Amide (Amixide)

Composition Pharmacodynamics Indications Carefully Contraindications Dosing and Administration Side effects Form release / dosage
Read on
Active substanceAmitriptyline + ChlordiazepoxideAmitriptyline + Chlordiazepoxide
Similar drugsTo uncover
  • Amide
    pills inwards 
    San Pharmaceutical Industries Co., Ltd.     India
    • Dosage form: & nbspfilm coated tablets
    Composition:

    Active substances:

    Amitriptyline hydrochloride (in terms of amitriptyline) - 28.30 (25.00) mg

    Chlordiazepoxide 10.00 mg

    Excipients:

    lactose - 23.20 mg, starch - 56.13 mg, microcrystalline cellulose - 10.00 mg, disodium edetate - 0.07 mg, sodium lauryl sulfate - 1.50 mg, indigocarmine - 0.28 mg, silicon dioxide colloid - 1 , 50 mg, sodium methylparahydroxybenzoate (methylparaben sodium) - 0.02 mg, crospovidone - 5.50 mg; shell: methyl methacrylate, dimethylaminoethyl methacrylate and butyl methacrylate copolymer (Eudragit E-100) 1.25 mg, talc purified 4.00 mg, magnesium stearate 1.50 mg, titanium dioxide 1.00 mg, indigocarmine 0.75 mg, macrogol -6000 (polyethylene glycol 6000) 0.25 mg.

    Description:

    Round biconvex tablets covered with a film coating of blue color with a risk on one side. Cross-sectional view: the core of the tablet is light blue, surrounded by a blue shell.

    Pharmacotherapeutic group:Antidepressant
    ATX: & nbsp

    N.06.C.A.01   Amitriptyline in combination with psycholeptics

    Pharmacodynamics:

    Combined drug, the effect of which is due to its constituent components: a tricyclic antidepressant amitriptyline and anxiolytic chlordiazepoxide. Amide has a pronounced antidepressant and anxiolytic effect.

    The mechanism of antidepressant action of amitriptyline is associated with an increase in the concentration of monoamines, including noradrenaline, dopamine, serotonin and others, in the central nervous system (CNS). The accumulation of these neurotransmitters is associated with the inhibition of the reverse neuronal capture of neurotransmitters in the central nervous system. With prolonged use reduces the functional activity of beta-adrenergic and serotonin receptors in the brain, normalizes adrenergic and serotonergic transmission, restores the balance of these systems, disturbed in depressive states. With anxiety-depressive conditions reduces anxiety, agitation and depressive manifestations. Amitriptyline also has some analgesic effect, which may be due to changes in monoamine concentrations in the central nervous system, especially serotonin, and effects on endogenous opioid systems.

    Has a pronounced peripheral and central anticholinergic action due to high affinity for m-holinoretseptoram; a strong sedative effect,associated with affinity for H1-histamine receptors, and alpha-adrenergic blocking action.

    Chlordiazepoxide is a tranquilizer from the benzodiazepine group, which has an anxiolytic effect, a pronounced sedative and moderate hypnotic effect, as well as anticonvulsant and central muscle relaxant effects. The mechanism of action of chlordiazepoxide is associated with increased inhibitory effect of GABA (gamma-aminobutyric acid) in the central nervous system by increasing the sensitivity of GABA receptors to the mediator as a result of stimulation of benzodiazepine receptors. Anxiolytic action is caused by the influence on the amygdala complex of the limbic system and is manifested in the reduction of emotional tension, easing anxiety, fear, anxiety.

    Sedation effect is caused by the influence on the reticular formation of the brainstem and the nonspecific nuclei of the thalamus and is manifested by a decrease in the symptoms of neurotic origin (anxiety, fear). Has a pronounced sedative effect.

    The main mechanism hypnotics is the inhibition of cells of the reticular formation of the brain stem.Reduces the impact of emotional, vegetative and motor stimuli, which break the mechanism of falling asleep. In the first 3-5 days of admission, moderate hypnotic effect (facilitates falling asleep), as well as slightly reduce blood pressure.

