INTRAVENOUS AMITRIPTYLINE IN PEDIATRICS

Oral amitriptyline has been used as an analgesic in a wide range of pa in settings. Despite long-term availability of a parenteral form, the few reports about this formulation have been limited to pharmacokineti c studies in normal volunteers, trials in depressed patients, and anal yses of electroencephalogram (EEG) activation. We retrospectively revi ewed our experience using intravenous (IV) amitriptyline at Children's Hospital, Boston and at Children's Hospital at Stanford. Eight childr en (aged 5-16.6 years), who were unable to tolerate medications by the oral route, received IV amitriptyline for a variety of indications, i ncluding neuropathic pain, depression, sleep disturbance, and as an ad juvant agent for opioid analgesia. One patient experienced an extrapyr amidal reaction temporally related to the administration of IV amitrip tyline, which was successfully managed with diphenhydramine. Further p rospective controlled studies are needed to further assess the safety, efficacy and tolerability of this novel use of amitriptyline.