amitriptyline / Generic mfg. - LARVOL DELTA

Concomitant Psychotropic Medication is Associated with Reduced Outcomes of Trauma-Focused Psychotherapy for Post-Traumatic Stress Disorder. (PubMed, Psychother Psychosom) - "Several psychotropic co-medications were associated with reduced outcomes of evidence-based trauma-focused psychotherapy for PTSD. By identifying this as a potentially modifiable factor, psychotherapy outcomes may be optimized. Trials are warranted to evaluate whether tapering or substituting these agents improves outcomes."

Journal • CNS Disorders • Mood Disorders • Post-traumatic Stress Disorder

Pudendal Nerve Stimulator Provides Long-Term Relief from Persistent Urethral Discomfort (ASRA-FALL 2025) - "• HPI: oOutpatient clinic w/ 7/10 low back pain, urethral pain, and left anterior thigh pain persisting for several years despite multidisciplinary treatment oModerate relief w/ Oxycodone 15mg Q6H, Morphine 30mg BID, Amitriptyline 75mg QHS • DDX: oPelvic floor hypertonicity leading to pudendal neuralgia INTERVENTION AND RESULTS • Interventions: oTrial L fluoroscopic pudendal nerve block w/ 90% improvement in leg pain, 100% in urethral pain lasting 8 months. o>75% pain improvement, continues to this day oEliminated morphine from pain regimen. oPNS removed 2 months later given symptom resolution DISCUSSION • Pudendal Nerve Block Literature Review: oHas utility in pudendal neuralgia diagnosis and treatment.4 oAssociated w/ reduced opioid needs and fewer episodes of unacceptable pain.5 oRisk of waning efficacy, only 25% of patients w/ relief after 6 months.6 • Pudendal PNS Literature Review: oNo robust literature on pudendal PNS implantation for CPP. oLimited study of..."

Back Pain • Gynecology • Liposarcoma • Lumbar Back Pain • Musculoskeletal Pain • Neuralgia • Retroperitoneal Sarcoma • Sarcoma • Solid Tumor

Effect of Preemptive Amitriptyline on Postoperative Pain after Impacted Mandibular Third Molar Extraction: A Randomized Clinical Trial. (PubMed, Front Dent) - "The time interval from surgery to the first analgesic intake was significantly longer in the amitriptyline group (P<0.001). Preemptive consumption of amitriptyline can effectively reduce postoperative pain and analgesic consumption following impacted mandibular third molar extraction surgery."

Clinical • Journal • Pain

Resistance to thyroid hormone: clinical and biochemical paradox. (PubMed, BMJ Case Rep) - "Treatment included propranolol, amitriptyline, loperamide and vitamin D supplementation, resulting in symptomatic improvement. It also highlights the phenotypic variability of THRβ and the need for individualised management. Differential diagnoses like TSH-producing adenoma (TSHoma), laboratory assay interference and drug-induced thyroid dysfunction were ruled out."

Journal • Cardiovascular • Endocrine Disorders • Urinary Incontinence

Disparities in Prophylactic Medication Use for Cyclic Vomiting Syndrome Between Academic and Non-academic Hospitals: A Retrospective Cohort Study Using the TriNetX Network [WITHDRAWN] (ACG 2025) - "Baseline characteristics of patients is shown in Table 1. Prescription rates for CVS prophylaxis were significantly higher in academic settings vs non-academic settings [11.1% vs 7.49%, p value = < 0.0001] with a RR 1.48; 95% CI: 1.39-1.587. Amitriptyline was the most commonly prescribed agent, followed by nortriptyline, topiramate and aprepitant (Table 2)."

Retrospective data • Bipolar Disorder • CNS Disorders • Depression • Epilepsy • Gastrointestinal Disorder • Mood Disorders • Psychiatry • Rare Diseases

Prolonged Prophylactic Migraine Therapy Associated With Reduction in Frequency and Severity of Cyclic Vomiting Syndrome Episodes: A Retrospective Review (ACG 2025) - "Prophylactic therapies included amitriptyline, propranolol, topiramate, and candesartan. Of 54 patients with CVS, 16 met inclusion criteria. Mean episode frequency declined from 5.2 episodes/year pre-treatment to 1.6 episodes/year post-treatment (p< 0.001). Average episode duration also decreased from 3.4 days to 1.7 days (p=0.002)."