    Central muscle relaxant action is caused by inhibition of the polysynaptic spinal afferent inhibitory pathways (to a lesser extent, monosynaptic). Perhaps a direct inhibition of the motor nerves and muscle functions.

    Anticonvulsant action is realized by strengthening presynaptic inhibition. The spread of epileptic activity is suppressed, but the excited state of the focus is not removed.

    Oppresses central sympathetic influences, possesses antiarrhythmic effect. It causes relaxation of the musculature of the uterus, has antihypoxic properties (including with myocardial infarction).

    Pharmacokinetics:

    At oral reception Amiksid quickly and completely is soaked up in GASTROINTESTINAL TRACT, Withmah in the plasma is achieved within 2-7,7 hours.

    Amitriptyline binds to plasma proteins by 94%.

    Chlordiazepoxide binds to plasma proteins by 96%; T1/2 is 5 to 30 hours.

    Both components are metabolized in the liver.

    Amitriptyline forms two active metabolites - nortriptyline and 10-oxyamitriptyline. T1/2 - 10 to 28 hours for 10-hydroxy amitriptyline and 16 to 80 hours for nortriptyline.

    Chlordiazepoxide is metabolized with the formation of pharmacologically active metabolites of desmethyldiazepam, desmethylchlorodiazepoxide, demoxepam and oxazepam. T1/2 Chlordiazepoxide is variable and is 5-30 h, T1/2 the main active metabolite (desmethyldiazepam) is several days. It is excreted in the urine in unchanged form and in the form of conjugated metabolites.

    Amide penetrates the placental barrier and is excreted in breast milk.

    Indications:

    Apply strictly according to the doctor's prescription.

    Amyxide is indicated for moderate and severe depressions of different genesis with predominance of anxiety of varying severity.

    The therapeutic response to Amixide occurs earlier and with more positive responses to therapy than when amitriptyline or chlordiazepoxide used separately.

    Contraindications:

    -Increased sensitivity to amitriptyline, chlordiazepoxide and / or any component of the drug;

    - Myocardial infarction (acute and recovery period);

    - Blockade of intracardiac conduction (of any degree);

    -Arrhythmia;

    -Heart failure;

    - Severe renal or hepatic insufficiency;

    -Atonia of the bladder;

    - Stomach ulcer and duodenal ulcer in the stage of exacerbation;

    -Pylostenosis, paralytic obstruction of the intestine;

    - Myasthenia gravis;

    - Acute alcohol intoxication;

    -Hyperplasia of the prostate;

    -Closed angle glaucoma;

    - Acute intoxication with hypnotics, anelgesic and psychoactive drugs;

    - Lactase deficiency, lactose intolerance, glucose-galactose malabsorption;

    -Not recommended for the treatment of depression in children and adolescents under 18 years.

    Carefully:

    FROM caution should be used in patients with chronic alcoholism, with bronchial asthma, bipolar disorder and epilepsy, oppression of bone marrow hematopoiesis, hyperthyroidism, bladder hypotension, angina pectoris, arterial hypertension, intraocular hypertension, stroke, schizophrenia (possible activation of psychosis), with renal dysfunction and / or liver.

    If you have any of the above diseases or conditions, consult a doctor before taking the drug.

    Incompatible with MAO inhibitors (there may be an increase in the frequency of periods of hyperpyrexia, severe seizures, hypertensive crises and death). A break in treatment between taking MAO inhibitors and amitriptyline should be at least 14 days! (see section "Interaction with other drugs").

    Pregnancy and lactation:

    Amitriptyline

    In experimental studies, adverse effects amitriptyline on the fetus, but strictly controlled clinical studies of the safety of its use in pregnancy was not conducted.

    Use amitriptyline during pregnancy should only be in cases where the intended benefit to the mother exceeds the potential risk to the fetus. Amitriptyline Do not use in the third trimester of pregnancy, if this is not absolutely necessary. The use of large doses of tricyclic antidepressants in the third trimester of pregnancy can affect the newborn, including impaired behavior and neurological functions.In newborns, there are cases of drowsiness as a result of the effect of amitriptyline, and urinary retention, as a result of nortriptyline, if the drug was administered to women immediately before delivery.

