amitriptyline / Generic mfg. - LARVOL DELTA

Severe, refractory restless legs syndrome responding to hyperbaric oxygen therapy: a case report (WSS 2025) - "At the time of hyperbaric oxygen therapy (HBOT) initiation, she was taking buprenorphine patch 5 mcg/h weekly, amitriptyline 25 mg nocte, agomelatine 25 mg daily, gabapentin 600 mg daily, and zopiclone 7.5 mg nocte. This case highlights the potential for HBOT to serve as a novel adjunctive therapy for patients with refractory RLS, particularly when conventional treatment options have been exhausted. If further validated, HBOT may offer a promising avenue for improving quality of life in this challenging patient population."

Case report • Clinical • CNS Disorders • Insomnia • Movement Disorders • Respiratory Diseases • Restless Legs Syndrome • Sleep Apnea • Sleep Disorder

Neurosarcoidosis presentation with refractory neuropathic pain: A case report (WASOG-AASOG 2025) - "Medications attempted but unsuccessful in managing symptoms included gabapentin, amitriptyline, mexiletine, steroids, and opiates. Immunomodulatory disease management included oral prednisone, methotrexate, and infliximab...This patient meets the criteria for probable neurosarcoidosis, with pathologic confirmation of systemic granulomatous disease and a typical neurologic presentation. Limited published data and a lack of therapeutic alternatives exist for patients with severe PNS involvement, aside from corticosteroids. These patients require a multi-modal approach, and further research is needed to improve treatment options and prevent worsening disability."

Case report • Clinical • Addiction (Opioid and Alcohol) • Immunology • Neuralgia • Pain • Sarcoidosis

Effective Control of Neuropathic Pain With Amitriptyline in Neuromyelitis Optica Spectrum Disorder: A Case Report. (PubMed, Cureus) - "The patient was treated with methylprednisolone pulse therapy, followed by maintenance immunosuppressive therapy with inebilizumab and prednisolone, resulting in neurological improvement. This case highlights the potential of amitriptyline as an effective treatment for NP in NMOSD, a common and often resistant symptom in this condition. Given the complex mechanisms underlying NMOSD-related pain, individualized management strategies that include pharmacological agents like amitriptyline are crucial for improving patient quality of life (QOL), and further research is needed to optimize these approaches."

Journal • CNS Disorders • Musculoskeletal Pain • Neuralgia • Neuromyelitis Optica Spectrum Disorder • Pain • Rare Diseases

Physiologically-Based Pharmacokinetic Modeling Predicts Altered Maternal Pharmacokinetics of Amitriptyline during Pregnancy (WFSBP 2025) - " A PBPK model, including AMI, but also its active metabolite nortriptyline (NOR), was developed to investigate pregnancy-induced pharmacokinetic changes in AMI treated pregnant women. We added valuable information on AMI pharmacokinetics during pregnancy (similar sum serum concentrations of AMI+NOR, but increased AMI concentration and decreased NOR concentration). For clinical practice the treating physician should be aware that despite active moiety serum concentration comparable to before pregnancy, tolerability may be affected due to increased AMI serum concentrations and as consequence increased anticholinergic effects."

PK/PD data • CNS Disorders • Depression • Psychiatry

Botulinum Toxin-A, Generating a Hypothesis for Orofacial Pain Therapy. (PubMed, Toxins (Basel)) - "Each require tailored prophylactic pharmacotherapy, such as carbamazepine, gabapentin, pregabalin, amitriptyline, metoprolol, and topiramate. In addition, the advantage of BoNT-A for providing a safe sustained effect after a single application for chronic pain prophylaxis is discussed, as opposed to the daily use of current conventional prophylactic medications. Finally, we summarize the clinical applications of BoNT-A for chronic orofacial pain therapy."

