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Q: Elavil alternatives ( No Answer,   6 Comments )
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Subject: Elavil alternatives
Category: Health > Medicine
Asked by: arubin-ga
List Price: $50.00
Posted: 19 Feb 2004 17:16 PST
Expires: 20 Mar 2004 17:16 PST
Question ID: 308622
A friend of mine has been taking Elavil for a number of years.  I've
heard that the drug has been discontinued.  However, the friend is
sensitive to a number of the amitriptyline brands.  Can anyone suggest
which amitriptyline brands may be most similar to Elavil?

Location is in the United States -- this may be relevant as different
brands are sold in different countries.

Request for Question Clarification by nancylynn-ga on 05 Mar 2004 05:37 PST
I can find distributors that sell Elavil (not the generic). However,
your friend may still have the same problems he/she's experiencing
with the generics since their properties are identical. (Unless, as
Pinkfreud-ga suggests, the coloring agent in the generic is causing an
allergic reaction.)

Could you please tell:

1. What kinds of problems/ side-effects your friend is having now with
 amitriptyline?

2. Why was Elavil first prescribed: for depression, for migraines, or
for pain management? (Elavil has several uses.) If I know why Elavil
was prescribed, I can find alternative drugs your friend can discuss
with his/her doctor.

3. Is your friend's doctor aware of these problems? If so, what has
the doctor advised or suggested?

Thank you.

Regards,
nancylynn-ga

Request for Question Clarification by nancylynn-ga on 05 Mar 2004 07:58 PST
Another point: because of these adverse side-effects, has your friend
stopped using, or decreased use of, amitriptyline?

If so, that could help explain your friend's problems. It is VERY
dangerous to stop taking -- or decrease dosage of -- amitriptyline or
Elavil, unless one does so under the supervision of a doctor.

Clarification of Question by arubin-ga on 05 Mar 2004 09:28 PST
1.  Headache. 

2.  Depression (possibly pain management, as well).

3.  The doctor who originally prescribed Elavil is no longer available
-- this has been a continuing prescription for some years.  Some
doctors she's seen for other conditions haven't had specific advice. 
She hasn't yet seen either her primary care physician or a specialist
on the question of an Elavil substitute.

I was hoping that someone here could point me to the research to point
a non-specialist doctor in the right direction.

and ...

She hasn't yet run out of the Elavil.  We just got another month's
supply from a local pharmacy.

Request for Question Clarification by nancylynn-ga on 05 Mar 2004 09:55 PST
"I was hoping that someone here could point me to the research to point
a non-specialist doctor in the right direction."

If you can tell me where you live, I will be glad to search for
psychiatrists and doctors who specialize in pain management in the
region where you live.

In fact, a specialist may determine that she should be switched to
another drug entirely. But you're right, your friend needs a
specialist to evaluate the problems she's having and adjust dosage or
change meds.

If you live a small town and prefer not to say just precisely where
you live, could you tell me the closest metro area to where you are?
Or give me some medium-size towns in your vicinity?

I will search for specialists in that region who should be able to
treat your friend.

Regards,
nancylynn-ga

Request for Question Clarification by pinkfreud-ga on 05 Mar 2004 12:29 PST
Have you ruled out the use of a compounding pharmacy, as mentioned in
my comments? Compounding is truly the best way to obtain a functional
equivalent to Elavil.

Clarification of Question by arubin-ga on 05 Mar 2004 13:35 PST
nancylynn:  Located in Orange County, California.  However, the
medical plan has only limited coverage for psychological services. 
You may also be correct that the drug mixture needs to be readjusted,
but I'm not sure that's PRECISELY an answer to my question.

 pinkfreud::  I haven't ruled out the use of a compunding pharmacy. 
That's probably among the best solutions to the question should have
asked (How does she  OBTAIN an he he amitriptyline brand similar to
Elavil).

Request for Question Clarification by pinkfreud-ga on 05 Mar 2004 14:02 PST
A resident of Orange County would probably find this compounding
pharmacy convenient:

http://www.mcguffpharmacy.com/

Here's contact information for McGuff Compounding Pharmacy Services:

http://www.mcguffpharmacy.com/Services/services.htm

Request for Question Clarification by nancylynn-ga on 05 Mar 2004 15:25 PST
Hello again arubin-ga:

Rest assured: I didn't post my suggestion that your friend be
evaluated by a psychiatrist or at a pain management clinic as an
"Answer."  (Your credit card won't be charged.)

I'm afraid I strayed a bit -- jumped the gun by bringing up using
specialists, at this point.

You're saying your friend does fine on Elavil, the name drug, but not
so well on its generics, e.g. amitriptyline.