    In order to avoid the development of the "cancellation" syndrome in newborns (manifested by shortness of breath, drowsiness, intestinal colic, increased nervous excitability, increase or decrease in blood pressure, tremor or spastic phenomena) amitriptyline should be abolished gradually, starting a dose reduction, at least 7 weeks before the expected delivery.

    Amitriptyline penetrates into breast milk and may cause drowsiness in infants. Therefore, if treatment with amitriptyline is necessary for the mother, breast-feeding should be stopped.

    Chlordiazepoxide

    The use of chlordiazepoxide in the first trimester of pregnancy is contraindicated, in other cases it is allowed only if there are absolute indications, and the use of a safer alternative is impossible or contraindicated. It should be borne in mind that with the use of chlordiazepoxide in pregnancy, a significant change in the fetal heart rate is possible.

    If it is necessary to use it regularly during lactation, breastfeeding should be discontinued.

    Dosing and Administration:

    Assign inside (after eating), Amyxide doses are set individually.

    The initial daily dose is 1 tablet 12.5 / 5mg 2-3 times a day. If necessary, the dose of the drug can be increased to 6 tablets 25/10 mg per day for 2-3 doses.

    After obtaining a persistent antidepressant effect, after 2-4 weeks the doses gradually and slowly decrease. In case of signs of depression with decreasing doses, it is necessary to return to the previous dose.

    If the patient's condition does not improve within 3-4 weeks of treatment, then further therapy is impractical.

    In elderly patients with mild disorders, in outpatient practice, the doses are 12.5 / 5 mg; 25/5 mg or 25/10 mg, usually once a day at night.

    Side effects:

    Very frequent (> 1/10); frequent (> 1/100, <1/10); infrequent (> 1/1000, <1/100), rare (> 1/10000, <1/1000); very rare (<1/10000).

    Some of the undesirable reactions listed below (headache, tremor, decreased concentration, constipation, decreased libido) may also be symptoms of depression and tend to weaken or disappear as the patient improves.

    From the side of the central nervous system: very often - drowsiness, tremor, dizziness, headache; often a decrease in concentration of attention, a violation of taste (dysgeusia), paresthesia, extrapyramidal symptoms: ataxia, akathisia, parkinsonism, dystonic reactions, tardive dyskinesia, slowness; infrequently, convulsions.

    Mental disorders: very often - states of confusion (in elderly patients, confusion may be manifested by anxiety, excitement, elements of hallucinatory delusional disorders), disorientation; infrequently - weakening of cognitive abilities, hypomania, mania, anxiety, insomnia, nightmares; rarely - aggression, delirium (in the elderly), hallucinations (in patients with schizophrenia); very rarely - in the period of treatment and soon after its termination - suicidal thoughts, suicidal behavior (due to the presence of amitriptyline).

    From the cardiovascular system: very often - palpitations, tachycardia, orthostatic hypotension; often - atrioventricular block, violation of intraventricular conduction (change in ECG parameters: increase in intervals P-Q, Q-T, expansion of the complex QRS, signs of blockade of the bundle branch legs, nonspecific changes in the interval S-T or T wave, incl. in patients without heart disease) lowering blood pressure (BP); infrequent - arrhythmia, increased blood pressure; rarely - myocardial infarction.

    From the digestive system: very often - dry mouth, constipation, nausea; often - atrophy of the gums, inflammation of the mouth, tooth decay, burning sensation in the mouth; infrequently - diarrhea, vomiting, swelling of the tongue; rarely - an increase in salivary glands, intestinal obstruction, hepatitis (including impaired liver function and cholestatic jaundice).

