomnia

Warnings and Precautions
Special care should be used in children under twelve years. Elavil must not be used in children under twelve except under the guidance of a child psychiatrist.

Adolescents (12-18 years old) have a stronger reaction to Elavil than do adults and may need smaller doses.

Elavil is not addictive. However, suddenly discontinuing Elavil may cause withdrawal symptoms. Dosages should be gradually tapered to minimize withdrawal. Even gradual dosage reduction may produce some withdrawal symptoms.

Elavil can cause photosensitivity and can reduce sweating which impairs the body's ability to adapt to heat. Patients should avoid saunas and other very hot environments.

Elavil can cause drowsiness and dizziness: a patient taking Elavil should not drive or operate heavy machinery until he knows that it does not impair his ability do engage in these activities.

For Pregnant or Nursing Mothers: Controlled studies have not been done in pregnant women, but there have been reports of newborns suffering from muscle spasms and heart, breathing, and urinary problems when their mothers had taken tricyclic antidepressants immediately before delivery. Animal studies show that some tricyclic antidepressants may have undesirable effects on a fetus. Tricyclic antidepressants pass into breast milk and are reported to cause drowsiness in nursing infants.

Contraindications
Elavil should not be used for people with the following medical conditions:

1. Impaired liver or kidney function — dosage may need to be lowered
2. epilepsy
3. diabetes — Elavil can affect blood glucose levels and blood sugar levels may need to be check more often than usual
4. recovering from a heart attack, or acute congestive heart failure
5. narrow-angle glaucoma
6. electroshock therapy
7. hyperthyroid
8. schizophrenia — Elavil may aggravate the condition
9. hyperactivity — Elavil may cause over stimulation
10. paranoid delusions

Adverse Reactions
Elavil may cause the following reactions:

1. drowsiness
2. dizziness
3. insomnia
4. blurred vision, dry eyes — patients who wear contacts may be especially affected
5. constipation
6. skin rash or allergy
7. dry mouth
8. photosensitivity
9. agitation
10. diarrhea
11. high blood pressure
12. hair loss
13. increased or decreased libido
14. nausea
15. sweating
16. swelling
17. weight gain or loss
18. confusion
19. worsening of paranoid psychosis in schizophrenic patients
20. seizures
21. delirium
22. delusions
23. hallucinations
24. Tourette’s syndrome
25. liver / kidney toxicity
26. heart rhythm disturbances
27. abnormally low white
28. blood cell and platelet count
29. tremors
30. nightmares

Interactions with Drugs and Other Substances
Drugs or substances that may interact with Elavil are:

1. MAO Inhibitors (within 14 days) serious, even fatal, interactions can occur when taken with Elavil
2. Vitamin C - high doses may blunt the effects of Elavil
3. all atropine like drugs, all sedative drugs, antihistamines, norepinephrine, Dilantin (phenytoin), and Coumadin (warfarin) — Elavil may increase the effects of these drugs
4. Antabuse (disulfiram) - its effects can increase if taken with Elavil and alcohol
5. Catapres (clonidine), Hylorel (guanadrel), Ismelin / Esimil (guanethidine), Primatene tablets(ephedrine) and Tenex (guanfacine) — Elavil may decrease the effects of these drugs
6. Tagamet (cimetidine), estrogens, Prozac (fluoxetine), Luvox (fluvoxamine), Normodyne (labetalol), Ritalin (methylphenidate), oral contraceptives, phenothiazines, Quinaglute (quinidine), and Zantac (ranitidine) — these drugs may increase the effects of Elavil
7. Norvir (ritonavir) and other protease inhibitors may cause toxicity when taken with Elavil
8. Stimulant drugs (such as cocaine, amphetamines, Proventil, and sutafed) — these medications can cause severe high blood pressure and/or high fever when taken with Elavil
9. Thyroid medications can increase the risk of heart rhythm disorders
10. Demerol (meperidine) can cause a lower rate of breathing when taken with Elavil
11. alcohol — when taken with Elavil can increase the intoxicating effects of alcohol and combination can depress brain function significantly; alcohol should be avoided completely
12. smoking accelerates the elimination of this drug from the body and increases the dosage required
13. barbiturate medicines for inducing sleep or treating seizures (convulsions)
14. blood thinners
15. diltiazem
16. lithium
17. medicines for anxiety or sleeping problems, such as diazepam or temazepam
18. medicines for colds and breathing difficulties
19. medicines for movement abnormalities as in Parkinson's disease, or for gastrointestinal problems
20. other medicines for mental depression
21. seizure (convulsion) or epilepsy medicine

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