140 – Circling the Drain, Part 7: 7 January 2025

Margaret and me being silly at Wilpena Pound on 25 March 2015.

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Shortly after my June 2021 hospital admission, Dr Kannusamy prescribed a daily dose of 25 milligrams of Amitriptyline Alphapharm.  He told me this was effective for stomach bloat and breathlessness.  I now know the primary usage of Amitriptyline is for depression.  The Amitriptyline Alphapharm did not help me.  I did not have depression.

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Mayo Clinic says this about Amitriptyline Alphapharm.

Amitriptyline is used to treat symptoms of depression. It works on the central nervous system (CNS) to increase levels of certain chemicals in the brain. This medicine is a tricyclic antidepressant (TCA). This medicine is available only with your doctor's prescription.

  

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This is what the Australian Government website Health Direct, says about Amitriptyline Alphapharm.

What it is used for For the treatment of major depression. Nocturnal enuresis where organic pathology has been excluded.

 

Health Direct refers to the possible use of Amitriptyline Alphapharm for “nocturnal enuresis”.  Nocturnal enuresis is bedwetting.  I was definitely not peeing in my sleep.  Back then, I would have been very grateful to be able to sleep at all.

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Amitriptyline Alphapharm sometimes has bad side effects.  This is from Mayo Clinic.

Amitriptyline may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you or your caregiver notice any of these adverse effects, tell your doctor right away. Do not take amitriptyline if you have taken a monoamine oxidase (MAO) inhibitor (isocarboxazid [Marplan®], phenelzine [Nardil®], selegiline [Eldepryl, or tranylcypromine [Parnate]) in the past 2 weeks. Do not start taking a MAO inhibitor within 5 days of stopping amitriptyline. If you do, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, sudden high body temperature, extremely high blood pressure, or severe convulsions. Do not take other medicines unless they have been discussed with your doctor. Using this medicine together with cisapride (Propulsid, may increase the chance of having serious side effects.

 I cannot say whether I suffered side effects from the Amitriptyline Alphapharm.  I suffered massive pain but I don’t know whether Amitriptyline Alphapharm caused the pain.  I know was not warned about the possible side effects of Amitriptyline Alphapharm

****Apart from possible side effects, there were known medical reasons why Amitriptyline Alphapharm was very bad for me.

After my open heart surgery in November 2018, I began a daily 100 milligrams of Aspirin.  This is normal for heart surgery patients.  My treating heart doctor recommended that I take the Aspirin.  Aspirin was named in the typed medications list I took with me to hospital in June 2021.

 Mayo Clinic says this about mixing Amitriptyline Alphapharm with Aspirin.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. ·         Aspirin

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The website ehealthme lists the following “Common Amitriptyline hydrochloride and Aspirin interactions:

·         Abdominal cramps: 13 reports

·         Abdominal discomfort: 10 reports

·         Abdominal pain: 13 reports

·         Abnormal behavior: 6 reports

·         Abnormal behaviour: 6 reports

·         Abnormal heart rhythms: 13 reports

·         Abscess (pus): 4 reports

·         Acute myocardial infarction (acute heart attack): 4 reports

·         Adverse event: 4 reports

·         A[trial] fib[rillation] (most common type of arrhythmia): 15 reports

·         Agitation (state of anxiety or nervous excitement): 21 reports

·         Agrypnia: 17 reports”

When admitted to the hospital, I brought with me a typed copy of my medications which I also took to A & E.  I had ensured that my medications list was accurate and on admission I provided a copy of the medications list to staff in my hospital ward.  I saw the list in my file when nursing staff checked my condition.

For me, Amitriptyline Alphapharm taken with Aspirin raised the possibility of “Abdominal cramps” and “Abdominal discomfort” – a worsening of the very symptoms I was already suffering.

As well as stomach bloating and vile stomach pain, one of my major symptoms was an inability to get proper sleep.  One side effects of Amitriptyline Alphapharm in conjunction with Aspirin is sleep deprivation.

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 Amitriptyline Alphapharm in conjunction with Aspirin is associated with “Abnormal heart rhythm”, “acute heart attack” and “Atrial fibrillation (irregular heart beat)” in patients without heart disease.

I had undergone open heart surgery.

Amitriptyline Alphapharm in combination with Aspirin can cause a side effect called “Agrypnia”.  This is from the “Abstract” of an article in the website Public Medicine about Agrypnia .

Abstract Agrypnia (from the Greek: to chase sleep) excitata (AE) is a syndrome characterized by loss of sleep and permanent motor and autonomic hyperactivation (excitata). Disruption of the sleep-wake rhythm consists in the disappearance of spindle-delta activities, and the persistence of stage 1 non-rapid eye movement (NREM) sleep. Rapid eye movement (REM) sleep persists but fails to stabilize, appearing in short recurrent episodes, isolated, or mixed with stage 1 NREM sleep. Diurnal and nocturnal motor, autonomic and hormonal overactivity is the second hallmark of AE.

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Apart from all these known dangers, there was a more important reason why Dr Kannusamy should never have prescribed Amitriptyline Alphapharm for me.  

Mayo Clinic gives this warning about the danger of Amitriptyline Alphapharm for patients with heart disease.

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially: ·         Heart disease;

 Heart disease patients should not be prescribed Amitriptyline Alphapharm without very sound medical reasons.  I had told hospital staff about my November 2018 open heart surgery.  This was explicitly stated in my medical history and symptoms summary.  My open heart surgery file was physically available because my surgery was performed in a “sister hospital” run by the same hospital group.

Amitriptyline Alphapharm given to patients with heart disease can cause sudden, unexpected death.

This is extracted from The Lancet, the Journal of the British Medical Association.

A hospital-based drug information system has been used to investigate a suspicion linking unexpected death with the administration of the tricyclic antidepressant, amitriptyline, in patients with a diagnosis of cardiac disease. 6 out of 53 patients with cardiac disease who were identified by the system died suddenly and unexpectedly after administration of the drug, compared with none of 53 control patients matched for sex, age, diagnosis, and length of stay in hospital. This high frequency of unexpected death was not found in patients receiving imipramine, nor in patients without cardiac disease receiving amitriptyline. Amitriptyline should be used with caution in patients with cardiac disease.

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There was yet another compelling reason why I should not have been given Amitriptyline Alphapharm.

It is an addictive medication.  

I was not told I might become addicted if I took Amitriptyline Alphapharm.  I should have been warned about possible addiction.

in my case, Dr Kannusamy was very incompetent and caused harm.