Amitriptyline and Diazepam

Amitriptyline and Diazepam

When different drugs are used together, different interactions may occur, like using amitriptyline and diazepam are used together, what is the kind of interaction between them?

If they have similar actions, additive effects may happen.

If they have opposite actions, canceling effects may happen.

These interactions may cause an increase or decrease in the effectiveness of the drugs or even the side effects.

This happens due to increase or decrease in:

• The absorption of the drug

Like drugs not taken with food as food may affect their absorption as an example, fibers like wheat bran slows down the absorption of digoxin and decreases its effectiveness.

• The distribution of the drug

Like drugs causing others to be freer, not binding to plasma proteins, making their concentration higher, which may cause toxicity, for example, diazepam and phenytoin, diazepam makes phenytoin more available, which increases the risk for toxicity.

• The metabolism of the drug (the alteration of the drug to be excreted outside the body)

Some drugs interact by inducing or inhibiting the enzymes responsible for metabolizing other drugs, which result in an increase or decrease in the concentration of these drugs, for example, Phenytoin and Rifampicin, are enzyme inducers, resulting in the decrease of the interacted drug as they enhance the excretion of it from the body.

• The elimination of the drug

Patients with renal impairment taking drugs excreted through the urine must get altered doses to avoid the accumulation of the drugs in the body leading to toxic doses.

So, what is amitriptyline, and what is diazepam, and what is the kind of interaction between amitriptyline and diazepam?

Amitriptyline belongs to a family of drugs called tricyclic antidepressants.

It is used in mental and mood problems, like depression.

Amitriptyline helps in relieving anxiety and tension, improving mood, sleeping better, and increasing your level of energy.

It works by affecting certain neurotransmitters in the brain like serotonin.

Amitriptyline is also used in certain eating disorders and migraine headaches.

There are also off-label uses of amitriptyline:

• Increase in the production of saliva
• Sleeping problems
• Irritable bowel syndrome (gastrointestinal disorder causing chronic discomfort)
• Neuralgia caused after the infection of herpes zoster

Neuralgia is caused by damaged or diseased nerves, leading to burning, stabbing pains, or aches.

• Chronic pain
• Interstitial cystitis (bladder problem causing pain and pressure in the pelvis, bladder, also causing urinary frequency or urgency)
• Migraine (severe and recurrent headache)
• Anxiety
• Post-traumatic stress disorder (disorder happening after a traumatic event like feeling extreme fear, shock, or helplessness)

Dosage and administration:

Amitriptyline is found in tablet form with many concentrations.

Depression

25 – 50 mg initially, increased by 25 mg every 5 – 7 days, till reaching 100 – 200 mg per day.

The dose may be divided through the day or just taken at bedtime.

If needed, the dose may be increased to 300 mg per day.

Neuralgia caused after the infection with herpes zoster

65 – 100 mg per day, and it is used for at least 3 weeks.

Migraine

10 – 25 mg per day.

The dose may range from 10 to 400 mg per day.

Eating disorder

150 mg per day for 8 weeks.

 

Contraindicated drugs:

Drugs that should never be used with amitriptyline.

• disopyramide
• dronedarone
• ibutilide
• indapamide
• iobenguane I 123
• isocarboxazid
• pentamidine
• phenelzine
• pimozide
• procainamide
• procarbazine
• quinidine
• safinamide
• selegiline
• sotalol
• tranylcypromine

What about Diazepam?

Diazepam is one of a very famous family called benzodiazepines.

It is used in treating anxiety, alcohol withdrawal symptoms, seizures, providing sedation in the ICU (intensive care unit), providing sedation before having surgery, relaxation of spastic muscles, and in status epilepticus.

Dosage and administration:

Diazepam is available in many dosage forms, tablets, oral solutions, rectal gels, injectable solutions, and intramuscular devices, with many different concentrations.

 

Anxiety

2 – 10 mg every 6 – 12 hours.

Maximum dose: 30 mg every 8 hours

Alcohol withdrawal symptoms

10 mg every 6 – 12 hours during the first 24 hours.

The dose is reduced to 5 mg every 6 – 8 hours.

Muscle spasms

2 – 10 mg every 6 – 8 hours.

There are no completely contraindicated drugs with diazepam, but drugs are causing serious interactions, and you have to use an alternative drug.

Serious interactions causing drugs:

• abametapir
• apalutamide
• benzhydrocodone/acetaminophen
• calcium/magnesium/potassium/sodium oxybates
• carbamazepine
• cimetidine
• clarithromycin
• darunavir
• erythromycin base
• erythromycin ethylsuccinate
• erythromycin lactobionate
• erythromycin stearate
• fedratinib
• hydrocodone
• idelalisib
• ivosidenib
• ketoconazole
• lonafarnib
• metoclopramide intranasal
• mifepristone
• nefazodone
• rifabutin
• rifampin
• selinexor
• sodium oxybate
• St John’s Wort
• sufentanil SL
• tipranavir
• tucatinib
• valerian
• voxelotor

Amitriptyline and diazepam together may cause increased side effects, like dizziness, drowsiness, confusion, and concentration difficulties.

Elder patients especially experience thinking and judgment impairment, and problems with coordination.

Alcohol is really dangerous if used with amitriptyline and diazepam.

Driving and operating heavy machinery should not be performed unless making sure about how the drug will affect the patient.

Always confirm with your doctor the information mentioned in a medical article.

Diazepam and pregnancy

Does diazepam lower blood pressure

 

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