    From the endocrine system: very often - weight gain, gain appetite; rarely - decreased appetite; very rarely - the syndrome of inadequate hypersecretion of antidiuretic hormone;

    Co side of the reproductive system: very often - weakening or increase of sexual desire; often - in men - impotence, erectile dysfunction; rarely - in women - galactorrhea, delayed orgasm, loss of ability to achieve orgasm; in men - an increase in the size (swelling) of the testicles, delay in ejaculation, gynecomastia.

    From the urinary system: often - urinary retention.

    From the hematopoiesis: rarely - oppression of bone marrow functions, agranulocytosis, leukopenia, thrombocytopenia, eosinophilia.

    From the sense organs: very often - reduced visual acuity, violation of accommodation; often - mydriasis; infrequent - noise in the ears, increased intraocular pressure; rarely - loss of ability to accommodation, aggravation of narrow-angle glaucoma in the elderly.

    From the skin: very often hyperhidrosis; infrequently - skin rash, hives, angioedema; rarely - alopecia, photosensitivity.

    General disorders: often - weakness; infrequently - swelling of the face; rarely pyrexia.

    Laboratory indicators: often - ECG change: increased intervals P-Q, Q-T, expansion of the complex QRS, signs of blockade of the bundle branch legs, nonspecific changes in the interval S-T or T wave; rarely - a deviation from the norm of liver tests, increased activity of phosphatase, transaminase.

    Communication with reception of Amixide is not established: lupus-like syndrome (migratory arthritis, the appearance of antinuclear antibodies and a positive rheumatoid factor).

    If you experience any of the undesirable reactions described in the manual or if you notice any other undesirable phenomena, tell your doctor.

    Overdose:

    Amitriptyline

    Symptoms overdoses of amitriptyline may develop slowly or occur suddenly. In the first hours there are drowsiness or excitement, hallucinations and symptoms associated with the anticholinergic action of the drug: mydriasis, tachycardia, urinary retention, dry mucous membranes, weakened intestinal motility. Cramps, fever. In the future, a sharp suppression of the functions of the central nervous system, a violation of consciousness, progressing to coma and respiratory failure is possible. Heart Symptoms: arrhythmia (ventricular tachyarrhythmia, flutter and ventricular fibrillation). On the ECG, the characteristic changes are the lengthening of the interval PR, expansion of the complex QRS, interval lengthening QT, flattening or inverting the T wave, segment depression ST and a different degree of blockade of intracardiac conduction, which can cause cardiac arrest. Can develop heart failure, arterial hypotension, cardiogenic shock, metabolic acidosis and hypokalemia, confusion, anxiety, hallucinations and ataxia.

    A case of a lethal arrhythmia occurred 56 hours after an overdose of amitriptyline.

    Treatment. The victim should be immediately taken to the hospital for symptomatic and maintenance therapy. It is necessary to wash the stomach and lavage, incl. in later terms after oral administration of the drug; The reception of activated carbon is 20-30 g every 4-6 hours during the first 24-48 hours after poisoning. A thorough monitoring of the patient's condition is necessary, including in apparently uncomplicated cases, for at least 48 hours. It is necessary to control the level of consciousness, heart rate, blood pressure and respiratory rate. At short intervals, the content of electrolytes and gases in the blood. To prevent stopping breathing, it is necessary to ensure airway patency with the help of artificial ventilation. ECG monitoring should be continued for 3-5 days.

    With the expansion of the complex QRS, heart failure and ventricular arrhythmias can be an effective shift of blood pH to the alkaline side (the appointment of a solution of sodium bicarbonate or hyperventilation) with rapid administration of hypertonic sodium chloride solution (100-200 mmol Na+). With ventricular arrhythmias, it is possible to use traditional antiarrhythmic drugs, for example, 50-100 μL of lidocaine (1-1.5 mg / kg) intravenously with further infusion at a rate of 1-3 mg / min.

    If necessary, cardioversion and defibrillation are used. Circulatory insufficiency is corrected with the help of plasma substitutes, in severe cases - by infusing dobutamine (at first - at a rate of 2-3 μg / min with a further increase in dose depending on the effect). Excitation and convulsions can be stopped with diazepam.

    In metabolic acidosis, standard therapy should be started.

