AMITRIPTYLINE

Details

Stereochemistry	ACHIRAL
Molecular Formula	C20H23N
Molecular Weight	277.4033
Optical Activity	NONE
Defined Stereocenters	0 / 0
E/Z Centers	0
Charge	0

SHOW SMILES / InChI

Structure Search

SMILES

CN(C)CCC=C1C2=C(CCC3=C1C=CC=C3)C=CC=C2

InChI

InChIKey=KRMDCWKBEZIMAB-UHFFFAOYSA-N

InChI=1S/C20H23N/c1-21(2)15-7-12-20-18-10-5-3-8-16(18)13-14-17-9-4-6-11-19(17)20/h3-6,8-12H,7,13-15H2,1-2H3

HIDE SMILES / InChI

Description
Sources: http://www.emedexpert.com/facts/amitriptyline-facts.shtml
Curator's Comment: description was created based on several sources, including http://www.rxlist.com/elavil-drug.htm https://www.ncbi.nlm.nih.gov/pubmed/23235671; https://www.ncbi.nlm.nih.gov/pubmed/11157426; http://www.ncbi.nlm.nih.gov/pubmed/16871467; http://www.ncbi.nlm.nih.gov/pubmed/2578912; http://www.ncbi.nlm.nih.gov/pubmed/?term=15943846

Amitriptyline is a derivative of dibenzocycloheptadiene and a tricyclic antidepressant (TCA) and is mainly used to treat symptoms of depression. It works on the central nervous system (CNS) by inhibiting the membrane pump mechanism responsible for uptake of norepinephrine and serotonin in adrenergic and serotonergic neurons. Amitriptyline has been frequently used as an active comparator in clinical trials on newer antidepressants. It is rarely used as a first-line antidepressant nowadays due to its high degree of toxicity in overdose and generally poorer tolerability than the newer antidepressants.

CNS Activity

Originator

Approval Year

Targets

Primary Target	Pharmacology	Potency
Sodium-dependent noradrenaline transporter 38 Target ID: P23975 Gene ID: 6530.0 Gene Symbol: SLC6A2 Target Organism: Homo sapiens (Human) Sources: http://www.ncbi.nlm.nih.gov/pubmed/14744476	Inhibitor 8297	3.45 nM [IC50]
Sodium-dependent serotonin transporter 40 Target ID: P31645 Gene ID: 6532.0 Gene Symbol: SLC6A4 Target Organism: Homo sapiens (Human) Sources: http://www.ncbi.nlm.nih.gov/pubmed/14744476	Inhibitor 8297	13.3 nM [IC50]
5-hydroxytryptamine receptor 2A 69 Target ID: P28223 Gene ID: 3356.0 Gene Symbol: HTR2A Target Organism: Homo sapiens (Human) Sources: http://www.ncbi.nlm.nih.gov/pubmed/7855217	Antagonist 2778

Conditions

Condition	Modality	Targets	Highest Phase	Product
Depressive disorder 4 Sources: https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=1e6d2c80-fbc8-444e-bdd3-6a91fe1b95bd	Preventing		Approved 8429	AMITRIPTYLINE HYDROCHLORIDE Approved Use For the relief of symptoms of depression. Endogenous depression is more likely to be alleviated than are other depressive states. Launch Date 1997

C_max

Value	Dose	Co-administered	Analyte	Population
15.3 ng/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/10383563	75 mg single, oral dose: 75 mg route of administration: Oral experiment type: SINGLE co-administered:		AMITRIPTYLINE plasma	Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: FASTED

AUC

Value	Dose	Co-administered	Analyte	Population
593 ng × h/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/10383563	75 mg single, oral dose: 75 mg route of administration: Oral experiment type: SINGLE co-administered:		AMITRIPTYLINE plasma	Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: FASTED

T_1/2

Value	Dose	Co-administered	Analyte	Population
20.4 h EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/10383563	75 mg single, oral dose: 75 mg route of administration: Oral experiment type: SINGLE co-administered:		AMITRIPTYLINE plasma	Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: FASTED

F_unbound

Value	Dose	Co-administered	Analyte	Population
7.7% EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/6125396	150 mg 1 times / day multiple, oral dose: 150 mg route of administration: Oral experiment type: MULTIPLE co-administered:		AMITRIPTYLINE plasma	Homo sapiens population: UNHEALTHY age: ADULT sex: FEMALE / MALE food status: FASTED

