아미트리프틸린
Amitriptyline
Amitriptyline hydrochloride
다른 이름: Elavil · Lentizol · Tryptanol · Amitriptylini hydrochloridum · Amitriptylinum · Amitriptyline hydrochloride
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Adjunctive treatment of pruritus | 1-2 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
| Acral pruritic dermatitis | 2.2 mg/kg PO twice daily | PO | q12h | 2-4 week trial recommended | 🌎 NA |
| Separation anxiety or generalized anxiety | 1-2 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
| Behavior disorders amenable to tricyclics | 1-4 mg/kg PO q12h. Begin at 1-2 mg/kg PO q12h for 2 weeks, increase by 1 mg/kg up to maximum dosage (4 mg/kg) as necessary. If no clinical response, decrease by 1 mg/kg PO q12h for 2 weeks until at initial dosage. | PO | q12h | — | 🌎 NA |
| Behavior disorders amenable to tricyclics | 2.2-4.4 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
| Behavior disorders amenable to tricyclics | 0.25-1.5 mg/kg PO every 12-24h | PO | q12-24h | — | 🌎 NA |
| Neuropathic pain | 1-2 mg/kg PO q12-24h | PO | q12-24h | — | 🌎 NA |
| Adjunctive treatment of pain associated with appendicular osteosarcoma | 1-2 mg/kg PO q12-24h | PO | q12-24h | — | 🌎 NA |
| Management of chronic anxiety, compulsive disorders, and separation anxiety | 1-2 mg/kg | PO | q12-24h | — | 🌍 EU |
- Acral pruritic dermatitis: Only occasionally effective.
- Separation anxiety or generalized anxiety: Use with behavior modification.
- Management of chronic anxiety, compulsive disorders, and separation anxiety: Clomipramine is an authorized preparation for dogs and is claimed to have better anticompulsive properties.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Adjunctive treatment of behavior disorders amenable to tricyclics | 5-10 mg per cat PO once daily | PO | q24h | — | 🌎 NA |
| Adjunctive treatment of behavior disorders amenable to tricyclics | 0.5-2 mg/kg PO q12-24h; start at 0.5 mg/kg PO q12h | PO | q12-24h | — | 🌎 NA |
| Adjunctive treatment of behavior disorders amenable to tricyclics | 0.5-1 mg/kg PO q12-24h | PO | q12-24h | — | 🌎 NA |
| Adjunctive treatment of behavior disorders amenable to tricyclics | 0.5-1 mg/kg PO q12-24h. Allow 3-4 weeks for initial trial. | PO | q12-24h | 3-4 weeks initial trial | 🌎 NA |
| Self-mutilation behaviors associated with anxiety | 5-10 mg per cat PO once to twice daily | PO | q12-24h | — | 🌎 NA |
| Self-mutilation behaviors associated with anxiety | 1-2 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
| Pruritus (after other more conventional therapies have failed) | 5-10 mg per cat PO once daily or 2.5-7.5 mg/cat once to twice daily. When discontinuing, taper dose over 1-3 weeks. | PO | q12-24h | — | 🌎 NA |
| Symptomatic therapy of idiopathic feline lower urinary tract disease (FLUTD) | 2.5-12.5 mg (total dose) PO once daily at night | PO | q24h | — | 🌎 NA |
| Symptomatic therapy of idiopathic feline lower urinary tract disease (FLUTD) | 5-10 mg (total dose) PO once daily at night; the drug is in popular use at present and further studies are needed | PO | q24h | — | 🌎 NA |
| Symptomatic therapy of idiopathic feline lower urinary tract disease (FLUTD) | 2.5-12.5 mg (total dose) PO at the time the owner retires for the night. Dosage is adjusted to produce a barely perceptible calming effect on the cat. If no improvement is seen within 2 months, the medication may be gradually tapered and then stopped. | PO | q24h | 2 months trial | 🌎 NA |
| Neuropathic pain | 2.5-12.5 mg/cat PO once daily | PO | q24h | — | 🌎 NA |
| Neuropathic pain | 0.5-2 mg/kg PO once daily; may be a useful addition to NSAIDs for chronic pain. | PO | q24h | — | 🌎 NA |
| Management of psychogenic alopecia, hypervocalization, and idiopathic cystitis | 0.5-1 mg/kg | PO | q24h | — | 🌍 EU |
- Self-mutilation behaviors associated with anxiety: With behavior modification.
- Pruritus (after other more conventional therapies have failed): Taper dose over 1-3 weeks when discontinuing.
- Symptomatic therapy of idiopathic feline lower urinary tract disease (FLUTD): Reserved for cases with severe, recurrent signs.
- Management of psychogenic alopecia, hypervocalization, and idiopathic cystitis: Very bitter taste; can cause ptyalism.
새
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Adjunctive treatment of feather plucking | 1-2 mg/kg PO q12-24 hours. Anecdotal reports indicate some usefulness. Barring side-effects, may be worth a more prolonged course of therapy to determine efficacy. | PO | q12-24h | Prolonged course | 🌎 NA |
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
아미트리프틸린은 1세대 삼환계 항우울제(TCA)입니다. 반려견의 일차적 행동 장애(예: 분리 불안) 치료에 있어서는 클로미프라민이나 SSRI(예: 플루옥세틴)와 같은 최신 약물로 대체되는 추세이지만, 수의학에서는 여전히 다방면으로 활용되는 약물입니다.
임상 팁: 이 약물의 다중 수용체 활성은 신경병증성 통증, 소양증(강력한 항히스타민 효과), 그리고 고양이 특발성 하부 요로 질환(FLUTD/FIC)의 보조 치료에 특히 유용하게 만듭니다. 조류의 깃털 뽑기 행동을 조절하기 위해 사용되기도 합니다.