Retrospective data • Review • CNS Disorders • Gastroenterology • Gastrointestinal Disorder • Migraine • Pain • Rare Diseases

Reassessing Tricyclic Antidepressants in IBS: A Review of Amitriptyline Efficacy (ACG 2025) - "Our five included studies investigated the effectiveness of amitriptyline (10mg-75mg) in treating irritable bowel syndrome (IBS), mainly focusing on its impact on pain, stress-related symptoms, and overall quality of life in 236 patients. All five of our included trials were randomized clinical trials comparing amitriptyline to placebo (Table 1). The ATLANTIS trial is the largest among all included studies."

Clinical • Review • Gastroenterology • Gastrointestinal Disorder • Xerostomia

When the Flow Stops: Functional Biliary Obstruction Secondary to Chronic Opioid Use (ACG 2025) - "Treatment included low-dose amitriptyline and lifestyle modifications. Opioids can elevate sphincter of Oddi tone via μ-opioid receptor activation, leading to functional outflow obstruction...Early recognition of opioid-induced SOD can help avoid unnecessary procedures and guide effective symptom control.Figure: Image 1: Computed Tomography (CT) of the AbdomenModerate biliary tree dilation without evidence of calcified choledocholithiasis, along with accompanying dilation of the pancreatic duct.Figure: Image 2: Magnetic resonance cholangiopancreatography (MRCP)Progressive dilation of both intrahepatic and extrahepatic bile ducts, along with prominence of the pancreatic duct, most notably in the region of the pancreatic head. No evidence of obstructing calculi or mass lesion is observed."

CNS Disorders • Diabetes • Epilepsy • Gastrointestinal Disorder • Hepatology • Metabolic Disorders • Pancreatitis • Type 2 Diabetes Mellitus

Chronic Functional Bowel Disorder with Fibromyalgia in a 52-Year-Old Male: A Case of Persistent Multisystem Symptoms (ACG 2025) - "Amitriptyline was replaced by duloxetine (30 mg daily) for persistent pain and fatigue. This case supports the role of gut-brain-microbiome dysfunction in multisystem disorders. Multimodal therapy targeting both gastrointestinal and systemic pathways can improve outcomes in complex, comorbid presentations.Figure: Figure 1: Colonoscopy showing normal mucosa with no evidence of inflammation or structural lesions.Figure: Figure 2: Stool Microbiome Composition Bar Chart: Comparison between control and IBS + Fibromyalgia patient."

Clinical • Cardiovascular • Constipation • Fatigue • Fibromyalgia • Gastroenterology • Gastrointestinal Disorder • Hypertension • Immune Modulation • Immunology • Inflammation • Inflammatory Bowel Disease • Musculoskeletal Pain • Pain • Rheumatology

Navigating the Diagnostic Complexities of Post-Appendectomy Chronic Abdominal Pain (ACG 2025) - "of 453 ml, unconfirmed secondary adrenal insufficiency diagnosed via ACTH stimulation test (2023), and stool Calprotectin level of 114 µg/g.Hydrocortisone caused exogenous Cushingoid features and weight gain. Hydromorphone used for pain management caused dependency issues, while amitriptyline and gabapentin provided minimal pain relief...However, inaccessibility leads to its non-implementation.Thus, a multidisciplinary approach involving opioid deprescribing, adrenal axis monitoring, and CBT is required for managing chronic postsurgical pain. The hormonal dysregulation, central sensitization, and maladaptive cognition interplay indicate significant gaps in chronic pain models, underscoring the need for holistic care."

Addiction (Opioid and Alcohol) • CNS Disorders • Endocrine Disorders • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammatory Bowel Disease • Mood Disorders • Nephrology • Neuroendocrine Tumor • Pain • Psychiatry • Renal Disease • Solid Tumor

Hereditary Angioedema Presenting With Isolated Gastrointestinal Symptoms (ACG 2025) - "Her symptoms had not responded significantly to trials of amitriptyline, hyoscyamine, simethicone, peppermint oil derivatives, or proton pump inhibitors (PPIs)...Further questioning revealed the patient had started lisinopril a few months prior...In cases of hereditary angioedema, it is important recognize triggers, such as angiotensin converting enzyme inhibitors. Avoidance of triggers is essential to management.Figure: Figure 1: Computed tomography (CT) with marked small bowel wall thickening."

