amitriptyline / Generic mfg. - LARVOL DELTA

Tricyclic antidepressant amitriptyline potentiates brain-derived neurotrophic factor expression mediated by PKC delta-NF-kappa B signaling in primary cultured astrocytes with connexin43-knockdown. (PubMed, Neurochem Int) - "These findings suggest that Cx43 downregulation in astrocytes, which has been considered a pathological feature of depression, may paradoxically contribute to the therapeutic efficacy of antidepressants by sensitizing a specific signaling pathway. Our study provides new insights into the molecular mechanism of antidepressant action and highlights the potential role of astrocytic Cx43 in modulating therapeutic responses."

Journal • CNS Disorders • Depression • Psychiatry

Opportunities and challenges for the implementation of pharmacogenomics in supportive care for gastrointestinal cancer patients in Zimbabwe. (PubMed, Pharmacogenomics) - "PGX guidelines were fully implemented for tramadol, codeine, omeprazole, and ondansetron; partially for ibuprofen and celecoxib; and unimplementable for amitriptyline. There is an opportunity to improve supportive care in gastrointestinal cancer patients through pharmacogenomics though some specific medicines challenges to full implementations are due to limited registered medicines."

Biomarker • Journal • Gastrointestinal Cancer • Oncology • Solid Tumor

Predicting xenobiotic metabolism: a computational approach mining LC-MS/MS data with SIRIUS and BioTransformer. (PubMed, Arch Toxicol) - "We challenged our workflow to the analysis of human metabolites from 6 well-known drugs, administered to primary human hepatocytes and human liver microsomes: amitriptyline (10 µM), carbamazepine (12.5 µM), cyclophosphamide (20 µM), fipronil (20 µM), phenytoin (50 µM), and verapamil (6 µM). This strategy proved efficient in accelerating the study of drug metabolism, potentially avoiding tedious manual metabolite identification. In sum, we demonstrate that this computational workflow holds potential in automating metabolite identification, expanding metabolite coverage, and elucidating metabolites of newly developed drugs."

Journal

Psychiatric Medications Procurement at Primary Health Centers (PHCs) in Tumkur: Insights from an Effectiveness Implementation Hybrid Randomized Controlled Trial on Mental Health Tele-mentoring of Primary Care Doctors (PCDs). (PubMed, Indian J Psychol Med) - "Within-group analysis over time showed a statistically significant increase in the proportion of PHCs procuring amitriptyline in both the OMHT arm (p = .01) and the TAU arm (p = .03). Additionally, in the OMHT arm, there was a significant increase over time in the proportion of PHCs procuring alprazolam (p = .03) and clonazepam (p = .02). In the between-group comparison of total quantities procured during the combined training and post-training phases, the OMHT arm demonstrated significantly higher procurement of escitalopram (p < .01) and risperidone (p < .01) compared to the TAU arm, indicating greater confidence in prescribing practices of key psychiatric medications among trained PCDs. Clinical Trials Registry of India (CTRI/2024/02/062906)."

Journal • CNS Disorders • Mental Retardation • Psychiatry

What's Hot, What's Not: Review of Pharmacological Options for Managing Burning Mouth Syndrome. (PubMed, Ann Pharmacother) - "Multiple agents with different mechanisms of action may be beneficial in the management of BMS. In the absence of treatment guidelines, providers may refer to this review when managing their patients."

Journal • Review • Pain

Adjustment for dispensed doses does not explain higher antidepressant concentrations in post-mortem toxicology. (PubMed, Br J Clin Pharmacol) - "Dose adjustment generally did not improve the separation of poisoning vs non-poisoning suicides, indicating that post-mortem concentrations may not have clear dose-concentration relationships."

Journal

Amitriptyline for Refractory Idiopathic Intractable Hiccups: A Case Report. (PubMed, Clin Neuropharmacol) - "This is the first case in over 30 years providing additional evidence for amitriptyline use in the relief of intractable hiccups. Amitriptyline may be more useful in patients experiencing intractable hiccups with comorbid mood disorders and in cases of suspected psychogenic origin."

Journal • CNS Disorders • Mood Disorders • Psychiatry

Oreonudines A-H, Benzylisoquinoline-Derived Alkaloids with Diverse Skeletons from Oreomecon nudicaulis and Their Antidepressant Activities. (PubMed, J Nat Prod) - "Among them, mecoquitupline (15) showed significant inhibitory activity against 5-HT (88.0%) and NE (58.8%) reuptake, outperforming the tricyclic antidepressant amitriptyline (53.6% and 35.5%, respectively), and notably activated the neurotrophic BDNF/CREB signaling pathway...In contrast, 12 and 16 selectively inhibited NE and 5-HT reuptake, respectively, by targeting the corresponding transporters. These findings highlight mecoquitupline (15) as a promising dual-action antidepressant candidate with potent activity."