작용 기전
Amitriptyline and its active metabolite, nortriptyline, exhibit a complex pharmacologic profile, affecting multiple receptor systems:
- Serotonin (SERT) & Norepinephrine (NET) Reuptake Inhibition: Blocks the amine pump → increases synaptic levels of 5-HT and NE → mood stabilization and descending pain pathway modulation.
- H1-Receptor Antagonism: Potent antihistamine effect → stabilizes mast cells and provides antipruritic action.
- M1-Muscarinic (Anticholinergic) Antagonism: Causes smooth muscle relaxation (useful in FLUTD) but also leads to side effects like dry mouth and urine retention.
- Alpha-1 Adrenergic Antagonism: Can cause mild vasodilation and sedation.
- NMDA Receptor & Sodium Channel Blockade: Contributes to its efficacy in treating chronic, neuropathic pain.
안전성·주의사항
금기사항
- Prior sensitivity to any tricyclic antidepressant
- Concomitant use with monoamine oxidase inhibitors (MAOIs)
부작용
- Sedation
- Constipation
- Urinary retention
- Hyperexcitability (dogs)
- Seizures (rare)
- Cardiac dysrhythmias
- Bone marrow suppression
- Vomiting
- Diarrhea
- Hypersalivation (cats)
- Anorexia (cats)
- Thrombocytopenia
- Neutropenia
- Unkempt hair coat (cats)
- Ataxia
- Disorientation
주의
Use with extreme caution in patients with seizure disorders as tricyclic agents may reduce seizure thresholds. Use with caution in patients with thyroid disorders, hepatic disorders, keratoconjunctivitis sicca (KCS), glaucoma, cardiac rhythm disorders, diabetes, or adrenal tumors. FDA Pregnancy Category D (restrict use to pregnant animals only when benefits clearly outweigh risks).
약물 상호작용
Increased effects; hyperthermia and ileus possible
May inhibit tricyclic antidepressant metabolism and increase the risk of toxicity
May have additive effects on QTc interval; possible serious arrhythmias may result
Potential life-threatening serotonin syndrome; use together not recommended
Increased sedative effects
Possible increased amitriptyline levels
Increased risk for QTc interval prolongation and tricyclic adverse effects
Potential increased amitriptyline levels, increased risk for serotonin syndrome; enhanced monitoring suggested if used together
May increase the risk of cardiac effects (arrhythmias, hypertension, hyperpyrexia)
Increased risk for arrhythmias; monitor closely
Risk of fatal serotonin syndrome. Requires a minimum 2-week washout period.
Metabolized by CYP2D6; may alter amitriptyline metabolism.
Concurrent use increases the risk of serotonin syndrome.
Concurrent use increases the risk of serotonin syndrome.
Increased risk of serotonin syndrome and seizure threshold reduction.
모니터링
- Clinical efficacy (behavior, pain, or pruritus improvement)
- Adverse effects
- Baseline cardiac evaluation (ECG) prior to therapy
- Baseline CBC and serum chemistry panel prior to therapy
- Liver enzymes in cats (prior to therapy, 1 month after initial therapy, and yearly thereafter)
약동학
반감기
흡수
Rapidly absorbed from both the GI tract and parenteral injection sites. Transdermal (PLO-gel based) absorption in cats is poor. Peak levels occur in 1-2 hours after oral administration in cats and within 2-12 hours in other species.
분포
Highly bound to plasma proteins. Enters the CNS and enters maternal milk in levels at or greater than those found in maternal serum.
대사
Metabolized in the liver to several metabolites, including the active metabolite nortriptyline.
배설
Eliminated primarily via hepatic metabolism.
과다투여
Overdosage with tricyclics can be life-threatening (arrhythmias, cardiorespiratory collapse). Because toxicities and therapies are complicated, it is recommended to contact an animal poison control center immediately in any potential overdose situation.
- Dogs: Common findings include lethargy and tachycardia.
- Cats: Common findings include vocalization, ataxia, mydriasis (dilated pupils), tachycardia, disorientation, lethargy, and agitation.
제품
제형
- Tablets
- Injection
인용의약품
- Amitriptyline HCl Tablets: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, & 150 mg
규제 현황
POM (Prescription Only Medicine). Clomipramine is the authorized TCA for dogs in the EU.
POM-V. Prescribed under the cascade as human generic preparations.
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Tablets should be stored at room temperature. The injection should be kept from freezing and protected from light.
보호자 정보
인내심이 중요합니다: 행동 변화는 하루아침에 일어나지 않습니다. 완전한 효과를 보려면 일반적으로 수주 간 매일 꾸준히 투약해야 합니다.
- 갑자기 중단하지 마십시오: 약물 투여를 중단할 때는 금단 증상을 예방하기 위해 수의사의 지시에 따라 서서히 용량을 줄여야 합니다.
- 부작용: 반려동물이 졸려 하거나 입 마름(입술을 자주 핥는 모습)을 보일 수 있습니다. 변비나 배뇨 곤란이 발생할 수 있으므로 이러한 증상이 보이면 수의사에게 알리십시오.
- 독성 경고: 어린이 보호용 포장재에 보관하고 어린이와 다른 반려동물의 손이 닿지 않는 곳에 엄격히 보관하십시오. 과다 복용 시 치명적일 수 있습니다.
- 투약 방법: 알약은 쓴맛이 날 수 있습니다. 기호성이 높은 간식이나 필 포켓에 숨겨서 먹이는 것을 권장합니다.
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