Drug Uses

Elavil is indicated for the relief of symptoms of depression. Endogenous depression is more likely to be alleviated than are other depressive states.

How Taken

Elavil comes as a tablet to take by mouth. It is usually taken one to four times a day and may be taken with or without food. Take Elavil exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Continue to take Elavil even if you feel well. Do not stop taking Elavil without talking to your doctor, especially if you have taken large doses for a long time. Your doctor probably will want to decrease your dose gradually. This drug must be taken regularly for a few weeks before its full effect is felt.

Warnings/Precautions

Before taking Elavil, tell your doctor if you have liver disease; kidney disease; asthma; thyroid disease; diabetes; stomach or intestinal problems; high blood pressure or heart disease; had a heart attack in the last 6 weeks; an enlarged prostate or difficulty urinating; or glaucoma. You may not be able to take Elavil, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above. Elavil may be harmful to an unborn baby. Do not take Elavil without first talking to your doctor if you are pregnant or could become pregnant during treatment. Elavil passes into breast milk and may affect a nursing baby. Do not take Elavil without first talking to your doctor if you are breast-feeding a baby. If you are over 60 years of age, you may be more likely to experience side effects such as drowsiness, dizziness, unsteadiness, feeling uncoordinated and low blood pressure. Your doctor may prescribe a lower dose of this medication.

Missed Dose

Take the missed dose as soon as you remember. If it is almost time for the next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not take a double dose of this medication unless otherwise directed by your doctor.

Possible Side Effects

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Elavil. Older adults are especially liable to certain side effects of Elavil, including rapid heartbeat, constipation, dry mouth, blurred vision, sedation, and confusion, and are in greater danger of sustaining a fall. Side effects may include: Abnormal movements, anxiety, black tongue, blurred vision, breast development in males, breast enlargement, coma, confusion, constipation, delusions, diarrhea, difficult or frequent urination, difficulty in speech, dilation of pupils, disorientation, disturbed concentration, dizziness on getting up, dizziness or light-headedness, drowsiness, dry mouth, excessive or spontaneous flow of milk, excitement, fatigue, fluid retention, hair loss, hallucinations, headache, heart attack, hepatitis, high blood pressure, high fever, high or low blood sugar, hives, impotence, inability to sleep, increased or decreased sex drive, increased perspiration, increased pressure within the eye, inflammation of the mouth, intestinal obstruction, irregular heartbeat, lack or loss of coordination, loss of appetite, low blood pressure, nausea, nightmares, numbness, rapid and/or fast, fluttery heartbeat, rash, red or purple spots on skin, restlessness, ringing in the ears, seizures, sensitivity to light, stomach upset, strange taste, stroke, swelling due to fluid retention in the face and tongue, swelling of testicles, swollen glands, tingling and pins and needles in the arms and legs, tremors, vomiting, weakness, weight gain or loss, yellowed eyes and skin. Side effects due to rapid decrease or abrupt withdrawal from Elavil include: Headache, nausea, vague feeling of bodily discomfort Side effects due to gradual dosage reduction may include: Dream and sleep disturbances, irritability, and restlessness.

Storage

Store Elavil tablets in a well-closed container. Avoid storage at temperatures above 30°C (86°F). In addition, Elavil tablets 10 mg must be protected from light and stored in a well-closed, light-resistant container.

Overdose

Critical manifestations of overdose include: cardiac dysrhythmias, severe hypotension, convulsions, and CNS depression, including coma. Changes in the electrocardiogram, particularly in QRS axis or width, are clinically significant indictors of tricyclic antidepressant toxicity. Other signs of overdose may include: impaired myocardial contractility, confusion, disturbed concentration, transient visual hallucinations, and dilated pupils, disorders of ocular motility, agitation, hyperactive reflexes, stupor, drowsiness, muscle rigidity, vomiting, hypothermia, and hyperpyrexia. Deaths may occur from over dosage with this class of drugs.

More Information

Use caution when driving, operating machinery, or performing other hazardous activities. Elavil may cause drowsiness or dizziness. If you experience drowsiness or dizziness, avoid these activities. Dizziness is likely to occur when you rise from a sitting or lying position. Rise slowly to prevent dizziness and a possible fall. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking Elavil. Do not stop taking Elavil suddenly. This could cause symptoms such as nausea, headache, and malaise.

