Use of transdermal amitriptyline gel in a patient with chronic pain and depression

A man with severe inflammatory bowel disease suffered from chronic abdomina l pain and depression. A transdermal amitriptyline gel preparation was comp ounded since he was unable to take drugs orally Serum concentrations of ami triptyline and its active metabolite nortriptyline were measured over 24 ho urs. Symptoms of depression were monitored before starting transdermal ther apy and at the end of 6 weeks. Pain symptoms and amitriptyline adverse drug events were monitored daily. Steady-state serum concentrations of drug and metabolite were within the therapeutic range over 24 hours. The patient re ported that his mood was improved but his abdominal pain remained unchanged . Transdermal amitriptyline gel was well tolerated and is an alternative de livery system in patients unable to take drugs orally.