Cardiovascular • CNS Disorders • Complement-mediated Rare Disorders • Constipation • Depression • Dyslipidemia • Gastroenterology • Gastrointestinal Disorder • Hereditary Angioedema • Hypertension • Mood Disorders • Psychiatry

Behavioral standardization and validation of a new model of cancer-induced depression in sarcoma-bearing mice. (PubMed, Physiol Behav) - "Next, studies investigated oral effects of amitriptyline (AMI), fluoxetine (FLU), or 5-fluorouracil (5-FU, i.p.) at 10 or 20 mg/kg/day (alone or in combination) on behavior and oxidative/nitrosative profile of subacute-treated mice. Such biochemical changes and depressive phenotype were partly attenuated by amitriptyline and fluoxetine 10 or 20 mg/kg/day for 10 days, but co-treatment with 5-fluoruracil did not show additional improvements. This physiopathological study represent a promising discovery highlighting the potential of non-clinical protocols to understand mesenchymal tumor-related depression and to develop new pharmacological tools against the multivariate spectrum of cancer-related diseases."

Journal • Preclinical • CNS Disorders • Depression • Mental Retardation • Mood Disorders • Oncology • Psychiatry • Sarcoma • Solid Tumor • Transplantation

Preventing relapse in patients with major depressive disorder after an effective acute course of electroconvulsive therapy. (PubMed, Australas Psychiatry) - "Imipramine, phenelzine, amitriptyline and CBT demonstrated encouraging results, while escitalopram failed to show a favourable outcome. Clinicians aiming to reduce the risk of relapse after an effective acute course of ECT could consider lithium, nortriptyline, venlafaxine and CBT."

Journal • CNS Disorders • Depression • Major Depressive Disorder • Mood Disorders • Psychiatry

Comprehensive insights into diabetic peripheral neuropathy: pathophysiology and therapeutic approaches. (PubMed, J Diabetes Metab Disord) - "The United States Food and Drug Administration has approved pharmacological treatments for painful diabetic peripheral neuropathy: pregabalin, duloxetine, gabapentin, extended-release tapentadol, tramadol, and the capsaicin 8% patch. Non-Food and Drug Administration-approved therapies, such as amitriptyline and the 5% lidocaine patch, are also widely used...A multifaceted approach incorporating pharmacological and non-pharmacological therapies is essential for optimizing patient outcomes in diabetic peripheral neuropathy. Targeting underlying pathophysiological mechanisms while providing symptomatic relief can enhance treatment efficacy and improve the quality of life for individuals with diabetic peripheral neuropathy."

Journal • Review • Diabetes • Diabetic Neuropathy • Metabolic Disorders • Neuralgia • Pain • Peripheral Neuropathic Pain

Pharmacological Insights into Optimal Dosing in Burning Mouth Syndrome: A Narrative Review of the Non-Linear Actions of Amitriptyline and Aripiprazole. (PubMed, J Clin Med) - " The pharmacological actions of amitriptyline and aripiprazole in BMS are not linearly dose-dependent, but rather exhibit a personalized therapeutic window driven by complex interactions with NMDA and D2 receptors and adaptive physiological responses. This intricate pharmacological landscape mandates a personalized medicine approach to optimize treatment outcomes, improve patient adherence, and enhance the quality of life for individuals suffering from this challenging nociplastic pain condition."

Journal • Review • Pain • DRD2

Conservative Laparoscopic Management of Retroperitoneal Vascular Injury During Veress Needle Entry: A Case Report in a high BMI Patient Undergoing Diagnostic Laparoscopy for Subfertility (ESGE 2025) - "During 3 months follow up, the patient reported symptoms of meralgia paresthetica, likely secondary to intraoperative positioning, and was successfully managed with amitriptyline...A combination of secondary laparoscopic access, careful inspection, and intraoperative CT imaging enabled a safe, conservative approach without haematoma disruption or laparotomy. Such strategies are critical for preserving the benefits of minimally invasive surgery, particularly in fertility-related procedures."