    Dialysis is ineffective, as the concentration of amitriptyline in the blood is low.

    The reactions to overdose in different patients vary significantly. Children are particularly prone to the occurrence of cardiotoxic phenomena and seizures. In adults, moderate or severe intoxication develops with amitriptyline at a dose of more than 500 mg, with a dose of about 1000 mg, a lethal outcome is possible.

    Chlordiazepoxide

    As a result of an overdose of chlordiazepoxide, the following symptoms: drowsiness, a state of disorientation, indiscriminate speech, and in severe cases, loss of consciousness and coma.

    In case of acute poisoning, it is necessary to empty the stomach (vomiting, gastric lavage).

    Treatment when an overdose of chlordiazepoxide is primarily symptomatic and consists in monitoring the basic vital functions (breathing, pulse, blood pressure).

    A specific antidote is flumazenil (a benzodiazepine receptor antagonist).

    Interaction:

    The drug should be used in monotherapy. Active components included in Amixide strengthen the effect on the central nervous system of the following medicines: neuroleptics, central and narcotic analgesics, sedatives and hypnotics, anticonvulsant drugs, anesthetics, and alcohol - it is possible to significantly increase the inhibitory effect on the central nervous system, respiratory depression and hypotensive effect. Amitriptyline shows synergism when interacting with other antidepressants. However, simultaneous use of antidepressants of various classes can cause serious undesirable phenomena, including the development of serotonin syndrome.It is recommended to observe a period free from taking medication when switching from one class of antidepressants to another.

    Tricyclic antidepressants, including amitriptyline, are metabolized by isoenzyme CYP2D6 hepatic cytochrome P450. This isoenzyme in man has several isoforms. In addition, the metabolism of amitriptyline involves isoenzymes CYP2D19 and CYP3A.

    Isozyme CYP2D6 can be inhibited by various psychotropic drugs, for example, neuroleptics, serotonin reuptake inhibitors (except citalopram, a very weak inhibitor), as well as beta-blockers and antiarrhythmic drugs (procainamide, phenytoin, propafenone, esmolol, amiodarone). These drugs can inhibit the metabolism of tricyclic antidepressants and significantly increase their concentration in blood plasma.

    Contraindicated combinations:

    Amyxide is incompatible with MAO inhibitors (because of the risk of developing a serotonin syndrome, including myoclonus, spasms during excitation, delirium and to whom).

    The use of Amixide can be started 2 weeks after the cancellation of the irreversible non-selective MAO inhibitor and the day after the reversal of the reversible inhibitor of moclobemide.

    The use of MAO inhibitors can begin 2 weeks after the elimination of Amide.

    In either case, both the MAO inhibitor and Amixide should be started from small doses, gradually increasing them depending on the effect.

    Not recommended combinations:

    Sympathomimetics: amitriptyline enhances the effect on the cardiovascular system of epinephrine, ephedrine, isoprenaline, norepinephrine, dopamine and phenylephrine, used, for example, for anesthesia (local and general) or in the form of drops in the nose. Adrenoblockers: when used simultaneously with the active components included in Amixide, it is possible to weaken the hypotensive effect of guanethidine, clonidine, betanidine, reserpine, and methyldopa.

    M-holinoblokatory: Tricyclic antidepressants can enhance the action m-holinoblokatorov (for example, derivatives of phenothiazine, antiparkinsonics, blockers of H1-histamine receptors, atropine, biperidene) on the organs of vision, the central nervous system, intestines and bladder. It is necessary to avoid the simultaneous use of m-holinoblockers and aminotriptyline in connection with an increased risk of development of adverse events, including paralytic intestinal obstruction and hyperpyrexia.

    Simultaneous use of amitriptyline and phenothiazine derivatives, in addition, may increase the risk of malignant neuroleptic syndrome. Drugs capable of lengthening the interval QT - antiarrhythmic drugs (for example, quinidine), H1-histamine receptor blockers (for example, astemizole and terfenadine), some neuroleptics (in particular, pimozide and sertindole), anesthetics (isoflurane. droperidol), chloral hydrate, sotalol - when used in conjunction with amitriptyline may increase the risk of ventricular arrhythmias.

