Apo-Amitriptyline Special Precautions

May block the antihypertensive action of guanethidine or similarly acting compounds.
Should be used with caution in patients with a history of seizures or urinary retention or with narrow-angle glaucoma or increased intraocular pressure.
Arrhythmias, sinus tachycardia and prolongation of the conduction time have been reported, particularly with high doses. A few instances of unexpected death have been reported in patients with cardiovascular disorders. Myocardial infarction and stroke have also been reported with drugs of this class. Therefore, these drugs should be used with caution in patients with a history of cardiovascular diseases such as myocardial infarction and congestive heart failure.
Close supervision is require for hyperthyroid patients or those receiving thyroid medication.
Occupational hazards: May impair mental and/or physical abilities required for performance of hazardous tasks, such as operating machinery or driving a motor vehicle.
Schizophrenic patients and those with paranoid symptomatology may have increased symptoms, manic-depressives may experience a shift to the manic phase. In these circumstances amitriptyline dosage may be reduce or a phenothiazine antipsychotic agent may be administered concurrently.
When given with anticholinergic agents or sympathomimetic drugs, close supervision and careful adjustment of dosages are required. May enhance the response to alcohol and the effects of barbiturates and other CNS depressants.
The possibility of suicide in depressed patients remains during treatment and until significant remission occurs, this type of patients should not have easy access to large quantities of the drug.
Concurrent electroshock therapy may increase the hazards of therapy; such treatment should be limited to patients for whom it is essential.
Discontinue the drug several days before elective surgery if possible.
Use in pregnancy and lactation: Safe use during pregnancy and lactation has not been established in pregnant patients, nursing mothers or women who may become pregnant, weigh possible benefits against possible hazards to mother and child. Amitriptyline and nortriptyline are excreted in low concentrations in breast milk.