Amitriptilina

Antidepressivo tricíclico. Inibe recaptação de noradrenalina e serotonina.

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Gestação:Categoria CRisco não pode ser descartado, usar se benefício justificar

Este medicamento tem dados farmacogenéticos

Configure seus genótipos para ver alertas personalizados de dosagem.

INDICAÇÕES

Adultos

10-25mg à noite, aumentar gradualmente

1x/dia à noite

IMAOGRAVE

Crise hipertensiva

⛔ Intervalo de 14 dias

Outros anticolinérgicosGRAVE

Potencialização

⛔ Monitorar

Compatível, preferir ISRS

2 genes with drug interactions

Pharmacogenomics testing may help personalize dosing for this medication. Results depend on patient's genetic profile.

Data source: PharmGKB

Phenotype	Variant	Clinical Implications
Poor Metabolizer	3, 4, 5, 6	-Reduced conversion of amitriptyline to nortriptyline -Higher amitriptyline plasma levels (up to 2-3x) -Increased risk of adverse effects (sedation, QTc prolongation, anticholinergic effects) -Cardiotoxicity risk at high levels
Ultra-rapid Metabolizer	1xN, 2xN	-Rapid metabolism of amitriptyline -Lower plasma levels, potentially subtherapeutic -May have reduced efficacy

*Poor Metabolizer: Reduce starting dose by 50%
*Poor Metabolizer: Titrate slowly with therapeutic drug monitoring (TDM)
*Poor Metabolizer: Consider alternative antidepressant (SSRI)
*Poor Metabolizer: Monitor ECG for QTc prolongation
*Ultra-rapid Metabolizer: May need higher doses for therapeutic effect
*Ultra-rapid Metabolizer: Use TDM to guide dosing
*Ultra-rapid Metabolizer: Consider alternative if poor response despite adequate doses

Phenotype

Variant

Clinical Implications

Poor Metabolizer

*3, *4, *5, *6

-Reduced conversion of amitriptyline to nortriptyline
-Higher amitriptyline plasma levels (up to 2-3x)
-Increased risk of adverse effects (sedation, QTc prolongation, anticholinergic effects)
-Cardiotoxicity risk at high levels

Ultra-rapid Metabolizer

*1xN, *2xN