Doses

Dose	Population	Adverse events
100 mg 1 times / day single, intravenous Studied dose Dose: 100 mg, 1 times / day Route: intravenous Route: single Dose: 100 mg, 1 times / day Sources: https://pubmed.ncbi.nlm.nih.gov/17512256/	healthy, 21 to 70 years n = 5 Health Status: healthy Age Group: 21 to 70 years Sex: M+F Population Size: 5 Sources: https://pubmed.ncbi.nlm.nih.gov/17512256/	Disc. AE: Bradycardia... Other AEs: Agitation, Dry mouth... AEs leading to discontinuation/dose reduction: Bradycardia (grade 3, 20%) Other AEs: Agitation (20%) Dry mouth (20%) Drowsiness (20%) Language disorder (20%) Sources: https://pubmed.ncbi.nlm.nih.gov/17512256/
10 % 1 times / day single, topical Highest studied dose Dose: 10 %, 1 times / day Route: topical Route: single Dose: 10 %, 1 times / day Sources: https://pubmed.ncbi.nlm.nih.gov/21676162/	unhealthy, 57 years n = 1 Health Status: unhealthy Condition: pain Age Group: 57 years Sex: M Population Size: 1 Sources: https://pubmed.ncbi.nlm.nih.gov/21676162/	Other AEs: Thought disorder, Mental concentration difficult... Other AEs: Thought disorder Mental concentration difficult Sources: https://pubmed.ncbi.nlm.nih.gov/21676162/
520.3 mg 1 times / day single, oral (mean) Studied dose Dose: 520.3 mg, 1 times / day Route: oral Route: single Dose: 520.3 mg, 1 times / day Sources: https://pubmed.ncbi.nlm.nih.gov/20923818/	healthy, mean age 22.1 years n = 96 Health Status: healthy Age Group: mean age 22.1 years Sex: M+F Population Size: 96 Sources: https://pubmed.ncbi.nlm.nih.gov/20923818/	Other AEs: Mental status changes... Other AEs: Mental status changes Sources: https://pubmed.ncbi.nlm.nih.gov/20923818/
25 mg 1 times / day multiple, oral Studied dose Dose: 25 mg, 1 times / day Route: oral Route: multiple Dose: 25 mg, 1 times / day Sources: https://pubmed.ncbi.nlm.nih.gov/24259978/	unhealthy, mean age 43.2 years n = 16 Health Status: unhealthy Condition: globus pharyngeus Age Group: mean age 43.2 years Sex: M+F Population Size: 16 Sources: https://pubmed.ncbi.nlm.nih.gov/24259978/	Other AEs: Dry mouth, Sleepiness... Other AEs: Dry mouth (75%) Sleepiness (68.8%) Dizziness (25%) Constipation (18.8%) Palpitations (6.3%) Malaise (6.3%) Sources: https://pubmed.ncbi.nlm.nih.gov/24259978/
75 mg 1 times / day multiple, oral Recommended Dose: 75 mg, 1 times / day Route: oral Route: multiple Dose: 75 mg, 1 times / day Sources: https://pubmed.ncbi.nlm.nih.gov/8494126/	unhealthy, mean age 55 years n = 27 Health Status: unhealthy Condition: chronic pain Age Group: mean age 55 years Sex: M+F Population Size: 27 Sources: https://pubmed.ncbi.nlm.nih.gov/8494126/	Disc. AE: Drowsiness, Dry mouth... Other AEs: Drowsiness, Nausea... AEs leading to discontinuation/dose reduction: Drowsiness (10%) Dry mouth (10%) Other AEs: Drowsiness (51.8%) Nausea (7.4%) Headache (7.4%) Dry mouth (63%) Thirst (7.4%) Tiredness (7.4%) Bad taste (18.5%) Attention concentration difficulty (7.4%) Hyperglycaemia (3.7%) Sources: https://pubmed.ncbi.nlm.nih.gov/8494126/
59 mg 1 times / day multiple, oral (mean) Studied dose Dose: 59 mg, 1 times / day Route: oral Route: multiple Dose: 59 mg, 1 times / day Sources: https://pubmed.ncbi.nlm.nih.gov/10493324/	unhealthy, mean age 60.4 years n = 25 Health Status: unhealthy Condition: diabetic peripheral neuropathy pain Age Group: mean age 60.4 years Sex: M+F Population Size: 25 Sources: https://pubmed.ncbi.nlm.nih.gov/10493324/	Disc. AE: Ankle edema, Dizziness... Other AEs: Sedation, Dry mouth... AEs leading to discontinuation/dose reduction: Ankle edema (4%) Dizziness (4%) Other AEs: Sedation (32%) Dry mouth (32%) Postural hypotension (20%) Weight gain (24%) Ataxia (8%) Constipation (12%) Lethargy (20%) Edema (8%) Headache (12%) Pruritus (12%) Bad taste (4%) Nausea (4%) Diarrhea (4%) Blurred vision (8%) Sources: https://pubmed.ncbi.nlm.nih.gov/10493324/
520.3 mg 1 times / day single, oral (mean) Studied dose Dose: 520.3 mg, 1 times / day Route: oral Route: single Dose: 520.3 mg, 1 times / day Sources: https://pubmed.ncbi.nlm.nih.gov/20923818/	healthy n = 96 Health Status: healthy Sex: M+F Population Size: 96 Sources: https://pubmed.ncbi.nlm.nih.gov/20923818/	Other AEs: Tachycardia... Other AEs: Tachycardia Sources: https://pubmed.ncbi.nlm.nih.gov/20923818/

