&lt;p&gt;Therapeutic Dose of Amitriptyline for Older Patients with Burning Mouth Syndrome&lt;/p&gt;

Suga, Takayuki; Takenoshita, Miho; Watanabe, Takeshi; Tu, Trang Thi Huyen; Mikuzuki, Lou; Hong, Chaoli; Miura, Kazuhito; Yoshikawa, Tatsuya; Nagamine, Takahiko; Toyofuku, Akira

doi:10.2147/ndt.s235669

Cited by 10 publications

(7 citation statements)

References 33 publications

(54 reference statements)

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“…For the cases drowsiness is shown daytime, taking in the early evening would be suggested. For amitriptyline, the complaining rate of drowsiness was lower in 80 years old and older patients (23.1%) in this study than those under 65 years old patients (57.5%), 65-75 years old patients (48.1%), and over 75 years old patients (36.4%) in our previous study (5). On the other hand, sleep disorders were observed in 3 patients (11.1%) with aripiprazole.…”

Section: Discussioncontrasting

confidence: 54%

“…However, the adverse events associated with these medications are sometimes troublesome, especially in elderly patients. According to the aging society in Japan, the patients with BMS are aging recently ( 3 , 5 ). In elderly patients, the pharmacokinetics, including drug-metabolism and elimination, were decreased, and higher plasma medication levels would be induced ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, comorbid physical diseases, including various somatic symptoms that elderly patients generally have, may exacerbate and complicate not only BMS symptoms but also adverse events. Therefore, the risk related to the various adverse events would be higher in the elderly patients ( 5 ) and make a selection of medications difficult. In the present study, adverse events were observed more in the patients with amitriptyline (69.2%) than in the patients with aripiprazole (25.9%) as we had hypothesized.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the risk of adverse events is high for elderly patients since the decline of hepatic activity and renal function leads to a higher medication concentration in plasma ( 4 ). The psychopharmacotherapy in elderly patients with BMS would be more complicated and difficult also because of multiple comorbid physical diseases, such as hypertension, cardiovascular diseases, diabetes, and osteoporosis ( 5 ). The selection of medication and decision of prescribing doses would be very difficult, although the dose of amitriptyline and dose of aripiprazole are usually very low in the treatment for BMS.…”

Section: Introductionmentioning

confidence: 99%

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The Effectiveness and Adverse Events of Amitriptyline and Aripiprazole in Very Elderly Patients With BMS

et al. 2022

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Burning mouth syndrome (BMS) is defined by chronic oral burning sensations without any corresponding abnormalities. Besides amitriptyline, aripiprazole has been reported as a possible medication to manage BMS. However, especially for elderly patients, the adverse events of these medications would be a problem. The aim of the present study was to investigate the differences in the effectiveness and adverse events of amitriptyline and aripiprazole in very elderly patients with BMS. This is a retrospective comparative study of 80 years old and older patients with BMS who were initially treated with amitriptyline or aripiprazole and who were new outpatients of our department from April 2017 to March 2020. All clinical data, including sex, age, comorbid physical diseases, comorbid psychiatric disorders, the prescribed doses (initial, maximum, and effective dose), prognosis, and adverse events, were collected from their medical charts. Each medication was selected considering their medical history. Amitriptyline was prescribed in 13 patients (11 women, 82.3 ± 2.1 years old) and aripiprazole was prescribed in 27 patients (26 women, 84.2 ± 3.8 years old). There were no significant between-group differences in sex, age, duration of illness, pain intensity, salivation, and psychiatric comorbidity at the first examination. Amitriptyline clinically improved more patients (7 patients, 53.8%) with the effective dose of 10 (7.5, 15.0) mg than aripiprazole (11 patients, 40.7%) of which the effective dose was 1.0 (0.5, 1.5) mg, although there were no significant between-group differences. The adverse events of amitriptyline were found in 9 patients (69.2%) and most patients had constipation (46.2%). For aripiprazole, 7 patients (25.9%) showed adverse events, most of them reported sleep disorder (11.1%). Amitriptyline had significantly longer duration taking medication (p = 0.021) and lower discontinuation (p = 0.043) despite of higher occurrence rate of adverse events (p = 0.015) compared to aripiprazole. These results suggest that both psychopharmacotherapies with a low dose of amitriptyline and aripiprazole are effective for the very elderly patients with BMS. Furthermore, aripiprazole may have some advantages in the adverse events compared to amitriptyline; however, the low dose amitriptyline monotherapy may have more benefit in the effectiveness and tolerability over prudent collaboration with primary physicians.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Effectiveness and Adverse Events of Amitriptyline and Aripiprazole in Very Elderly Patients With BMS

et al. 2022

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“…Importantly, this synaptic inhibition is preserved during aging. The therapeutic concentrations of AMI for the treatment of depression are 3-6 µM (Glotzbach and Preskorn, 1982;Lavoie et al, 1990), while lower concentrations are also effective for chronic pain and migraine (Riediger et al, 2017;Urquhart et al, 2018;Suga et al, 2019). These therapeutic actions of AMI are maintained in the elderly (Barber and Gibson, 2009).…”

Section: Discussionmentioning

confidence: 99%

Amitriptyline Decreases GABAergic Transmission in Basal Forebrain Neurons Using an Optogenetic Model of Aging

Bang

Tobery

Montgomery

et al. 2021

Front. Aging Neurosci.

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The antidepressant drug amitriptyline is used in the treatment of clinical depression and a variety of neurological conditions such as anxiety, neuropathic pain disorders and migraine. Antidepressants are associated with both therapeutic and untoward effects, and their use in the elderly has tripled since the mid-1990s. Because of this widespread use, we are interested in testing the acute effects of amitriptyline on synaptic transmission at therapeutic concentrations well below those that block voltage-gated calcium channels. We found that 3 μM amitriptyline reduced the frequency of spontaneous GABAergic inhibitory postsynaptic currents (IPSCs) and reduced quantal content in mice at ages of 7–10 mo. and 23–25 mo., suggesting a presynaptic mechanism of action that does not diminish with age. We employed a reduced synaptic preparation of the basal forebrain (BF) and a new optogenetic aging model utilizing a bacterial artificial chromosome (BAC) transgenic mouse line with stable expression of the channelrhodopsin-2 (ChR2) variant H134R specific for GABAergic neurons [VGAT-ChR2(H134R)-EYFP]. This model enables optogenetic light stimulation of specific GABAergic synaptic terminals across aging. Age-related impairment of circadian behavior was used to confirm predictable age-related changes associated with this model. Our results suggest that low concentrations of amitriptyline act presynaptically to reduce neurotransmitter release and that this action is maintained during aging.

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Treatment Modalities of Burning Mouth Disease

Waal

2021

Burning Mouth Disease

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<p>Therapeutic Dose of Amitriptyline for Older Patients with Burning Mouth Syndrome</p>

Cited by 10 publications

References 33 publications

The Effectiveness and Adverse Events of Amitriptyline and Aripiprazole in Very Elderly Patients With BMS

The Effectiveness and Adverse Events of Amitriptyline and Aripiprazole in Very Elderly Patients With BMS

Amitriptyline Decreases GABAergic Transmission in Basal Forebrain Neurons Using an Optogenetic Model of Aging

Treatment Modalities of Burning Mouth Disease

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