Journal

MIGRA-MS: A case series on chronic migraine and multiple sclerosis (EHF-EHC 2025) - "Prior treatments included interferons and glatiramer acetate; current therapies consisted of ocrelizumab, natalizumab, alemtuzumab, teriflunomide, or dimethyl fumarate...All received a median of three classic preventives (amitriptyline in all cases) and onabotulinumtoxinA (PREEMPT, 155 IU) with only one responder; two patients received an extended dose (195 IU) without benefit and later CGRP monoclonal antibodies (galcanezumab, erenumab, eptinezumab) with no response, and atogepant with only transient or partial benefit...In this case series of relapsing–remitting MS with chronic resistant migraine, response to onabotulinumtoxinA and anti-CGRP therapies was limited, with no drug interactions or adverse effects observed. An individualized approach and further studies are needed to assess emerging treatments in this subgroup."

Clinical • CNS Disorders • Migraine • Multiple Sclerosis • Pain

Evaluating agreement between physician and ChatGPT in migraine prophylaxis selection: A pilot comparative study (EHF-EHC 2025) - "To evaluate the level of agreement between human clinicians and an artificial intelligence (AI) model (ChatGPT) in recommending first-line prophylactic therapies for patients with migraine, and to assess the potential clinical value of AI-generated support.In this observational pilot study, we analyzed 21 consecutive patients with a confirmed diagnosis of episodic migraine evaluated at a pain clinic.For each patient, the treating clinician selected a first-line preventive treatment among four options: amitriptyline, propranolol, topiramate or flunarizine. This pilot study demonstrates that ChatGPT can produce clinically coherent prophylactic treatment proposals in the management of migraine, with a statistically significant moderate agreement with experienced pain physicians. Further validation on larger cohorts is warranted to explore its potential as a clinical decision support tool."

CNS Disorders • Migraine • Pain

Migraine worsening after excellent initial response to galcanezumab (EHF-EHC 2025) - "Several prophylactics were tried (topiramate, amitriptyline, and atogepant) with no improvement...However, in the last few months of treatment, she experienced recrudescence of symptoms – she's now awaiting treatment with eptinezumab...While he tried several preventive medications (topiramate, amitriptyline, venlafaxine and valproic acid), he was also medicated with corticosteroids...Recent literature and medical experience refer to Galcanezumab as a good sustained treatment to refractory migraine. However, these cases highlight the situations in which, despite the initial response being great, there's no prolonged effect on pain relief."

Cardiovascular • CNS Disorders • Complement-mediated Rare Disorders • Hepatology • Hereditary Angioedema • Migraine • Pain

Comparative effectiveness: Amitriptyline and toxin botulinum in tension type headache (EHF-EHC 2025) - "Amitriptyline remains the first-line drug in the treatment of most people. However, botulinum toxin is an important alternative for cases that do not respond to the conventional approach"

HEOR • Pain

Comparative efficacy and safety of venlafaxine versus amitriptyline for migraine prophylaxis: A systematic review and meta-analysis (EHF-EHC 2025) - "Safety profiles were similar, suggesting venlafaxine may be a clinically appropriate alternative for migraine prophylaxis. Further trials are needed to confirm these findings."

Retrospective data • Review • CNS Disorders • Constipation • Gastroenterology • Gastrointestinal Disorder • Migraine • Pain • Xerostomia

Clinical-genotype machine prescription for migraine – A HUNT study (EHF-EHC 2025) - "In total, 475 participants tried a preventive (amitriptyline, beta-blocker, candesartan or topiramate) and 565 a triptan (371 sumatriptan) during the project period. Figure 1 . SHAP bar blot of ten most important clinical features across all four preventive models"

Clinical • CNS Disorders • Migraine • Pain

Preventive migraine care before headache clinical referral: Are we doing it right? (EHF-EHC 2025) - "Commonly prescribed agents in primary care shifted from propranolol and amitriptyline in 2017 to topiramate and amitriptyline in 2023. Our findings suggest a clear evolution toward more appropriate and guideline-informed referral practices. Primary care providers are increasingly initiating preventive therapy before seeking specialist input."

Clinical • CNS Disorders • Migraine • Pain

Cervical meningioma underlying facial episodic paresthesia, tinnitus and vertigo (EHF-EHC 2025) - "We studied the case of a 62-year-old woman with a 1-year history of progressively worsening occipital headache without neurovegetative symptoms, previously diagnosed with tension-type headache and treated with amitriptyline without benefit.On admission, further clinical history revealed persistent right-sided tinnitus, intermittent dizziness, and paraesthesia in the right mastoid and mandibular regions...MRI is the gold standard for diagnosis. This case highlights the need to consider spinal tumors in patients with neck pain, tinnitus, vertigo, and cranial paraesthesia."

Brain Cancer • CNS Disorders • Meningioma • Migraine • Musculoskeletal Pain • Otorhinolaryngology • Solid Tumor • Vertigo • GFAP

Specialist transition headache clinic from an UK perspective: From children to young adults (EHF-EHC 2025) - "The most common preventive treatments tried were pizotifen, propranolol and amitriptyline. A structured transition headache clinic can successfully bridge the gap and provide continuity of care during a pivotal time in the young adult"s lives, both academically and developmentally. As more patients access novel treatments in adulthood, continued follow-up will be crucial to assess long-term outcomes."

