Tryptizol: characteristics, functions and side effects of this drug

Tryptizol is one of the brand names for amitriptyline, a tricyclic antidepressant that influences the reuptake of serotonin and norepinephrine.

This drug is considered an essential medicine by the WHO, given its great efficacy and safety, although it is worth mentioning that it has quite a few side effects.

Next let's talk in depth about Tryptizol, what it is used for, what are its therapeutic doses, side effects, precautions and what it interacts with.

• Related article: "Types of psychotropic drugs: uses and side effects"

What is Tryptizol?

Tryptizol is one of the brand names for amitriptyline, a tricyclic antidepressant. and analgesic that is also marketed under the names Deprelio, Elavil, Tryptanol, Laroxyl, Sarotex, Lentizo.

This drug was discovered in 1960 and, given its great medical and psychiatric importance, in addition to its great efficacy and Safety, this compound is on the World Health Organization list of essential drugs (WHO).

Unlike other tricyclic antidepressants, Tryptizol has an efficacy similar to that of selective serotonin reuptake inhibitors (SSRIs)

, which makes it one of the most widely used antidepressants of its group.

• You may be interested in: "SSRI: types, functioning and effects of this antidepressant"

What is this medicine used for?

The conditions for which Tryptizole is used are the same as for generic amitriptyline. This medication is approved and indicated for the treatment and prevention of several different medical conditions and mental disorders.:

• Major depressive disorder in adults.
• Neuropathic pain in adults (p. g., fibromyalgia or postherpetic neuralgia).
• Prophylaxis (prevention) of chronic tension headache in adults.
• Prophylaxis of migraine in adults.
• Treatment of nocturnal enuresis in children from 6 years of age (only when no other treatment has worked and there is no apparent pathological cause).

In some cases, Tryptizol It is also used for the treatment of eating disorders. Also, although depending on the case and if it is considered appropriate, Tryptizol has the particularity of being used for persistent hiccups.

• Related article: "Types of antidepressants: characteristics and effects"

Mechanism of action

As we have discussed, Tryptizol is a tricyclic antidepressant. It works by inhibiting the reuptake of serotonin and norepinephrine in the networks of neurons of the nervous system. By doing this, the drug enhances the action of these neurotransmitters in the brain and thus improves the depressive states based on the biological hypothesis that depression is due to a malfunction of the noradrenaline and the serotonin.

Amitriptyline also blocks sodium, potassium, and NMDA ion channels (N-methyl-D-aspartate). This would explain its effect on neuropathic pain and in the prevention of chronic tension headache and migraine. This drug has a high affinity for alpha-adrenergic, muscarinic M1, and histamine H1 receptors. Tryptizole has sedative and anticholinergic properties, greater compared to other tricyclic antidepressants.

Its therapeutic action, both antidepressant and analgesic, takes an average of two to four weeks to establish. Instead, its sedative action is quite fast and intense. Its adverse effects can begin to manifest itself from the first dose.

Tryptizol, and amitriptyline in general, is very well absorbed from the digestive tract. Once it has been administered, this drug is metabolized into nortriptyline in the body, an active metabolite that also has antidepressant action. This compound has a more potent inhibitory action on norepinephrine reuptake than serotonin.

• You may be interested in: "Types of neurotransmitters: functions and classification"

What are the therapeutic doses of this medicine?

Before intervening with this drug, the professional who prescribes Tryptizol should perform an ECG of the heart of their patients to check for signs of unusual heartbeats. The doctor should re-evaluate the treatment after about 3 months and, if necessary, perform another ECG.

The patient should not stop treatment without first consulting the opinion of his medical professional.

This drug It can be taken with or without food, in the form of tablets swallowed with water and without chewing.

1. Major depressive disorder

The starting dose in the treatment of depression in adults is 25 mg twice a day.. Depending on the response to the medicine, the dose can be gradually increased up to 150 mg per day divided into two doses.

For the elderly (over 65 years) and patients with cardiovascular disease, the recommended starting dose is 10 to 25 mg per day. Depending on your response to the medicine, the doctor may decide to gradually increase the dose to a daily dose of 100 mg divided into two doses.

The duration of this treatment for depression is at least 6 months. As with other medications for the treatment of depressive disorders, the patient may begin to notice improvement after a few weeks. For this reason, it should be insisted that you take the drug for as long as your doctor recommends, still not noticing a significant improvement in the short term.

• You may be interested in: "Major Depression: Symptoms, Causes, and Treatment"

2. Neuropathic pain, chronic tension-type headache and migraine prevention

The adult dose for the treatment of neuropathic pain, chronic tension headache and migraine prophylaxis is 10 to 25 mg at night. The recommended daily dose for these conditions is 25 to 75 mg. Depending on how the patient is responding to the drug, the doctor may gradually increase the dose..

If a dose greater than 100 mg is administered, frequent follow-up visits should be made. It will be the doctor who decides if the dose should be taken once a day or in two doses..

