زائر
amitiptyine hydhide
(a meetip'tieen)
Eavi, evate (AN), Nvtiptyn (AN)
Pegnany ategy
Dg ass
Tiyi antidepessant (TA; tetiay amine)
Theapeti atins
Mehanism f atin nknwn; TAs inhibit the eptake f the netansmittes nepinephine and setnin, eading t an inease in thei effets; antihinegi at NS and peiphea eepts; sedative.
Indiatins
· eief f symptms f depessin (endgens mst espnsive); sedative effets may hep when depessin is assiated with anxiety and seep distbane.
· nabeed ses: nt f hni pain (eg, intatabe pain f ane, peiphea nepathies, psthepeti neagia, ti dex, enta pain syndmes); peventin f nset f ste and migaine headahes; teatment f pathgi weeping and aghing senday t febain disease (de t mtipe sesis)
ntaindiatins and atins
· ntaindiated with hypesensitivity t any tiyi dg; nmitant theapy with an MA inhibit; eent MI; myegaphy within pevis 24 h sheded within 48 h; atatin.
· se atisy with eetshk theapy; peexisting V disdes (sevee nay heat disease, pgessive heat faie, angina petis, paxysma tahyadia); ange-se gama, ineased intaa pesse, inay etentin, etea etha spasm; seize disdes; hypethyidism; impaied hepati, ena fntin; psyhiati patients (shizpheni paanid patients may exhibit a wsening f psyhsis with TA theapy); mani-depessive patients; eetive sgey (disntine as ng as pssibe befe sgey).
Avaiabe fms
Injetin--10 mgm; tabets--10, 25, 50, 75, 100, 150 mg
Dsages
May be given IM if patients ae nabe nwiing t take a dg. Swith t a dg as sn as pssibe.
ADTS
· Depessin, hspitaized patients: Initiay, 100 mgday P in divided dses: gaday inease t 200–300 mgday as eqied. May be given IM 20–30 mg qid, initiay ny in patients nabe nwiing t take dg P. epae with a mediatin as sn as pssibe.
· tpatients: Initiay, 75 mgday P, in divided dses; may inease t 150 mgday. Ineases shd be made in ate aftenn hs. Tta daiy dsage may be administeed hs. Initiate singe daiy dse theapy with 50–100 mg hs; inease by 25–50 mg as neessay t a tta f 150 mgday. Maintenane dse is 40–100 mgday, whih may be given as a singe bedtime dse. Afte satisfaty espnse, ede t west effetive dsage. ntine theapy f 3 m nge t essen pssibiity f eapse.
· hni pain: 75–150 mgday P.
· Peventin f stemigaine headahes: 50–150 mgday P.
· Peventin f weeping in MS patients with febain disease: 25–75 mg P.
PEDIATI PATIENTS
Nt emmended in hiden < 12 y.