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

Comparison of the effectiveness of first-line preventive treatment of migraine in primary care: study protocol for a pragmatic clinical trial (PREMI study). (PubMed, Trials) - P4 | "There are epidemiological, clinical and pharmacological sex-differences in migraine which may result in differences in the use of migraine preventive drugs. However, the effectiveness of the most frequent preventive treatment and the differences in effectiveness and safety between women and men have not yet been studied. Moreover, as new expensive drugs have been authorized for preventive treatment, indicated when the usual drugs have failed, assessing the effectiveness and safety of the usual oral preventive drugs through a clinical trial is especially important. We also plan to evaluate their cost-effectiveness, and the clinical trial will count on an active contribution from patients through an app designed for this purpose, which may help in the management of the disease in the future."

Clinical • Journal • CNS Disorders • Migraine • Pain

Effects of antidepressant exposures on a stream detrital food chain: Microbial decomposers and invertebrate detritivores. (PubMed, Ecotoxicol Environ Saf) - "Thus, fluoxetine and amitriptyline exhibited different bottom-up effects on the detrital food chain by acting on distinct microbial enzymes. Consequently, this study demonstrates that antidepressants disrupt key ecosystem processes, impacting nutrient cycling and freshwater ecosystem health."

Journal

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

Potentially Inappropriate Medication Use in Patients With Parkinson's Disease: Analysis of Korean National Health Insurance Claims Data. (PubMed, J Clin Neurol) - "The prevalence and usage of PIMs were high in Korean PD patients during 2014-2019, and the utilization of PIMPDs persisted throughout this period. These findings can be used to develop evidence-based guidelines for robust polypharmacy management strategies to ensure the safety of medications used by PD patients."

Journal • Reimbursement • US reimbursement • CNS Disorders • Movement Disorders • Parkinson's Disease

Modeling the efficacy of a novel antidepressant zuranolone for major depressive disorder. (PubMed, J Affect Disord) - "We used changes in rating scale scores from baseline to perform a model-based meta-analysis, characterizing the progression of drug efficacy and placebo response over time and comparing zuranolone's efficacy and safety profiles with those of established antidepressants (escitalopram and amitriptyline). Primary adverse events related to zuranolone included somnolence, headache, dizziness, and sedation, with no severe safety signals observed. Zuranolone demonstrates a safety profile comparable to escitalopram as well as rapid-onset antidepressant action, sustained clinical efficacy, and favorable tolerability, highlighting its potential as a promising therapeutic option for MDD."

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

Amitriptyline (TCA) (IHC 2025) - No abstract available

CNS Disorders • Migraine

Mind and Body Approaches to Pain Reduction in Youth With Migraine (clinicaltrials.gov) - P2 | N=132 | Completed | Sponsor: Children's Hospital Medical Center, Cincinnati | Active, not recruiting ➔ Completed

Trial completion • CNS Disorders • Migraine • Pain

Synthesis and applications of biocompatible aromatic block copolypeptides as high-performance adsorbent materials (ACS-Fall 2025) - "Structural characterization confirmed successful synthesis and provided insights into composition-dependent material properties.Adsorption studies in simulated biological media (gastric fluid and intestinal fluid) with pharmaceuticals (amitriptyline, bupropion, hydroxychloroquine, and strychnine) revealed high binding capacities and rapid kinetics, driven by electrostatic interactions, hydrogen bonding, and π-stacking. Biocompatibility was validated through cytocompatibility assays with NIH 3T3 fibroblasts and RAW 264.7 macrophages, while C. elegans exposure studies further assessed systemic toxicity, demonstrating excellent safety profiles.With their tunable design, these polypeptides offer a promising platform for optimizing drug sequestration efficiency while minimizing off-target effects. This work underscores the potential of aromatic block copolypeptides as next-generation adsorbents for precise and effective overdose interventions, paving the way for safer, more..."

Gastrointestinal Disorder • Targeted Protein Degradation

Mechanistic Insights and Therapeutic Potential of the Antidepressant Amitriptyline against Leishmania (Leishmania) amazonensis. (PubMed, ACS Omega) - "Combination assays with standard drugs amphotericin B and miltefosine demonstrated additive interactions, reinforcing the potential of amitriptyline as complementary therapy. This work highlights the antileishmanial activity of tricyclic compounds and underscores the potential for further repositioning studies, broadening the assessment of clinically used, structurally related compounds."