Disclaimer

This drug information is for your information purposes only, it is not intended that this information covers all uses, directions, drug interactions, precautions, or adverse effects of your medication. This is only general information, and should not be relied on for any purpose. It should not be construed as containing specific instructions for any particular patient. We disclaim all responsibility for the accuracy and reliability of this information, and/or any consequences arising from the use of this information, including damage or adverse consequences to persons or property, however such damages or consequences arise. No warranty, either expressed or implied, is made in regards to this information.

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A new study has revealed more about how the medication ketamine, when used experimentally for depression, relieves symptoms of the disorder in hours instead of the weeks or months it takes for current antidepressants to work. While ketamine itself probably won’t come into use as an antidepressant because of its side effects, the new finding moves scientists considerably closer to understanding how to develop faster-acting antidepressant medications — among the priorities of the National Institute of Mental Health (NIMH), part of the National Institutes of Health.
Ketamine blocks a receptor called NMDA on brain cells, an earlier NIMH study in humans had shown, but the new study in mice shows that this is an intermediate step. It turns out that blocking NMDA increases the activity of another receptor, AMPA, and that this boost in AMPA is crucial for ketamine’s rapid antidepressant actions. The study was reported online in Biological Psychiatry on July 23, by NIMH researchers Husseini K. Manji, MD, Guang Chen, MD, PhD, Carlos Zarate, MD, and colleagues.
“Our research is showing us how to develop medications that get at the biological roots of depression. This new finding is a major step toward learning how to improve treatment for the millions of Americans with this debilitating disorder; toward eliminating the weeks of suffering and uncertainty they have to endure while they wait for their medications to work,” said NIH Director Elias Zerhouni, M.D.
Almost 15 million American adults have a depressive disorder. During the long wait to begin feeling the effects of conventional medications, patients may worsen, raising the risk of suicide for some. Depressive disorders also affect children and adolescents.
By aiming new medications at more direct molecular targets, such as NMDA or AMPA, scientists may be able to bypass some of the steps through which current antidepressants indirectly exert their effects — a roundabout route that accounts for the long time it takes for patients to begin feeling better with the conventional medications.
While ketamine appears to achieve this, it is an unlikely candidate to become a new treatment for depression, because of the side effects it can cause in humans, including hallucinations. It is approved as an anesthetic by the Food and Drug Administration at much higher doses than those given in the study, but its use is limited because it may cause hallucinations during recovery from anesthesia.
Both NMDA and AMPA are receptors for the neurotransmitter glutamate, one of the chemical messengers that enable brain cells to communicate with each other. The glutamate system has been implicated in depression recently, leading to efforts to unravel its molecular machinery in search of abnormalities and of better targets for antidepressant medications.
This focus on the glutamate system is a departure from the thinking that led to currently available antidepressants, which are thought to relieve depression through a lengthy trickle-down process of biochemical reactions that affect the circuitry underlying depression.
The fact that NMDA and AMPA receptors are part of the glutamate system and that targeting them directly led to such rapid, sustained relief of depression-like behaviors in this study — and that a single dose of ketamine did the same in humans in the earlier study — suggests that they are probably the key targets for antidepressant medications.
“In any other illness of depression’s magnitude, patients aren’t expected to just accept that their treatments won’t start helping them for weeks or months. The value of our research on compounds like ketamine is that it tells us where to look for more precise targets for new kinds of medications that can close the gap,” said NIMH Director Thomas R. Insel, MD. “We’re making tremendous progress.”
To conduct the new study, researchers induced depression-like behaviors in mice; for example, the mice gave up after being forced to engage in hopeless tasks, such as prolonged swimming. A dose of ketamine reversed the depression-like behaviors for at least two weeks.
When the researchers gave the mice a substance that blocks the AMPA receptor beforehand, ketamine was not able to reverse the depression-like behaviors. The boost in AMPA thus appears to be a necessary ingredient for ketamine’s antidepressant effects.
In a related experiment, the scientists used two different compounds instead of ketamine to try to block just one part of the NMDA receptor, an even more precise target. These other compounds also reduced depressive behaviors, suggesting that it may be feasible to develop other fast-acting antidepressants without ketamine’s side effects.
“Today’s antidepressant medications eventually end up doing the same thing, but they go about it the long way around, with a lot of biochemical steps that take time. Now we’ve shown what the key targets are and that we can get at them rapidly,” said Zarate. “Ketamine probably can’t become the medication of choice, but this research is leading to some very real possibilities for a whole new generation of antidepressant medications.”

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