Case report • Clinical • Anesthesia • Endometriosis • Gynecology • Infertility • Women's Health

CRRT FOR OPTIMIZED BICARBONATE DELIVERY IN SEVERE TRICYCLIC ANTIDEPRESSANT OVERDOSE: A CASE REPORT (CHEST 2025) - "We report a case in which CRRT was successfully used to enhance bicarbonate delivery in a patient with severe amitriptyline overdose...She received midazolam, lorazepam, sodium bicarbonate, and was intubated for airway protection.In the Emergency Department (ED), she was in cardiogenic shock requiring norepinephrine and vasopressin... CRRT may serve as a novel approach for optimizing bicarbonate delivery in severe TCA overdose, particularly in cases refractory to standard therapy. While not routinely used for this indication, CRRT offers a controlled alkalinization and should be considered in select cases. Further research is needed to define its role in TCA toxicity management."

Case report • Clinical • Acute Kidney Injury • Anesthesia • Cardiovascular • CNS Disorders • Depression • Epilepsy • Hepatology • Infectious Disease • Liver Failure • Metabolic Disorders • Nephrology • Pneumonia • Psychiatry • Renal Disease • Respiratory Diseases • Septic Shock

A CASE OF SEVERE HYPERTHERMIA AND SYSTEMIC INFLAMMATORY RESPONSE SYNDROME DUE TO A PSYCHOTROPIC MEDICATION (CHEST 2025) - "Infectious diseases recommended repeat blood cultures (which returned negative) and changing cefepime, vancomycin, and metronidazole to meropenem...Duloxetine, amitriptyline, and meropenem were all discontinued... A work-up driven by relevant history and physical exam findings is required for a patient presenting with fever. Besides infection, adverse and idiosyncratic drug reactions may be the underlying etiology of hyperthermia. Prompt recognition and management is required to prevent complications of an elevated core body temperature."

Clinical • Cardiovascular • CNS Disorders • Cognitive Disorders • Coronary Artery Disease • Depression • Hepatology • Immunology • Infectious Disease • Inflammation • Inflammatory Arthritis • Liver Failure • Psychiatry • Pulmonary Disease • Respiratory Diseases • Rheumatoid Arthritis • Rheumatology • Septic Shock • Systemic Inflammatory Response Syndrome

DISPARITIES IN MANAGEMENT OF REFRACTORY CHRONIC COUGH: A RETROSPECTIVE DATABASE REVIEW (CHEST 2025) - "For all patients, benzonatate was the most prescribed antitussive (23%), followed by guaifenesin (13%), codeine (11%) and gabapentin (7%). Black patients were more likely to be prescribed benzonatate (OR: 1.205, CI 1.14-1.274), guaifenesin (OR: 1.316, CI 1.213-1.428), and dextromethorphan (OR: 1.453, CI 1.314-1.608) compared to White patients but they were less likely to receive codeine (OR: 0.882, CI 0.793-0.981) and amitriptyline (OR: 0.661, CI 0.5-0.873)... This study highlights significant racial disparities in the prescribing patterns for RCC therapies. Black patients were more likely to receive non-opioid antitussives but less likely to be prescribed opioid-based treatments such as codeine and tricyclic antidepressants such as amitriptyline. These differences may reflect systemic biases or variations in clinical decision- making and warrant further investigation into their underlying causes."

Retrospective data • Review • Allergic Rhinitis • Asthma • Chronic Cough • Chronic Obstructive Pulmonary Disease • Cough • Gastroesophageal Reflux Disease • Immunology • Inflammation • Renal Cell Carcinoma • Respiratory Diseases

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) IN TRICYCLIC ANTIDEPRESSANT (TCA) OVERDOSE: A FORGOTTEN BUT CRITICAL COMPLICATION (CHEST 2025) - "Her agitation was managed with dexmedetomidine, along with as-needed doses of lorazepam and phenobarbital...Serum levels confirmed toxic amitriptyline/nortriptyline levels at 1698 ng/mL... TCA overdoses have decreased in frequency with the addition of newer antidepressants, but they remain a substantial cause of morbidity and mortality. While the cardiac and central nervous system (CNS) effects are well-documented, clinicians need to recognize the potential for pulmonary complications, including ARDS, to start adequate treatment."