Journal • Infectious Disease

Co-prescribing of antidepressants and opioids for non-cancer pain in England, 2010-2019: a descriptive study using CPRD primary care electronic health records. (PubMed, BMC Prim Care) - "There is a substantial group of people co-prescribed opioids and antidepressants in England, including combinations that may be less effective. This information will be useful to help GPs, dispensing professionals, policymakers and others understand how many people in the UK may be at risk of harm from using both types of medicines at the same time, and which groups are particularly affected. Future research should determine whether there are higher risks of adverse events in these co-prescribed groups."

Journal • Cardiovascular • CNS Disorders • Congestive Heart Failure • Heart Failure • Mood Disorders • Oncology • Pain • Psychiatry

Efficacy and safety of different medications compared for the treatment of postherpetic neuralgia: a network meta-analysis. (PubMed, Front Pharmacol) - "Amitriptyline plus pregabalin demonstrated the highest probability of clinical superiority (SUCRA = 0.92). The study showed that capsaicin patches and hydromorphone were more significant in relieving pain in PHN, whereas calcium channel modulators were more comprehensive in clinical management. The inclusion of more high-quality articles was needed to support this evidence due to quality bias in the literature."

Journal • Retrospective data • Review • Herpes Zoster • Neuralgia • Pain • Varicella Zoster

Eagle Syndrome, A Third Variant: Giant Styloid Processes, Pseudoarthrosis, and Unilateral Facial Spasms Progressing to Facial Paralysis. (PubMed, Case Rep Otolaryngol) - "The patient developed delayed first-bite syndrome successfully treated with amitriptyline...The relative rarity and varied presentations of Eagle syndrome often create a diagnostic challenge, especially for patients with progressive symptoms. Our patient's presentation emphasizes the importance of a thorough head and neck evaluation of any patient presenting with head and neck signs or symptoms persisting for longer than 3 weeks as well as awareness of what we believe is the first description of a third variant of Eagle syndrome."

Journal • CNS Disorders • Musculoskeletal Pain • Osteoarthritis • Pain

Adsorption of antidepressant and cardiovascular drugs to activated charcoal: amitriptyline, bupropion, minoxidil, propranolol, and venlafaxine. (PubMed, Clin Toxicol (Phila)) - "This study supports the use of activated charcoal for gastrointestinal decontamination in overdoses involving amitriptyline, bupropion, minoxidil, propranolol, and venlafaxine. However, drug-specific differences in adsorption behavior suggest a need for refined dosing strategies, particularly in cases involving drugs with lower binding efficiencies."

Journal • Addiction (Opioid and Alcohol) • Cardiovascular • CNS Disorders

Anticholinergic Equivalence in Psychotropic Medications: A Guide for Psychiatrists. (PubMed, J Clin Psychopharmacol) - "The anticholinergic equivalence table provides a practical, pharmacologically based tool for psychiatrists to quantify and compare the anticholinergic potential of psychotropic medications. This can aid in minimizing cumulative anticholinergic burden, making more informed prescribing decisions, and ultimately enhancing patient safety and therapeutic outcomes, especially in high-risk groups."

Journal • Alzheimer's Disease • Anesthesia • CNS Disorders • Cognitive Disorders • Psychiatry

Analysing the impact of gabapentinoid reclassification on prescribing rates of antidepressants recommended for neuropathic pain treatment in the UK (NeuPSIG 2025) - "A previous analysis exploring the impact of reclassification on gabapentinoid prescribing rates, showed a significant decrease in Defined Daily Dose (DDDs - assumed average daily doses of drugs for an adult) levels post-reclassification for gabapentin in Scotland, and significant negative changes in trend post-reclassification for pregabalin in Scotland, England and Wales[3]. The ITSA results suggest no significant difference in amitriptyline and duloxetine prescribing trends pre- and post-reclassification across the UK, with trends continuing to rise. This implies that gabapentinoid reclassification did not directly affect the prescribing rates of amitriptyline and duloxetine. This may inform future policy and guideline changes, to limit unnecessary and inappropriate prescribing of amitriptyline and duloxetine, additionally to other first-line neuropathic pain medication."

CNS Disorders • Neuralgia • Pain