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Amitriptyline should be avoided or used in caution in people with a history of heart disease, heart or rhythm abnormalities, diabetes, liver or kidney impairment, bipolar disorder, seizure disorder, narrow-angle glaucoma, dry eyes or vision problems, decreased gastrointestinal motility, urinary retention or an enlarged prostate.

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Cadiac ahythmias and sv hypotnsion a likly toccu with high dosag. Thy may alsoccu in patints with p-xisting hat disas taking nomal dosag.

Th dos can b takn onc daily, b dividd inttwdoss. A singl dos abov 75 mg is not commndd.

Dpssion is associatd with an incasd isk suicidal thoughts, sl-ham and suicid (suicid-latd vnts). This isk psists until signiicant mission occus. As impovmnt may not occu duing th ist w wks mtatmnt, patints should b closly monitod until such impovmnt occus. It is gnal clinical xpinc that th isk suicid may incas in th aly stags covy.

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tricyclic antidepressants tca including amitriptyline are primarily metabolised by the hepatic cytochrome p450 isozymes cyp2d6 and cyp2c19, which are polymorphic in the population.

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