AEs

Overview

CYP3A4	CYP2C9	CYP2D6	hERG
substrate 1737 inhibitor 1587	substrate 1037	substrate 1217 inhibitor 1852	inhibitor 1612

OverviewOther

Other Inhibitor	Other Substrate	Other Inducer
CYP2C19 1478 CYP2C8 911 OCT1 512 OCT2 647	CYP1A2 1054 CYP2C19 991 CYP2B6 664 UGT2B10 127 UGT1A4 347

Drug as perpetrator

Target	Modality	Activity
OCT2 648	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/19002438/	yes [IC50 14 uM]
OCT1 543	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/20567254/	yes [IC50 6.99 uM]
CYP3A4 1925	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/16415122/	yes [IC50 8.8 uM]
CYP2C8 965	inhibitor 3277 Sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2015019/	yes [Inhibition 200 uM]
CYP2D6 1891	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/12228186/	yes [Ki 31 uM]
CYP2C19 1553	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/12228186/	yes [Ki 37.7 uM]

Drug as victim

Target	Modality	Activity
CYP1A2 1054	substrate 3367 Sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2042727/	no
CYP2C19 991	substrate 3367 Sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2042727/	no
CYP2B6 664	substrate 3367 Sources: https://pubmed.ncbi.nlm.nih.gov/11259560/	yes
CYP2C9 1037	substrate 3367 Sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2042727/	yes
CYP2D6 1217	substrate 3367 Sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2042727/	yes
CYP3A4 1737	substrate 3367 Sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2042727/	yes
UGT1A4 347	substrate 3367 Sources: https://pubmed.ncbi.nlm.nih.gov/20133892/	yes
UGT2B10 127	substrate 3367 Sources: https://pubmed.ncbi.nlm.nih.gov/20133892/	yes

Tox targets

Target	Modality	Activity	Metabolite	Clinical evidence
hERG 1647	inhibitor 1626 Sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1571977/

Sourcing

Vendor/Aggregator	ID	URL
ChEBI	CHEBI:2666	https://www.ebi.ac.uk/chebi/searchId.do?chebiId=CHEBI:2666
MolPort	MolPort-001-662-651	https://www.molport.com/shop/molecule-link/MolPort-001-662-651
ZINC	ZINC000000968257	http://zinc15.docking.org/substances/ZINC000000968257
eMolecules	739635	https://www.emolecules.com/cgi-bin/more?vid=739635