In people over 65 years of age or with cardiovascular disease, the recommended starting dose is the same, 10 to 25 mg at night. Depending on your response to the medicine, the dose can be gradually increased to 75 mg per day and From that point on, the doctor will constantly monitor to make sure that no conditions exist adverse.

Patients taking Tryptizol for pain may take a few weeks to notice the decrease in pain.. In your case, the duration of treatment is very varied, depending on what the doctor recommends.

• Related article: "Neuropathic pain: causes, symptoms and treatment"

3. Nighttime urinary incontinence

Tryptizol it is used in children and adolescents only to treat nighttime urinary incontinence. Here the recommended doses vary according to age:

• Children under 6 years old: its taking is not recommended.
• From 6 to 10 years: 10 mg - 20 mg.
• From 11 to more years: 25 mg - 50 mg.

The doctor will gradually increase the dose and assess whether to continue treatment for urinary incontinence after 3 months.

Tryptizol should not be given to children and adolescents under 18 years of age to treat the following conditions of health: depression, neuropathic pain neither as prophylaxis of chronic tension headache nor migraine. This is so because no safety studies have been conducted, nor has the long-term efficacy of this drug been seen for this age group.

Side effects

As with all medications, whether they are psychotropic drugs or used for other medical conditions, Tryptizol may cause adverse side effects, mostly shared with the rest of tricyclic antidepressants, although it is worth mentioning that amitriptyline and its brand names differ from the rest of the drugs in its group in that it can give rise to symptoms anticholinergics.

Because it is a widely studied and widely used drug, its adverse symptoms are known quite precisely. There are quite a few, and then we see them ordered according to their probability of occurrence.

Common side effects (1 in 10 people):

• Heart problems
• prolonged QT interval.
• Drowsiness
• Trembling of the hands or other parts of the body
• Dizziness
• Headache
• Irregular, pounding, or fast heartbeat
• Dizziness when standing up due to low blood pressure (orthostatic hypotension)
• Dry mouth
• Constipation
• Sickness
• Excessive sweating
• Weight gain
• Babbling or speaking slowly
• Aggressiveness
• Nasal congestion
• Confusion
• Sexual disorders (decreased sex drive, erection problems)
• Attention problems
• Changes in taste
• Numbness or tingling in the arms or legs
• Coordination problems
• Popular dilation
• Heart block
• Fatigue
• Low sodium concentration in the blood
• Agitation
• Urinary disorders
• Feeling thirsty

Uncommon effects (1 in 100 people):

• Seizures
• Tinnitus
• Increased blood pressure
• Diarrhea, vomiting
• Skin rash, hive rash (urticaria), swelling of the face and tongue
• Difficulty urinating
• Increased milk production in lactation or secretion of breast milk without lactation.
• Increased pressure in the eyeball
• Collapse situations
• Worsening heart failure
• Worsening liver function (eg. ex. cholestatic liver disease)
• Increased pressure in the eyeball, attacks of intermittent blurred vision, rainbow vision, and eye pain
• Arousal and anxiety
• Sleep problems and nightmares

Rare side effects (1 in 1,000 people):

• Severe constipation
• Bloating of the stomach
• Fever
• Vomiting
• Paralysis of parts of the intestine
• Jaundice: yellowing of the skin and the whites of the eyes.
• Liver damage.
• Bruising and bleeding
• Pallor
• Throat pain
• Involvement in the blood and bone marrow.
• Decrease in the number of red blood cells, white blood cells and platelets.
• Suicidal thoughts and behaviors.
• Decreased appetite
• Delusions (especially in elderly patients) and hallucinations
• Heart rhythm or abnormal heart pattern
• Swelling of the salivary glands
• Hair loss
• Increased sensitivity to sunlight
• Enlargement of the breasts in men
• Fever
• Weightloss
• Abnormal liver function test results

Very rare side effects (1 in 10,000 people):

• Acute glaucoma: intermittent, rainbow vision and eye pain.
• Diseases of the heart muscle
• Feeling restless and needing to be in constant motion
• Peripheral nerve disorder
• Sharp increase in pressure in the eye
• Torsades de pointes: particular forms of abnormal heart rhythm.
• Allergic inflammation of the pulmonary alveolus and lung tissue

Side effects of unknown frequency

• Absence of appetite sensation
• Increase or decrease in blood sugar levels
• Paranoia
• Movement disturbances (involuntary movements or decreased movements)
• Hypersensitivity inflammation of the heart muscle
• Hepatitis
• Hot flushes
• Dry eyes

An increased risk of bone fractures has been observed in patients treated with this type of medicine.

