Amitriptyline

INTRODUCTION

Indications

Depression. Unlabeled Use: Anxiety, insomnia, treatment-resistant depression. Chronic pain syndromes (i.e., fibromyalgia, neuropathic pain/chronic pain, headache, low back pain).

Action

Potentiates the effect of serotonin and norepinephrine in the CNS. Has significant anticholinergic properties. Therapeutic Effects: Antidepressant action.

Adverse Reactions/Side Effects

CNS: lethargy, sedation. EENT: blurred vision, dry eyes, dry mouth. CV: ARRHYTHMIAS, hypotension, ECG changes. GI: constipation, hepatitis, paralytic ileus, increased appetite, weight gain. GU: urinary retention, ↓ libido. Derm: photosensitivity. Endo: changes in blood glucose, gynecomastia. Hemat: blood dyscrasias.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess heart rate, ECG, and heart sounds, especially during exercise (see Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Be alert for increased depression and suicidal thoughts and ideology, especially when initiating drug treatment or in children and teenagers. Notify physician or mental health professional immediately if patient exhibits worsening depression or other changes in mood and behavior.

• If used to treat chronic pain, assess pain levels periodically to help determine drug efficacy.

• Measure blood pressure periodically, and compare to normal values (see Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

• Watch for signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias. Report these signs to the physician.

• Monitor signs of hypoglycemia (weakness, malaise, irritability, fatigue) or hyperglycemia (drowsiness, fruity breath, increased urination, unusual thirst). Patients with diabetes mellitus should check blood glucose levels frequently.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight gain or increased body fat.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth), and implement fall prevention strategies (See Appendix E).

• Because of the risk of cardiac arrhythmias, use caution during aerobic exercise and endurance conditioning. Advise patient to also report any signs of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

• Help patient explore nonpharmacologic methods to reduce depression (exercise, counseling, support groups, and so forth).

• If treating neuropathic pain or other pain syndromes, implement appropriate interventions (physical agents, manual techniques, therapeutic exercise) to manage pain and reduce the need for drug therapy. Help patient also explore other non-pharmacologic methods to reduce chronic pain (relaxation techniques, imagery, counseling, and so forth).

• Causes photosensitivity; use ...