Low dose amitriptyline in the treatment of chronic pain

McQuay, Henry J; Carroll, Dawn; Glynn, Chris

doi:10.1111/j.1365-2044.1992.tb02383.x

Cited by 73 publications

(19 citation statements)

References 17 publications

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“…However, the doses chosen are those used in clinical practice and have been shown to be effective in both organic and functional pain syndromes (2–4, 7). The pharmacokinetics of the drug are such that steady state was achieved before the various physiologic tests, and drug levels were obtained and used in our analysis.…”

Section: Discussionmentioning

confidence: 99%

Effects of Amitriptyline on Gastric Sensorimotor Function and Postprandial Symptoms in Healthy Individuals: A Randomized, Double-Blind, Placebo-Controlled Trial

Bouras

Talley

Camilleri³

et al. 2008

The American Journal of Gastroenterology

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BACKGROUND Low-dose tricyclic antidepressants have been used to treat chronic somatic and gastrointestinal pain disorders, including refractory functional dyspepsia. However, there are only limited data on the effects of these drugs on upper gastrointestinal function. AIM To compare the effects of two doses of amitriptyline (AMT) and placebo on gastric accommodation, emptying, satiation, and postprandial symptoms in healthy volunteers. METHODS Using a parallel-group, double-blind, placebo-controlled design, 41 healthy volunteers were randomized to AMT 25 mg, AMT 50 mg, or placebo for 2 wk. During the final 3 days of therapy, the following end points were assessed: fasting and postprandial gastric volumes, 2- and 4-h gastric emptying, time and volume to maximum satiation using a nutrient drink test, and postprandial symptoms 30 min later using 10-cm visual analog scales. AMT and metabolite levels were measured. RESULTS AMT slowed gastric emptying at 2 h (median 75% for placebo, 57% for AMT 25 mg, 67% for AMT 50 mg; P = 0.037) and 4 h (median 98% for placebo, 96% for AMT 25 mg, 92% for AMT 50 mg; P = 0.003). AMT did not affect gastric volumes or satiation volume, but it did reduce nausea scores at 30 min in a dose-dependent manner (median 2.1 for placebo, 0.9 for AMT 25 mg, and 0.0 for AMT 50 mg; P = 0.009). CONCLUSION In healthy volunteers, AMT slows gastric emptying of solids, but it does not significantly affect gastric volumes or satiation. AMT reduces nausea after challenge with a high calorie liquid load.

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Section: Discussionmentioning

confidence: 99%

Effects of Amitriptyline on Gastric Sensorimotor Function and Postprandial Symptoms in Healthy Individuals: A Randomized, Double-Blind, Placebo-Controlled Trial

Bouras

Talley

Camilleri³

et al. 2008

The American Journal of Gastroenterology

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“…38,76,77,85,86] However, the reporting rate in placebo recipients was also high (12 to 62% excluding trials with placebo that mimicked the active agent), 18,76,77,85] Six to 18% of patients withdrew as a result of adverse events related to amitriptyline, [10,38,76,77] Results from one study suggest that the rate of withdrawal may be directly related to dose; withdrawal rates of 0, 7 and II %, respectively, were observed in patients receiving amitriptyline 25, 50 and 75 mg/day (fig, 3),1 86 1 Adverse events were deemed to be dose-limiting in 71 % of patients in one study.lIO] 38,76,77,85,86] However, the reporting rate in placebo recipients was also high (12 to 62% excluding trials with placebo that mimicked the active agent), 18,76,77,85] Six to 18% of patients withdrew as a result of adverse events related to amitriptyline, [10,38,76,77] Results from one study suggest that the rate of withdrawal may be directly related to dose; withdrawal rates of 0, 7 and II %, respectively, were observed in patients receiving amitriptyline 25, 50 and 75 mg/day (fig, 3),1 86 1 Adverse events were deemed to be dose-limiting in 71 % of patients in one study.lIO]…”

Section: Tolerabilitymentioning

confidence: 99%

Amitriptyline

Bryson¹,

Wilde²

1996

Drugs & Aging

185

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Amitriptyline is a tricyclic antidepressant agent which also has analgesic properties. Whether its analgesic effects are linked to its mood-altering activity or attributable to a discrete pharmacological action (or a combination of both) is unknown. Clinical trials demonstrate that oral amitriptyline achieves at least a good or moderate response in up to two-thirds of patients with post-herpetic neuralgia and three-quarters of patients with painful diabetic neuropathy, neurogenic pain syndromes that are often unresponsive to narcotic analgesics. Amitriptyline has also demonstrated efficacy in heterogeneous groups of patients with chronic non-malignant pain. Other possible areas of use for amitriptyline are in patients with fibromyalgia or as an adjuvant for uncontrolled cancer pain, although evidence for the latter application is limited. Adverse events resulting from the antimuscarinic activity of amitriptyline (primarily dry mouth and sedation) are commonly reported, even at the low dosages used for the control of pain. Low starting doses and careful dosage titration may help to minimise these effects. Orthostatic hypotension and tachycardia, sometimes associated with tricyclic antidepressant agents, may also pose a problem in the elderly. In summary, amitriptyline has a valuable place in the treatment of chronic pain conditions that affect the elderly provided that the drug is used judiciously to minimise adverse effects. Importantly, amitriptyline remains the best studied of the antidepressant agents in post-herpetic neuralgia and diabetic neuropathy and is an important and effective treatment option in these syndromes.

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“…It was thought that they reduced depression, which in turn reduced pain [8]. Subsequent animal, and later human, models demonstrated that antinociceptive effects could be achieved with relatively small doses of TCAs, even in the absence of clinical depression [9,10]. Therefore, other explanations had to be rendered for their analgesic effects.…”

Section: Basis Of Use Of Antidepressants For Pain: Mechanisms Of Actionmentioning

confidence: 96%

Antidepressants for chronic neuropathic pain

Reisner

2003

Current Science Inc

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Tricyclic antidepressants have been used to manage pain for several decades, and are superior treatments for some patients suffering from neuropathic pain. Unfortunately, older antidepressants have dose-limiting side effects that can lead to drug intolerance. The most common are anticholinergic side effects, although some patients experience sexual dysfunction. Cognitive impairment, sedation, and orthostatic hypotension also are relatively common. Taking an overdose of tricyclic antidepressants can be lethal in overdose. Several weeks of therapy may be required before antinociception occurs, but tricyclic antidepressants in optimal doses appear to be the most effective treatment for neuropathic pain; this is supported by systematic reviews comparing them with other agents. Newer medications such as atypical antidepressants and anticonvulsants may be overtaking older antidepressants, but they should not be overlooked as important options for the management of pain.

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Low dose amitriptyline in the treatment of chronic pain

Cited by 73 publications

References 17 publications

Effects of Amitriptyline on Gastric Sensorimotor Function and Postprandial Symptoms in Healthy Individuals: A Randomized, Double-Blind, Placebo-Controlled Trial

Effects of Amitriptyline on Gastric Sensorimotor Function and Postprandial Symptoms in Healthy Individuals: A Randomized, Double-Blind, Placebo-Controlled Trial

Amitriptyline

Antidepressants for chronic neuropathic pain

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