Clinical • CNS Disorders • Migraine • Pain

Primary cough headache – Botulinum toxin protocol treatment with a new indication? (EHF-EHC 2025) - "Indomethacin is the first-line treatment, but alternatives like acetazolamide or cerebrospinal fluid drainage have shown benefit in refractory or contraindicated cases...Initial treatment with flunarizine was ineffective...Trials with amitriptyline and propranolol were unsuccessful. A PREEMPT protocol with botulinum toxin was initiated, resulting in a reduction in headache frequency to 15 days/month after the first cycle, and fewer than 5/month after the second, with sustained improvement. Botulinum toxin is a safe and effective therapeutic option for PCH, especially in patients unresponsive to or intolerant of standard pharmacological treatments."

Clinical • Cardiovascular • CNS Disorders • Cough • Gastroenterology • Hypertension • Migraine • Otorhinolaryngology • Pain • Rare Diseases • Renal Disease • Respiratory Diseases • Sleep Disorder • Vertigo

Assessing the effectiveness of personalized migraine treatment – A 22-year N-of-1 study (EHF-EHC 2025) - "No significant adverse effects were reported Topiramate (2006) was ineffective (+8.3% headache days); amitriptyline (2008) increased headache days (+20.4%) but reduced zolmitriptan use (−37.7%)...Erenumab (2020–2021) worsened both metrics (+4.1%, +37.8%). Flunarizine (2023) had modest benefit (−17%), and oxitriptan (2023–2024) had minimal effect. Despite long-term triptan overuse, the patient never developed medication-overuse headache, and zolmitriptan remained effective throughout We report a case of chronic refractory migraine with long-term triptan overuse but without evidence of medication-overuse headache. This case raises the question of whether pharmacological resistance to preventives may be linked to preserved responsiveness to acute treatments"

CNS Disorders • Migraine • Mood Disorders • Obsessive-Compulsive Disorder • Pain • Personality Disorder

Side-shifting pattern of hemicrania continua: A rare variant (EHF-EHC 2025) - "Multiple migraine pharmaceutical regimens (propranolol, amitriptyline, triptans) yielded minimal benefit. Continuous headache with autonomic features should prompt consideration of HC even when laterality is not strictly side-locked. An indomethacin trial with withdrawal–rechallenge can confirm diagnosis and rapidly resolve symptoms, preventing years of ineffective migraine-directed therapy."

CNS Disorders • Migraine

Orbital pain beyond the acute phase: A long-term manifestation of carotid dissection (EHF-EHC 2025) - "She was managed with clopidogrel, atorvastatin and antihypertensive therapy.Cardiology follow-up revealed frequent symptomatic ventricular extrasystoles, treated with bisoprolol and flecainide...Low-dose amitriptyline was initiated, with partial symptomatic relief...Multidisciplinary assessment was essential to exclude recurrence or structural complications. This case highlights the need for long-term follow-up and individualised pain management beyond radiological resolution."

Cardiovascular • Hypertension • Musculoskeletal Pain • Pain • Rheumatology

Middle meningeal artery lidocaine infusion for refractory migraine: First case report in Portugal (EHF-EHC 2025) - "Various pharmacologic classes were tried without benefit: antihypertensives and calcium channel blockers (propranolol, candesartan, flunarizine), antiepileptics (valproic acid, topiramate, oxcarbazepine), antidepressants (amitriptyline, nortriptyline, venlafaxine, fluvoxamine, sertraline, clomipramine), other preventives (prednisolone, oxitriptan, melatonin), cycles of botulinum toxin (PREEMPT protocol), monoclonal antibodies (galcanezumab, fremanezumab, erenumab), and atogepant. At the time of the procedure, the patient was on eptinezumab 100 mg and botulinum toxin every three months but continued to have daily headaches, with severe intensity and reliance on eletriptan for acute relief...It constitutes an invasive therapeutic approach that should be considered only as a rescue option for carefully selected patients with severely refractory migraine. Further studies and long-term follow-up are needed to assess efficacy and safety."

Case report • Clinical • Anorexia • CNS Disorders • Migraine • Pain

Refractory primary cough headache: More than just a nuisance (EHF-EHC 2025) - "Several medications were tried without significant control (indomethacin, acetazolamide, propranolol, amitriptyline, topiramate and valproic acid). He remains with a lack of headache control. Although other primary headaches are usually regarded as benign because of their specific triggers, this case highlights the major impact they can have on a patient's quality of life."

CNS Disorders • Cough • Pain • Respiratory Diseases

Clinical characterisation and treatment patterns in tension-type headache: A retrospective study from a public hospital cohort (EHF-EHC 2025) - "The most prescribed preventives were amitriptyline, duloxetine, and venlafaxine. Identifying these patterns may help optimise individualised and multidisciplinary treatment approaches. The small and selected cohort, limited to a tertiary care setting, restricts generalisability and further correlation."

Retrospective data • CNS Disorders • Depression • Fibromyalgia • Migraine • Mood Disorders • Musculoskeletal Pain • Pain • Rheumatology

Quantifying the risk of drug-associated skin hyperpigmentation relative to the general population: A national cohort study using TriNetX. (PubMed, JAAD Int) - No abstract available

Journal