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(a mee TRIP ti leen)

Brand Names: US

  • Elavil [DSC]

Therapeutic Category

  • Antidepressant, Tricyclic (Tertiary Amine)
  • Antimigraine Agent

Medication Safety Issues

Sound-alike/look-alike issues:

Amitriptyline may be confused with aminophylline, imipramine, nortriptyline

Elavil may be confused with Aldoril, Eldepryl, enalapril, Equanil, Plavix

Elavil may be confused with Elavil OTC (an over-the-counter sleep aid containing melatonin, valerian root, and vitamins).

Geriatric Patients: High-Risk Medication:

Beers Criteria: Amitriptyline (alone or in combination) is identified in the Beers Criteria as a potentially inappropriate medication to be avoided in patients 65 years and older (independent of diagnosis or condition) due to its strong anticholinergic properties and potential for sedation and orthostatic hypotension. In addition, use TCAs with caution due to their potential to cause or exacerbate syndrome of inappropriate antidiuretic hormone secretion (SIADH) or hyponatremia; monitor sodium closely with initiation or dosage adjustments in older adults (Beers Criteria [AGS 2019]).

Pharmacy Quality Alliance (PQA): Amitriptyline (alone or in combination) is identified as a high-risk medication in patients 65 years and older on the PQA’s, Use of High-Risk Medications in the Elderly (HRM) performance measure, a safety measure used by the Centers for Medicare and Medicaid Services (CMS) for Medicare plans (PQA 2017).

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