Uses of Amiclo: - Depression

Combined anxiolytics & anti-depressant drugs

Amitriptyline inhibits the membrane pump mechanism responsible for the re-uptake of transmitter amines, such as norepinephrine and serotonin, thereby increasing their concentration at the synaptic clefts of the brain Label, 10. These amines are important in regulating mood. The monoamine hypothesis in depression, one of the oldest hypotheses, postulates that deficiencies of serotonin (5-HT) and/or norepinephrine (NE) neurotransmission in the brain lead to depressive effects. This drug counteracts these mechanisms, and this may be the mechanism of amitriptyline in improving depressive symptoms.Chlordiazepoxide binds to stereospecific benzodiazepine (BZD) binding sites on GABA (A) receptor complexes at several sites within the central nervous system, including the limbic system and reticular formation. This results in an increased binding of the inhibitory neurotransmitter GABA to the GABA(A) receptor. BZDs, therefore, enhance GABA-mediated chloride influx through GABA receptor channels, causing membrane hyperpolarization. The net neuro-inhibitory effects result in the observed sedative, hypnotic, anxiolytic, and muscle relaxant properties.

How to use Amitriptyline + Chlordiazepoxide: Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Amitriptyline + Chlordiazepoxide may be taken with or without food, but it is better to take it at a fixed time.

This may block the antihypertensive action of guanethidine or compounds with a similar mechanism of action. Caution is indicated in the coadministration of TCAs with any of the SSRIs and also in switching from one class to the other, particularly patient being withdrawn from fluoxetine (at least 5 weeks may be necessary for switch therapy to TCA). Concomitant use of tricyclic antidepressants with drugs that can inhibit cytochrome P450 2D6 may require lower doses than usually prescribed for either the tricyclic antidepressant. Furthermore, whenever one of these drugs is withdrawn from cotherapy, an increased dose of tricyclic antidepressant may be required. Cimetidine is reported to reduce hepatic metabolism of certain tricyclic antidepressants and benzodiazepines, thereby delaying elimination and increasing steady-state concentrations of these drugs. This combination should be discontinued several days before elective surgery.

This is contraindicated in patients with hypersensitivity to either benzodiazepines or tricyclic antidepressants. It should not be given concomitantly with a monoamine oxidase inhibitor. When it is desired to replace a monoamine oxidase inhibitor with this combination, a minimum of 14 days should be allowed to elapse after the former is discontinued. This combination should then be initiated cautiously with gradual increase in dosage until optimum response is achieved. This drug is contraindicated during the acute recovery phase following myocardial infarction.

Common - Constipation - Difficulty in urination - Weight gain - Confusion - Orthostatic hypotension (sudden lowering of blood pressure on standing) - Tiredness - Blurred vision - Dryness in mouth - Increased heart rate - Uncoordinated body movements - Depression - Memory impairment

This should preferably not be given during pregnancy and lactation.

Antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients (especially in teenager & children) during initial few months of a course of drug therapy, or at times of dose changes. Some people may have a particularly high risk of having suicidal thoughts or actions. These include people who have (or have a family history of) bipolar illness (also called manic-depressive illness) or suicidal thoughts or actions. Use with caution in patients with history of seizures, hyperthyroidism or those taking thyroid medication and patients with impaired renal or hepatic function. Patients on prolonged treatment should have periodic liver function test and blood count.

Deaths may occur from overdosage with this class of drugs. Multiple drug ingestion (including alcohol) is common in deliberate tricyclic antidepressant overdose. Common clinical manifestations are cardiac dysrhythmias, severe hypotension, convulsions, CNS depression, including coma and changes in the electrocardiogram, particularly in QRS axis or width.

Keep in a dry place, below 30°C. Protect from light. Keep out of the reach of children.