Precautions and contraindications

Before taking Tryptizol, it is necessary to know what the precautions and contraindications of this drug are. It is not recommended to take it in the following cases:

• If you are allergic to amitriptyline or other ingredients of the drug
• If you have recently had a heart attack (myocardial infarction)
• If you have had heart problems such as heart rhythm disturbances, detected on an electrocardiogram (ECG), heart block or coronary artery disease
• If you are taking MAOI currently or in the last 14 days
• If you have taken moclobemide the day before
• If you have severe liver disease
• It is not indicated in children under 6 years of age

If Tryptizol has been started, treatment with this medicine should be stopped and wait about 14 days before starting any treatment with an MAOI (monoamine inhibitors oxidase).

Amitriptyline is not recommended during pregnancy, unless the doctor has considered the benefits greater than the risks of the treatment.

It should be noted the risk of taking Tryptizole during the last part of pregnancy since there is a risk that the newborn will present symptoms of withdrawal such as irritability, increased muscle tension, tremors, irregular breathing, loud crying, poor suction, urinary retention and constipation.

Because this medicine can cause drowsiness and dizziness It is not recommended to use heavy machinery or drive during the first weeks after taking it.. Likewise, if these symptoms are noticed beyond the first two weeks, driving and using any heavy tool should be avoided, in addition to warning the doctor about adverse effects.

High doses and overdoses

At high doses, Tryptizol (amitriptyline) can lead to heart rhythm disorders and hypotension. This can also happen at usual doses in case you have a pre-existing heart condition.

Tryptizol has been shown to be responsible for a heart problem called a long QT interval, a condition that is identified by an ECG. It can also cause heart rhythm disorders, both in the form of a fast or irregular heartbeat. It is urgent notify the referring doctor in case of suffering any of the following symptoms or these assumptions:

• Slow heart rate
• Heart failure: the heart cannot pump blood properly.
• Low levels of potassium or magnesium in the blood.
• High level of potassium in the blood.
• You are taking any other medications that can cause heart problems.
• You have a planned surgery (amitriptyline may need to be stopped before anesthetics are given).
• In the case of urgent surgery, the anesthetist should be informed of the taking of amitriptyline.
• Thyroid gland too active.
• Taking thyroid drugs.

Symptoms associated with an overdose with amitriptyline are:

• Pupillary dilation
• Fast or irregular heartbeat
• Problems urinating
• Xerostomia: dry mouth and tongue
• Intestinal blockage
• Epileptic seizures
• Fever
• Agitation and nervousness
• Confusion and hallucinations
• Uncontrolled movements
• Low blood pressure
• Weak pulse
• Pallor
• Trouble breathing
• Blue-toned skin
• Decreased heart rate
• Drowsiness
• Loss of consciousness
• Eat
• Heart problems: heart block, heart failure, hypotension, cardiogenic shock, metabolic acidosis, hypokalemia

Interactions with other substances

Some medications interact with Tryptizol, being able to aggravate the adverse effects. That is why it is very important to inform your doctor about taking the following medications:

• MAOI (p. g., enelzine, iproniazid, isocarboxazid, nialamide, or selegiline)
• Adrenaline, ephedrine, isoprenaline, norepinephrine, phenylephrine, and phenylpropanolamine (present in cough, flu, and anesthetic medications)
• Medicines to treat high blood pressure
• Calcium channel antagonists (eg. g., diltiazem and verapamil), guanethidine, bethanidine, clonidine, reserpine, and methyldopa
• Anticholinergic drugs (eg. g., atropine, hyoscyamine)
• Thioridazine
• Tramadol
• Antifungal medications (eg. g., fluconazole, terbinafine, ketoconazole, and itraconazole)
• Sedatives (p. g., barbiturates)
• Antidepressants (p. e.g., SSRI)
• Medicines for certain heart conditions (eg. g., beta-blockers and antiarrhythmics)
• Cimetidine (used to treat stomach ulcers)
• Methylphenidate (used to treat ADHD)
• Ritonavir (used to treat HIV)
• Oral contraceptives.
• Rifampicin (to treat infections)
• Phenytoin and carbamazepine (used to treat epilepsy)
• St. John's Wort (Hypericum perforatum, phytotherapeutic antidepressant)
• Thyroid medications
• Valproic acid

Too the doctor should be informed if you are currently taking or have recently taken drugs that can alter the heart rhythm What:

• Medicines to treat irregular heartbeat (eg. g., quinidine and sotalol)
• Astemizole and terfenadine (used to treat allergies and seasonal rhinitis)
• Psychopharmaceuticals such as pimozide and sertindole
• Cisapride (to treat indigestion)
• Halofantrine (to treat malaria)
• Methadone (to treat pain and for detoxification)
• Diuretics (drugs to help urinate)

Anesthetics used in surgery have dangerous effects with Tryptizol, regardless of whether they are general or local anesthetics. Therefore, the doctor and anesthetist should be advised about taking amitriptyline before undergoing any surgery, be it open heart or dental intervention.

It is also not recommended to drink alcohol during treatment with this drug, as it can increase its sedative effect.