Patient/caregiver was educated on contraindications for using Amitriptyline as follows:
- Amitriptyline use, especially along with a few other antidepressants, such as, citalopram, fluoxetine, and sertraline, can significantly increase the serotonin levels in the body and lead to development of serotonin syndrome. Caution must be exercised even when discontinuing on any of the above mentioned antidepressant medications with potential to increase serotonin levels and starting on amitriptyline, by observing a window period of atleast 2 weeks, before the transition to amitriptyline is made. Using amitriptyline with these medications closely can result in dangerously elevated serotonin in the blood, leading to development of serotonin syndrome, which can contribute to nausea, vomiting, diarrhea, rapid heart rate and dangerous arrhythmias, mania, agitation, and hallucinations.
- Amitriptyline has significant anticholinergic activity (atropine-like) and so, must be avoided using along with any other medications that can have similar spectrum of activity. Many inhaler medications used in treating breathing disorders and medications used to manage Parkinson’s disease can contain atropine and thus, can potentiate the side-effects of amitriptyline intake. So, amitriptyline must be avoided/used with extreme caution in individuals with history of asthma, COPD, and Parkinson’s disease, to prevent extreme side-effects of paralytic ileus with bowel obstruction, constipation, and urinary retention from developing.