HIDEN > 12 Y AND GEIATI PATIENTS
10 mg tid P with 20 mg hs
Phamakinetis
te
nset
Peak
Datin
a
Vaies
2–4 h
2–4 wk
Metabism: Hepati; T12: 10–50 h
Distibtin: sses paenta; passes int beast mik
Exetin: ine
Advese effets
· NS: Sedatin and antihinegi (atpine-ike) effets, nfsin (espeiay in edey), distbed nentatin, hainatins, disientatin, deeased memy, feeings f neaity, desins, anxiety, nevsness, estessness, agitatin, pani, insmnia, nightmaes, hypmania, mania, exaebatin f psyhsis, dwsiness, weakness, fatige, headahe, nmbness, tinging, paesthesias f extemities, indinatin, mt hypeativity, akathisia, ataxia, tems, peiphea nepathy, extapyamida symptms, seizes, speeh bkage, dysathia, tinnits, ateed EEG
· V: thstati hyptensin, hypetensin, synpe, tahyadia, papitatins, MI, ahythmias, heat bk, peipitatin f HF, stke
· Endine: Eevated depessed bd sga, eevated patin eves, inapppiate ADH seetin
· GI: Dy mth, nstipatin, paayti ies, nasea, vmiting, anexia, epigasti distess, diahea, fatene, dysphagia, peia taste, ineased saivatin, stmatitis, gssitis, patid sweing, abdmina amps, bak tnge, hepatitis, jandie (ae), eevated tansaminase, ateed akaine phsphatase
· G: inay etentin, deayed mititin, diatin f the inay tat, gynemastia, testia sweing; beast enagement, mensta iegaity and gaathea; ineased deeased ibid; imptene
· Hematgi: Bne maw depessin, inding aganytsis; esinphiia, ppa, thmbytpenia, ekpenia
· Hypesensitivity: ash, pits, vasitis, petehiae, phtsensitizatin, edema (geneaized, fae, tnge), dg feve
· Withdawa: Symptms n abpt disntinatin f pnged theapy: nasea, headahe, vetig, nightmaes, maaise
· the: Nasa ngestin, exessive appetite, weight hange; sweating, apeia, aimatin, hypethemia, fshing, his
Inteatins
Dg-dg
· Ineased TA eves and phamagi (espeiay antihinegi) effets with imetidine, fxetine
· Ineased TA eves with methyphenidate, phenthiazines, a ntaeptives, disfiam
· Hypepyeti ises, sevee nvsins, hypetensive episdes and deaths with MA inhibits, fazidne
· Ineased antidepessant espnse and adia ahythmias with thyid mediatin
· Ineased deeased effets with estgens
· Deiim with disfiam
· Sympatheti hypeativity, sins tahyadia, hypetensin, agitatin with evdpa
· Ineased bitansfmatin f TAs in patients wh smke igaettes
· Ineased sympathmimeti (espeiay beta-adenegi) effets f diet-ating sympathmimeti dgs (nepinephine, epinephine)
· Ineased antihinegi effets f antihinegi dgs (inding antihinegi antipakisnian dgs)
· Ineased espnse (espeiay NS depessin) t babitates
· Deeased antihypetensive effet f ganethidine, nidine, the antihypetensives
· Deeased effets f indiet-ating sympathmimeti dgs (ephedine)
Nsing nsideatins
Assessment
· Histy: Hypesensitivity t any tiyi dg; nmitant theapy with an MA inhibit; eent MI; myegaphy within pevis 24 h sheded within 48 h; atatin; EST; peexisting V disdes; ange-se gama, ineased intaa pesse, inay etentin, etea etha spasm; seize disdes; hypethyidism; impaied hepati, ena fntin; psyhiati patients; mani-depessive patients; eetive sgey
· Physia: Weight; T; skin , esins; ientatin, affet, efexes, visin and heaing; P, BP, thstati BP, pefsin; bwe snds, nma tpt, ive evaatin; ine fw, nma tpt; sa sexa fntin, feqeny f menses, beast and sta exam; ive fntin tests, inaysis, B, EG
Inteventins
· estit dg aess f depessed and ptentiay siida patients.
· Give IM ny when a theapy is impssibe.
· D nt administe IV.
· Administe maj ptin f dse at bedtime if dwsiness, sevee antihinegi effets (nte that the edey may nt teate singe daiy dse theapy).
· ede dsage if min side effets devep; disntine if seis side effets .
· Aange f B if patient deveps feve, se that, the sign f infetin.
Teahing pints
· Take dg exaty as pesibed; d nt stp abpty witht nsting heath ae pvide.
· Avid sing ah, the seep-inding dgs, T dgs.
· Avid pnged expse t snight snamps; se a snseen ptetive gaments.
· These side effets may : headahe, dizziness, dwsiness, weakness, bed visin (evesibe; if sevee, avid diving and tasks eqiing aetness whie these pesist); nasea, vmiting, ss f appetite, dy mth (sma, feqent meas, feqent mth ae, and sking sgaess andies may hep); nightmaes, inabiity t nentate, nfsin; hanges in sexa fntin.
· ept dy mth, diffity in inatin, exessive sedatin.
Advese effets in Itai ae mst mmn; thse in Bd ae ife-theatening.
