阿米替林
Amitriptyline
Amitriptyline hydrochloride
別名: Elavil · Lentizol · Tryptanol · Amitriptylini hydrochloridum · Amitriptylinum · Amitriptyline hydrochloride
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
鳥
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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 |
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
阿米替林是一種第一代三環類抗憂鬱藥 (TCA)。雖然在治療犬隻原發性行為障礙（如分離焦慮）方面，它已在很大程度上被氯米帕明 (clomipramine) 或 SSRI（如氟西汀）等較新的藥物所取代，但阿米替林在獸醫學中仍然是一種用途廣泛的藥物。
臨床要點：其多重受體活性使其特別適用於輔助治療神經性疼痛、搔癢症（因其強效的抗組織胺作用）以及貓自發性下泌尿道疾病 (FLUTD/FIC)。它偶爾也用於鳥類醫學以控制拔羽行為。
作用機制
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.
安全性與警告
禁忌症
- Prior sensitivity to any tricyclic antidepressant
- Concomitant use with monoamine oxidase inhibitors (MAOIs)
不良反應
- 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
注意事項
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).
藥物相互作用
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.
監測
- 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)
藥物動力學
半衰期
吸收
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.
分佈
Highly bound to plasma proteins. Enters the CNS and enters maternal milk in levels at or greater than those found in maternal serum.
代謝
Metabolized in the liver to several metabolites, including the active metabolite nortriptyline.
排除
Eliminated primarily via hepatic metabolism.
過量
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.
可用產品
劑型
- Tablets
- Injection
人用標示
- Amitriptyline HCl Tablets: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, & 150 mg
各地核准狀態
POM (Prescription Only Medicine). Clomipramine is the authorized TCA for dogs in the EU.
POM-V. Prescribed under the cascade as human generic preparations.
暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Tablets should be stored at room temperature. The injection should be kept from freezing and protected from light.
飼主須知
耐心是關鍵：行為改變不會在一夜之間發生。通常需要數週持續每天服藥才能看到完整效果。
- 請勿突然停藥：若要停藥，必須在獸醫師的指導下緩慢減少劑量，以防止出現戒斷症狀。
- 副作用：您的寵物可能會顯得嗜睡或口乾（您可能會注意到牠們頻繁舔嘴唇）。可能會出現便秘或排尿困難；如果發現這些症狀，請通知您的獸醫師。
- 毒性警告：請務必將藥物存放在兒童防護包裝中，並遠離兒童和其他寵物。過量服用可能致命。
- 給藥方式：藥丸可能很苦。建議將其藏在適口性高的零食或餵藥用肉塊中。
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