PubMed

Title	Date	PubMed
[Cardiac arrest following amitriptylin and adrenaline].	1975 Jun 16	1145841
[Individual conditions of pharmacogenic confusion conditions. Comparison of amitriptyline and clozapine].	1976	1019368
Seizures during lithium-amitriptyline therapy.	1979 Sep	112590
Penetration of amitriptyline, but not of fluoxetine, into brain is enhanced in mice with blood-brain barrier deficiency due to mdr1a P-glycoprotein gene disruption.	2000 Apr	10700657
Prolonged QT interval and torsades de pointes caused by the combination of fluconazole and amitriptyline.	2000 Mar	10750939
Near fatal case of atrio-ventricular block induced by amitriptyline at therapeutic dose.	2000 Sep	11089775
Activation of cytochrome P450 gene expression in the rat brain by phenobarbital-like inducers.	2000 Sep	10945841
Long-term effects of tricyclic antidepressants on norepinephrine kinetics in humans.	2001	11341486
Application of the relative activity factor approach in scaling from heterologously expressed cytochromes p450 to human liver microsomes: studies on amitriptyline as a model substrate.	2001 Apr	11259560
Review of pharmacokinetic and pharmacodynamic interaction studies with citalopram.	2001 Aug	11532381
Adherence to treatment regimen in depressed patients treated with amitriptyline or fluoxetine.	2001 Aug	11511404
Cytochrome P450 2D6.1 and cytochrome P450 2D6.10 differ in catalytic activity for multiple substrates.	2001 Aug	11505218
Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients.	2001 Aug	11477329
Prolonged coma and loss of brainstem reflexes following amitriptyline overdose.	2001 Feb	11205078
[Non-fatal effect of highly toxic amitriptyline level after suicide attempt. A case report].	2001 Jan	11221556
Weight outcomes among antidepressant users in nursing facilities.	2001 Jan	11207842
Transient ST segment elevation in right precordial leads induced by psychotropic drugs: relationship to the Brugada syndrome.	2001 Jan	11204086
Effect of drugs used for neuropathic pain management on tetrodotoxin-resistant Na(+) currents in rat sensory neurons.	2001 Jan	11135733
Antinociception by tricyclic antidepressants in the rat formalin test: differential effects on different behaviours following systemic and spinal administration.	2001 Jul	11406338
The effect of amitriptyline on pain intensity and perception of stress in bruxers.	2001 Jun	11512111
Retro-orbital tumour--an uncommon cause of headache in pregnancy.	2001 Jun	11439800
Pharmacological modulation of SK3 channels.	2001 Jun	11378158
Treatment of neuropathic pain with venlafaxine.	2001 May	11346061
Advances in the management of neuropathic pain.	2001 May	11345017
Inhibition of synovial plasma extravasation by preemptive administration of an antiinflammatory irrigation solution in the rat knee.	2001 May	11323366
Efficacy of spinal manipulation for chronic headache: a systematic review.	2001 Sep	11562654
Amitriptyline is a potent blocker of human Kv1.1 and Kv7.2/7.3 channels.	2007 May	17456683
Intersegmental vessel formation in zebrafish: requirement for VEGF but not BMP signalling revealed by selective and non-selective BMP antagonists.	2010 Sep	20718746

Patents

Sample Use Guides

In Vivo Use Guide

For outpatients, 75 mg of amitriptyline HCl a day in divided doses. If necessary, this may be increased to a total of 150 mg per day. An alternate method of initiating therapy in outpatients is to begin with 50 to 100 mg amitriptyline HCl at bedtime. This may be increased by 25 or 50 mg as necessary in the bedtime dose to a total of 150 mg per day. Hospitalized patients may require 100 mg a day initially. This can be increased gradually to 200 mg a day if necessary up to 300 mg a day. Not recommended for patients under 12 years of age

Route of Administration: Oral

In Vitro Use Guide

Amitriptyline was used at 40 uM in isolated rat hepatocytes for 60,120,180 min.

Name

Type

Language

AMITRIPTYLINE

Official Name

English

1-PROPANAMINE, 3-(10,11-DIHYDRO-5H-DIBENZO(A,D)CYCLOHEPTEN-5-YLIDENE)-N,N-DIMETHYL-

Systematic Name

English

LAROXYL

Brand Name

English

3-(10,11-DIHYDRO-5H-DIBENZO(A,D)CYCLOHEPTEN-5-YLIDENE)-N,N-DIMETHYL-1-PROPANAMINE

Systematic Name

English

AMITRIPTYLINE [USP IMPURITY]

Common Name

English

AMITRIPTYLINE [MI]

Common Name

English

AMITRIPTYLINE [VANDF]

Common Name

English

amitriptyline [INN]

Common Name

English

NORTRIPTYLINE HYDROCHLORIDE IMPURITY F [EP IMPURITY]

Common Name

English

Amitriptyline [WHO-DD]

Common Name

English

AMITRIPTYLINE [MART.]

Common Name

English

SEROTEN

Common Name

English

PROHEPTADIENE

Common Name

English

TRIPTANOL

Common Name

English

DAMITRIPTYLINE

Common Name

English

FLAVYL

Common Name

English

Classification Tree Code System Code

WHO-ATC

N06CA01