(a meetip'tieen)
Eavi, evate (AN), Nvtiptyn (AN)
Pegnany ategy
Dg ass
Tiyi antidepessant (TA; tetiay amine)
Theapeti atins
Mehanism f atin nknwn; TAs inhibit the eptake f the netansmittes nepinephine and setnin, eading t an inease in thei effets; antihinegi at NS and peiphea eepts; sedative.
Indiatins
· eief f symptms f depessin (endgens mst espnsive); sedative effets may hep when depessin is assiated with anxiety and seep distbane.
· nabeed ses: nt f hni pain (eg, intatabe pain f ane, peiphea nepathies, psthepeti neagia, ti dex, enta pain syndmes); peventin f nset f ste and migaine headahes; teatment f pathgi weeping and aghing senday t febain disease (de t mtipe sesis)
ntaindiatins and atins
· ntaindiated with hypesensitivity t any tiyi dg; nmitant theapy with an MA inhibit; eent MI; myegaphy within pevis 24 h sheded within 48 h; atatin.
· se atisy with eetshk theapy; peexisting V disdes (sevee nay heat disease, pgessive heat faie, angina petis, paxysma tahyadia); ange-se gama, ineased intaa pesse, inay etentin, etea etha spasm; seize disdes; hypethyidism; impaied hepati, ena fntin; psyhiati patients (shizpheni paanid patients may exhibit a wsening f psyhsis with TA theapy); mani-depessive patients; eetive sgey (disntine as ng as pssibe befe sgey).
Avaiabe fms
Injetin--10 mgm; tabets--10, 25, 50, 75, 100, 150 mg
Dsages
May be given IM if patients ae nabe nwiing t take a dg. Swith t a dg as sn as pssibe.
ADTS
· Depessin, hspitaized patients: Initiay, 100 mgday P in divided dses: gaday inease t 200–300 mgday as eqied. May be given IM 20–30 mg qid, initiay ny in patients nabe nwiing t take dg P. epae with a mediatin as sn as pssibe.
· tpatients: Initiay, 75 mgday P, in divided dses; may inease t 150 mgday. Ineases shd be made in ate aftenn hs. Tta daiy dsage may be administeed hs. Initiate singe daiy dse theapy with 50–100 mg hs; inease by 25–50 mg as neessay t a tta f 150 mgday. Maintenane dse is 40–100 mgday, whih may be given as a singe bedtime dse. Afte satisfaty espnse, ede t west effetive dsage. ntine theapy f 3 m nge t essen pssibiity f eapse.
· hni pain: 75–150 mgday P.
· Peventin f stemigaine headahes: 50–150 mgday P.
· Peventin f weeping in MS patients with febain disease: 25–75 mg P.
PEDIATI PATIENTS
Nt emmended in hiden < 12 y.
HIDEN > 12 Y AND GEIATI PATIENTS
10 mg tid P with 20 mg hs
Phamakinetis
te
nset
Peak
Datin
a
Vaies
2–4 h
2–4 wk
Metabism: Hepati; T12: 10–50 h
Distibtin: sses paenta; passes int beast mik
Exetin: ine
Advese effets
· NS: Sedatin and antihinegi (atpine-ike) effets, nfsin (espeiay in edey), distbed nentatin, hainatins, disientatin, deeased memy, feeings f neaity, desins, anxiety, nevsness, estessness, agitatin, pani, insmnia, nightmaes, hypmania, mania, exaebatin f psyhsis, dwsiness, weakness, fatige, headahe, nmbness, tinging, paesthesias f extemities, indinatin, mt hypeativity, akathisia, ataxia, tems, peiphea nepathy, extapyamida symptms, seizes, speeh bkage, dysathia, tinnits, ateed EEG
· V: thstati hyptensin, hypetensin, synpe, tahyadia, papitatins, MI, ahythmias, heat bk, peipitatin f HF, stke
· Endine: Eevated depessed bd sga, eevated patin eves, inapppiate ADH seetin