    Antifungal drugs - eg, fluconazole and terbinafine - increase the concentration of amitriptyline in the serum and, in connection with this, increase its toxicity. Cases of fainting, fibrillation and fluttering of the ventricles were noted.

    Lithium salts (lithium carbonate) interact with amitriptyline by an unknown mechanism; this interaction can enhance the toxicity of lithium: tremor, tonic-clonic convulsions, difficulty remembering, mismatched thinking, hallucinations, malignant neuroleptic syndrome.

    Combinations requiring caution:

    Means that depress the central nervous system: amitriptyline can strengthen inhibition of CNS functions. It is caused by various psycho-depressants, for example, alcohol, sleeping pills, sedatives and strong analgesics.

    Drugs that affect the activity of cytochrome P450 isoenzymes can alter the metabolism of amitriptyline and cause significant fluctuations in its plasma concentration. Inducers of microsomal liver enzymes (barbiturates, carbamazepine, phenytoin, nicotine, rifampicin and oral contraceptives) increase metabolism of amitriptyline, reduce its concentration in the blood and, thus, weaken the antidepressant effect.

    Cimetidine, methylphenidate and blockers of "slow" calcium channels increase the concentration of amitriptyline in the blood plasma, which can be accompanied by increased toxicity.

    Amitriptyline and neuroleptics mutually suppress each other's metabolism, which can lead to a decrease in the convulsive threshold and the development of seizures. When combined, it may be necessary to adjust the dosage of these drugs.

    Avoid simultaneous use of amitriptyline, neuroleptics and hypnotics (droperidol).When joint admission should exercise extreme caution. Sucralfate reduces absorption of amitriptyline and can weaken it antidepressant effect.

    With the simultaneous use of valproic acid, the clearance of amitriptyline from the blood plasma decreases, which can lead to an increase in the concentration of amitriptyline and its metabolite, nortriptyline, in view of which the concentrations of amitriptyline and nortriptyline in serum should be monitored. You may need to reduce the dose of amitriptyline.

    In the appointment of amitriptyline to patients receiving phenytoin, should be monitored concentration of the latter in blood plasma because of increasedwrisk of oppression of his metabolism and, as a consequence, increase in toxic effects (ataxia, hyperreflexia, nystagmus, tremor). At the same time, the therapeutic effect of amitriptyline should be monitored, since an increase in its dose may be required.

    Drug preparations of St. John's wort reduce AUC0-12 hours and the maximum concentration of amitriptyline in the blood plasma by about 20% due to activation of the hepatic metabolism of amitriptyline with isoenzyme CYP3A4. This combination can be used in clinical practice provided that the dose of amitriptyline is adjusted depending on the results of measuring its concentration in the blood plasma.

    With the simultaneous use of amitriptyline and anticoagulants (coumarin derivatives), it is possible to increase the anticoagulant activity of the latter.

    Fluoxetine and fluvoxamine increase the concentration of amitriptyline in plasma (may require a decrease in the dose of amitriptyline by 50%).

    Simultaneous use of amitriptyline with disulfiram and other acetal dehydrogenase inhibitors can provoke delirium.

    Estrogen-containing oral contraceptive medications can increase the bioavailability of amitriptyline.

    The use of cocaine while taking amitriptyline increases the risk of heart arrhythmia.

    Amitriptyline may increase depression caused by glucocorticosteroids. Drugs for the treatment of thyrotoxicosis increase the risk of agranulocytosis.

    When used simultaneously with thyroid hormones - the mutual enhancement of the therapeutic effect and toxic effects (cardiac arrhythmias and a stimulating effect on the central nervous system).

    When used simultaneously with other hematotoxic drugs, it is possible to increase hematotoxicity.

