Combinations - Amitriptyline Hydrochloride (and Cimetidine). Help please

[Tanner Mirabel]

Hi. SWIM is known for having sleeping problems/anxiety and SWIM's doc recently prescribed him Amitriptyline Hydrochloride (25mg at night). The medicine has the longest list of most horrible possible side effect SWIM has ever seen (which include myocardial infarction, arrhythmias, heart block, stroke, coma, seizures, etc). SWIM is terrified of taking it, especially since he is taking Cimetidine (a histamine H2-receptor antagonist) to treat gastritis which could interact with Amitriptyline (see below).

"Cimetidine is reported to reduce hepatic metabolism of amitriptyline."

"Cimetidine may increase the serum concentration of tricyclic antidepressants (TCAs) to toxic levels in some patients. The mechanism may be related to inhibition of CYP450 hepatic metabolism of TCAs."

SWIM isn't sure whether he should go back to the doctor (who is aware that SWIM is on Cimetidine) or if he's just panicking.
Any advice would be appreciated
Cheers

[bloot]

There are a lot of people who are prescribed to separate medications which could possibly cause an interaction between them. Although SWIY doctor knows that SWIY is on the cimetidine doesn't mean that he would know if there could possibly be interactions between it and the Amytriptiline. SWIM would suggest making another appointment. Of course none of us here knows SWIY body that well so it may be a little hard to give advice about it. Hope that helped just as little bit.

[fiveleggedrat]

Probably not a risk, but Swim can get on another drug for gastritis, speaking from experience here. Swim is currently on rabeprazole sodium for this. Swiy could use ranitidine, or similar. Cimedtidine is notorious for interfering with CYP2D6 drug metabolism. That's why so many use it as a drug potentiator.

[Jatelka]

Rabeprazole (or another PPI) would be a far more 21st century drug for gastritis, also far more effective, with a much lower interaction profile.

Can I say that tricyclics aren't all bad? The effects mentioned occur in overdosage, and in the elderly/frail/otherwise unwell. They are extremely (by which I mean vanishingly small) unlikely to cause problems at the low dose mentioned

Many people find them extremely effective, for both sleep and depression

The flamingo has never taken tricyclics for sleep, but they were a life saver at other times

[hensley258]

Rather than Amitriptilyne, may I sugest Nortriptilyne. They are much the same in effectivness with Nortriptilyne having far less risks and side effects.

Both are Tri-cyclic antidepressants that effect the reuptake of Norephinepherine and serotinin Reiptake (Serotinin to a lesser degree)

And both are very effective, but Nortriptilyne seems to have fewer risks.

[Tanner Mirabel]

Thanks for replies. SWIM took Amitriptyline for a while but found the side effects to be unbearable, so now he is off both meds and currently on Lofepramine and Lansoprazole (for gastritis).