Amitriptyline. A review of its pharmacological properties & therapeutic use in chronic pain states

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Amitriptyline is a tricyclic antidepressant agent which also has

analgesic properties. Whether its analgesic effects are linked

to its mood-altering activity or attributable to a discrete

pharmacological action (or a combination of both) is unknown.

Clinical trials demonstrate that oral amitriptyline achieves

at least a good or moderate response in up to two-thirds of

patients with post-herpetic neuralgia and three-quarters of

patients with painful diabetic neuropathy, neurogenic pain

syndromes that are often unresponsive to narcotic analgesics.

Amitriptyline has also demonstrated efficacy in heterogeneous

groups of patients with chronic non-malignant pain.

Other

possible areas of use for amitriptyline are in patients with

fibromyalgia or as an adjuvant for uncontrolled cancer pain,

although evidence for the latter application is limited.

Adverse events resulting from the antimuscarinic activity of

amitriptyline (primarily dry mouth and sedation) are commonly

reported, even at the low dosages used for the control of

pain. Low starting doses and careful dosage titration may

help to minimise these effects. Orthostatic hypotension and

tachycardia, sometimes associated with tricyclic

antidepressant agents, may also pose a problem in the elderly.

In summary, amitriptyline has a valuable place in the

treatment of chronic pain conditions that affect the elderly

provided that the drug is used judiciously to minimise

adverse effects. Importantly, amitriptyline remains the best

studied of the antidepressant agents in post-herpetic

neuralgia and diabetic neuropathy and is an important and

effective treatment option in these syndromes.

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