    Special instructions:

    Amitriptyline, which is part of Amixide, in doses above 150 mg / day reduces the threshold of convulsive activity, therefore, one should consider the possibility of occurrence of convulsive seizures in patients with those with anamnesis and in the category of patients who are predisposed to this, for example, with brain injuries any etiology, simultaneous use of neuroleptics, in the period of rejection of ethanol (for patients with chronic alcoholism) or with the withdrawal of drugs with anticonvulsant properties, for example, b nodiazepines.

    It should be borne in mind that suicidal attempts are possible in patients younger than 25 years (the risk of which may persist until a significant remission is achieved).

    In this regard, with severe depression at the beginning of treatment, combinations of amitriptyline with drugs from the benzodiazepine group or with neuroleptic drugs can be indicated. In this case, constant medical supervision is necessary.

    With prolonged use (for several months), especially in high doses, addiction and drug dependence are possible.

    Cancellation of Amyxide should be carried out gradually, by lowering the dose to reduce the risk of withdrawal syndrome characterized by tremors, cramps, abdominal or muscle spasms, vomiting, sweating. With a sharp cancellation are also possible psychomotor agitation, fear, vegetative disorders, insomnia.

    Special care is required when using Amixide, especially at the beginning of treatment, in patients who have been receiving long-acting antihypertensive drugs of central action, beta-blockers, anticoagulants, cardiac glycosides.

    Amyxide should be discarded in the development of paradoxical reactions (acute agitation, anxiety, sleep disturbances and hallucinations).

    Treatment with Amioxide in old age should be carefully controlled, with minimal doses of the drug and gradually increased, in order to avoid the development of delirious disorders, hypomania and other complications.

    In patients with a depressive phase of bipolar disorder amoxicum may develop manic conditions.

    In patients receiving three / tetracyclic antidepressants concomitantly with local and general anesthetics, the risk of arrhythmia and a drop in blood pressure may be increased.

    Simultaneous administration of amitriptyline with MAO inhibitors can lead to death. A break in treatment between taking MAO inhibitors and tricyclic antidepressants should be at least 14 days! (see section "Interaction with other drugs").

    The intake of amitriptyline can alter the organism's tolerance to insulin and glucose. What requires correction of antidiabetic therapy in patients with diabetes mellitus. The state of depression can also affect glucose metabolism.

    With renal / hepatic insufficiency and long-term treatment, control over the picture of peripheral blood and "hepatic" enzymes is necessary.

    Epidemiological studies, which were mainly conducted in patients aged 50 years and older, indicate an increased risk of bone fractures when using selective serotonin reuptake inhibitors and tricyclic antidepressants. The mechanism of action that increases this risk is not known.

    During the treatment period, do not drink alcohol.

    Effect on the ability to drive transp. cf. and fur:

    During the treatment with Amixide, it is prohibited to drive vehicles and engage in other potentially dangerous activities that require an increased concentration of attention and speed of psychomotor reactions.

    Form release / dosage:

    Tablets, film-coated 25 mg + 10 mg.

    Packaging:10 tablets per strip of aluminum foil. For 3 or 10 strips, together with the instructions for use are placed in a cardboard box. A transparent film of polyolefin (sticker) with a printed logo is applied to the cardboard pack on both sides to ensure control of the first opening.
    Storage conditions:

    It refers to the list of the III list of narcotic drugs, psychotropic substances and their precursors, which are subject to control in the Russian Federation. In dry, dark place at a temperature of no higher than 25 ° C. Keep out of the reach of children.

    Shelf life:

    4 years. Do not use after the expiry date printed on the package.

    Terms of leave from pharmacies:On prescription
    Registration number:П N012912 / 01
    Date of registration:03.03.2009 / 22.01.2014
    Expiration Date:Unlimited
    The owner of the registration certificate:San Pharmaceutical Industries Co., Ltd.San Pharmaceutical Industries Co., Ltd. India
    Manufacturer: & nbsp
    Representation: & nbspSAN PHARMACEUTICAL INDUSTRIES LTD. SAN PHARMACEUTICAL INDUSTRIES LTD. India
    Information update date: & nbsp05.08.2017
    Illustrated instructions
      Instructions
      Up