Acute Respiratory Distress Syndrome • CNS Disorders • Epilepsy • Infectious Disease • Migraine • Pneumonia • Respiratory Diseases

Neck pain in migraine: A narrative review and steps to correct evaluation and treatment. (PubMed, Cephalalgia) - "Standard migraine therapies, such as amitriptyline and onabotulinumtoxinA, may help reduce neck pain and non-pharmacological treatments, such as physical therapy, acupuncture and behavioural strategies, show some promise. However, few studies have assessed the effects of acute or preventive migraine therapies, particularly calcitonin gene-related peptide-targeted treatments, on neck pain, highlighting a significant gap in our current knowledge. Future research should evaluate the effectiveness of these therapies on neck pain, both alone and in combination with non-pharmacological interventions."

Journal • Review • CNS Disorders • Migraine • Musculoskeletal Pain • Pain

Pharmacotherapy for fecal incontinence: potential treatment with a traditional Japanese medicine Kampo. (PubMed, Ann Coloproctol) - "Strongly recommended treatments include the antidiarrheal agent loperamide and stool bulking or solidifying agents, such as dietary fiber and polycarbophil. Other therapeutic options include ramosetron, a 5-HT3 receptor antagonist; amitriptyline, a tricyclic antidepressant; and sodium valproate and diazepam, which are GABAergic neuromodulators. Recently, research has explored the efficacy and mechanism of action of DKT, a traditional Japanese medicine Kampo. Historically used for abdominal symptoms like bloating and known for promoting intestinal motility, emerging evidence suggests DKT may also effectively manage FI."

Journal • Review

Understanding Antidepressant Change Patterns in the UK Biobank (WCPG 2025) - "The preference for antidepressants changed markedly over time, shifting from dosulepin, fluoxetine, to citalopram in the depression group, and from dosulepin to amitriptyline in the non-depression group. A total of 82,633 individuals in the UK Biobank were prescribed at least one antidepressant. Of these, 28,332 had a depression diagnosis and 24,543 did not. The most commonly prescribed antidepressants were Selective Serotonin Reuptake Inhibitors, including citalopram and fluoxetine in individuals with depression, and Tricyclic Antidepressants like amitriptyline in those without."

CNS Disorders • Depression • Insomnia • Major Depressive Disorder • Mood Disorders • Psychiatry • Sleep Disorder

Relax the Body: Dual-Agent Nighttime Therapy for Fibromyalgia: Symptom Reduction Using Tricyclic Antidepressants and Muscle Relaxants (ACR Convergence 2025) - "All participants were prescribed a low dose TCA (amitriptyline, doxepin, or trazodone) in the early evening, titrated as needed to induce deep sleep. Once patients reported improved sleep, a nightly muscle relaxant - either cyclobenzaprine or tizanidine - was introduced and gradually increased based on tolerability, up to 30 mg or 24 mg respectively... This study introduces a novel multimodal pharmacologic regimen combining tricyclic antidepressants and muscle relaxants to target both central and peripheral mechanisms contributing to FM symptomatology. Results suggest that such a combination can improve pain, sleep, and energy in a substantial portion of FM patients, with minimal side effects. Given the limitations of existing monotherapies and the heterogeneity of FM symptoms, this approach warrants further exploration in larger randomized controlled trials."

Anesthesia • CNS Disorders • Fatigue • Fibromyalgia • Musculoskeletal Pain • Pain • Rheumatology • Sleep Disorder

Amitriptyline-Induced Rabbit Syndrome: A Case of Refractory Oral Vertical Dyskinesia (MDS Congress 2025) - "She was started on valbenazine for her prior diagnosis of TD, but was discontinued as it worsened her symptoms...Trials of propranolol, carbidopa/levodopa, and benztropine showed minimal improvement... Rabbit syndrome is a rare, drug-induced oral vertical dyskinesia. Classically, it is characterized by rhythmic, peri-oral movements which resembles the chewing motion of a rabbit. Although it is typically associated with antipsychotics, it can also be triggered by other medications, including tricyclic antidepressants [1]."

Clinical • Preclinical • CNS Disorders • Depression • Mood Disorders • Movement Disorders • Psychiatry