I will research for you -- if you'd like:

1. Whether Elavil (the brand name) is indeed going to be discontinued.

2. The closest possible, purest amitriptyline equivalent to Elavil.

However, your local pharmacist can probably look up that information
for you. (As I believe Pinkfreud pointed out.)

I think my friend Pinkfreud is right and that you should try a
compounding pharmacy. (A primary care physician will have to write a
prescription for you to send in.)

If their color-free, filler-free alternative doesn't quite cut it,
then I think your friend needs to talk to her primary physician about
a specialist who meets your friend's insurance guidelines. I would
think a pain management clinic would be a good place for such an
evaluation -- if insurance will cover it. Otherwise, the primary doc
may be able to recommend a psychiatrist who specializes in pain
management.

So, if you'd like I can research the two issues noted above; or, you
can ask your pharmacist for the purist version of amitriptyline, or
try Pinkfreud's suggestion.

If I were you, frankly, my first step would be talking to the primary
care doctor about using a compounding pharmacy, per Pinkfreud's
suggestion.

This page from About.com, about reactions to Elavil, Endep, and
Amitriptyline, may be of interest to your friend:
http://depression.about.com/cs/amitriptyline/l/blsidefxamitrip.htm

Regards,
nancylynn-ga
Answer  
There is no answer at this time.

Comments  
Subject: Re: Elavil alternatives
From: pinkfreud-ga on 19 Feb 2004 18:57 PST
 
If your friend is sensitive only to certain brands of amitriptyline,
it seems likely that the problem is the diluent or "filler" (inactive
ingredients which are used in forming pills and capsules). If that is
the case, the material posted above will be of no use.
Subject: Re: Elavil alternatives
From: pinkfreud-ga on 20 Feb 2004 11:52 PST
 
Another possibility is that your friend may be sensitive to certain coloring-agents.
Subject: Re: Elavil alternatives
From: pinkfreud-ga on 28 Feb 2004 13:44 PST
 
Has your friend tried a compounding pharmacy? Compounding pharmacists
can custom-tailor a medication (with a physician's prescription, of
course). This can be very helpful in cases where there are
sensitivities to inactive substances such as fillers and colorings. If
no compounding pharmacy is nearby, there are several that operate
online.

The PDR of Pharmaceutical Preparations lists all inactive ingredients
for each manufacturer's version of a drug. As far as I know, this is
not available on the Internet, but most pharmacies are likely to have
a copy. A publication called "Mosby's Drug Consult" is another source
for this information.
Subject: Re: Elavil alternatives
From: pinkfreud-ga on 28 Feb 2004 21:29 PST
 
Here's some information on the inactive ingredients of Elavil:

"ELAVIL* (Amitriptyline HCl) is supplied as 10 mg, 25 mg, 50 mg, 75
mg, 100 mg, and 150 mg tablets and as a sterile solution for
intramuscular use. Inactive ingredients of the tablets are calcium
phosphate, cellulose, colloidal silicon dioxide, hydroxypropyl
cellulose, hydroxypropyl methylcellulose, lactose, magnesium stearate,
starch, stearic acid, talc, and titanium dioxide. Tablets ELAVIL 10 mg
also contain FD&C Blue 1, Tablets ELAVIL 25 mg also contain D&C Yellow
10, FD&C Blue 1, and FD&C Yellow 6. Tablets ELAVIL 50 mg also contain
D&C Yellow 10 FD&C Yellow 6 and iron oxide. Tablets ELAVIL 75 mg also
contain FD&C Yellow 6. Tablets ELAVIL100 mg also contain FD&C Blue 2
and FD&C Red 40. Tablets ELAVIL 150 mg also contain FD&C Blue 2 and
FD&C Yellow 6."

http://www.fda.gov/cder/foi/label/2001/12704s45lbl.pdf
Subject: Re: Elavil alternatives
From: pinkfreud-ga on 28 Feb 2004 21:45 PST
 
In case you are curious about compounding pharmacies as an option for
your friend, here's some info from a compounding pharmacy's website:

"Many patients are allergic to preservatives or dyes in standard
drugs, or are lactose intolerant. A pharmacist can compound
prescriptions that are preservative, dye, and lactose free...
 
Having trouble finding that medicine that works for you?
Pharmaceutical companies may stop making products for which there is
limited demand. And limited demand is likely to occur when a newer
and, sometimes, more effective medicine comes into the market. However
some patients may respond better to the now commercially unavailable
medicine. If we can obtain the medicine in its chemical form, we can
compound the prescription."

http://www.panoramapharmacy.com/benefits.htm
Subject: Re: Elavil alternatives
From: pinkfreud-ga on 04 Mar 2004 14:51 PST
 
Here's a list of some compounding pharmacies' websites:

http://directory.google.com/Top/Health/Pharmacy/Pharmacies/Compounding/

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