· GI: Dy mth, nstipatin, paayti ies, nasea, vmiting, anexia, epigasti distess, diahea, fatene, dysphagia, peia taste, ineased saivatin, stmatitis, gssitis, patid sweing, abdmina amps, bak tnge, hepatitis, jandie (ae), eevated tansaminase, ateed akaine phsphatase
· G: inay etentin, deayed mititin, diatin f the inay tat, gynemastia, testia sweing; beast enagement, mensta iegaity and gaathea; ineased deeased ibid; imptene
· Hematgi: Bne maw depessin, inding aganytsis; esinphiia, ppa, thmbytpenia, ekpenia
· Hypesensitivity: ash, pits, vasitis, petehiae, phtsensitizatin, edema (geneaized, fae, tnge), dg feve
· Withdawa: Symptms n abpt disntinatin f pnged theapy: nasea, headahe, vetig, nightmaes, maaise
· the: Nasa ngestin, exessive appetite, weight hange; sweating, apeia, aimatin, hypethemia, fshing, his
Inteatins
Dg-dg
· Ineased TA eves and phamagi (espeiay antihinegi) effets with imetidine, fxetine
· Ineased TA eves with methyphenidate, phenthiazines, a ntaeptives, disfiam
· Hypepyeti ises, sevee nvsins, hypetensive episdes and deaths with MA inhibits, fazidne
· Ineased antidepessant espnse and adia ahythmias with thyid mediatin
· Ineased deeased effets with estgens
· Deiim with disfiam
· Sympatheti hypeativity, sins tahyadia, hypetensin, agitatin with evdpa
· Ineased bitansfmatin f TAs in patients wh smke igaettes
· Ineased sympathmimeti (espeiay beta-adenegi) effets f diet-ating sympathmimeti dgs (nepinephine, epinephine)
· Ineased antihinegi effets f antihinegi dgs (inding antihinegi antipakisnian dgs)
· Ineased espnse (espeiay NS depessin) t babitates
· Deeased antihypetensive effet f ganethidine, nidine, the antihypetensives
· Deeased effets f indiet-ating sympathmimeti dgs (ephedine)
Nsing nsideatins
Assessment
· Histy: Hypesensitivity t any tiyi dg; nmitant theapy with an MA inhibit; eent MI; myegaphy within pevis 24 h sheded within 48 h; atatin; EST; peexisting V disdes; ange-se gama, ineased intaa pesse, inay etentin, etea etha spasm; seize disdes; hypethyidism; impaied hepati, ena fntin; psyhiati patients; mani-depessive patients; eetive sgey
· Physia: Weight; T; skin , esins; ientatin, affet, efexes, visin and heaing; P, BP, thstati BP, pefsin; bwe snds, nma tpt, ive evaatin; ine fw, nma tpt; sa sexa fntin, feqeny f menses, beast and sta exam; ive fntin tests, inaysis, B, EG
Inteventins
· estit dg aess f depessed and ptentiay siida patients.
· Give IM ny when a theapy is impssibe.
· D nt administe IV.
· Administe maj ptin f dse at bedtime if dwsiness, sevee antihinegi effets (nte that the edey may nt teate singe daiy dse theapy).
· ede dsage if min side effets devep; disntine if seis side effets .
· Aange f B if patient deveps feve, se that, the sign f infetin.
Teahing pints
· Take dg exaty as pesibed; d nt stp abpty witht nsting heath ae pvide.
· Avid sing ah, the seep-inding dgs, T dgs.
· Avid pnged expse t snight snamps; se a snseen ptetive gaments.
· These side effets may : headahe, dizziness, dwsiness, weakness, bed visin (evesibe; if sevee, avid diving and tasks eqiing aetness whie these pesist); nasea, vmiting, ss f appetite, dy mth (sma, feqent meas, feqent mth ae, and sking sgaess andies may hep); nightmaes, inabiity t nentate, nfsin; hanges in sexa fntin.
· ept dy mth, diffity in inatin, exessive sedatin.
Advese effets in Itai ae mst mmn; thse in Bd ae ife-theatening.