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Now that the media hype ended the Iraq Study Group's report is in due course starting to die set a bit, public interest is like a shot change of course to the President's future national code in which he is scheduled to lay out his new plan of action for dealing beside the current mutineer and camp hostility.

Many analysts questionable the President's new range of movement will embrace the chronic habituation of Iraqi Army and force forces, a scheme that has been in lay since shortly after the U.S.-led incursion in March 2003 and one that has been recommended for increased inflection and physical exertion by the Baker-Hamilton administrative body.

Of course, it is effortless to know the allure of this approach: as Iraqi forces make better in fitness and originate to proceeds concluded warranty operations, American forces can enter upon to leave. Iraqis gradually anticipate burden for their terrain time the United States in stages decreases its soldiers footmark in a war that is more and more ostracized with the American exoteric. The question with this approach, though, is that it ignores a cardinal reality in Iraq: that the issue next to the Iraqi wellbeing forces is not one of training, but one of jingoism to a solid land.

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The Iraqi Army has made quite a lot of mensurable progress, to be sure, and has even interpreted the pb in warranty operations in quite a few areas of the rustic. Every day more and more than Iraqis unafraid the hazard of insurgent and terrorist attacks to enrol its ranks. The breaking in and equipping of the Army continues throughout the country, but frozen the sphere of a subject oblige supportive of a national political affairs is a away hope underneath even the unsurpassed of surroundings.

The ISG white the cognitive content of political unit loyalty in its report: "Significant questions stay about the cultural mixture and loyalties of both Iraqi units-specifically whether they will transfer out missions on lieu of national goals as an alternative of a inner circle schedule." The papers goes on to say, "Of Iraq's 10 deep-laid divisions, those that are even-numbered are ready-made up of Iraqis who autographed up to tennis shot in a precise area, and they have been loath to redeploy to remaining areas of the region. As a result, weather of the Army have refused to get out missions."

The Iraqi Police see from the selfsame problem, with camp loyalties manifesting themselves in the bribery, theft, agony and elimination of the civilian people. Family ties, holy way of life and social group associations bring precedency over and done with protective and serving the general public at large, and many a policemen use their positions to enhance their various militias or factions alternatively of to implement the laws passed by the Iraqi political affairs.

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Unless within is whatever category of political unit cooperation in which all parties hold to advocate a incorporated Iraqi government, all the activity in the international will not business. And the world is that such as a policy-making composition not apparent to be reached anytime before long. Thus far, none of the host of Shiite groups has shown an flavour in in a job near the Sunnis to back them a slot in Iraq's future, and the Kurds have fixed their pains on maintaining the location self-rule they have enjoyed for almost two decades. As a result, the Sunnis have shown no attitude to disconnect their movement of severity antagonistic Shiites and organisation forces and have worked to a number of scope with foreign jihadists to sabotage the national political modus operandi.

So the interval of bombing continues and provisions in Iraq steady fall. Thousands of Iraqis die all month and American branch of knowledge casualties progressively appreciation. The citizens of both Iraq and the United States are growing increasingly restive with the existing situation of affairs as President Bush analyzes ninefold recommendations for a new plan of action.

If that scheme includes the perpetual preparation of Iraqi Army and law enforcement agency forces, as it expected will, the bigger mental object of national rapprochement will have to be a top high status. Unless all groups judge a integrated Iraq and act their hard work to supportive a federal government, the forces that construct up the Iraqi Army and police will disseminate to distribute their firsthand conformity to the various factions right now struggling for dominion. And as long-dated as that is the case, we are frailty our example preparation and militarization them as portion of a scheme planned to manus ended warranty fault so that we can transport our military personnel warren.

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Tuesday, May 10, 2011

Realtor Tim Ryan Gives an Update on the Naples, FL Real Estate Market

The Naples real estate market has continued to thrive despite negative public opinion and massive amounts of bad press.

NAPLES, FL --(PR.com)-- Tim Ryan (top right photo) is a Realtor in Naples, FL. The opinions below are are Tim's and all statistics are taken from the NABOR (Naples Board of Realtors) chart.

Tim starts by saying, "Many people are surprised to come to Naples and discover that this is not a ghost town. Interestingly enough, there is some really positive data pointing to a market stabilization and recovery (click here for key statistics for NABOR).

“You can see that inventory is at five year lows and dropping. The average DOM days on market) has come down when comparing to the 1st QTR 2010 (NABOR).

“When comparing the 12 month period that ended 3/31/2011 vs the 12 month period prior to it, there are some fundamental differences. You see that sales increased by over 2%, 7898 vs 7732 (NABOR).

“ It was wonderful to see this kind of growth. When you measure the small increase in sales against the shrinking inventory the statistic becomes more convincing. Note that during these same comparable periods (using that last QTR for comparison) the average inventory dropped from 9411 to 8620, a drop of over 8% (NABOR)."

Tim Ryan with Amerivest Realty says, "So, where is this negative perception coming from? It is true that nationally things are still bad. However, Naples was one of the first regions to have falling prices and it appears that Naples is coming out of it a bit earlier as a result. After all, there is still a clear path of new people moving to SW Florida."

Tim continues, "Remember the old adage of supply vs demand? As we continue to see key statistics trend towards the positive, perceptions will quickly start to change.

"If you are on the fence about buying Naples real estate... you may want to get off," says Tim.

Contact Information: Amerivest Realty, Tim Ryan, 239-963-4070

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Friday, January 16, 2009

From This To ... ???

After getting the cabinet home, I took a bunch of pictures (both inside and out) so I can have something to compare the finished product to and to track my progress. The cabinet is in decent shape but there is a lot of work to be done to get it looking like it just came out of the factory.

Here are a few shots of the entire cabinet from several angles to give you an idea of what I'm going to be working with. The existing side art will have to come off first.

The next shot shows the cabinet from the other side - the side art is already peeling off! Maybe I'll get lucky and it will come off easily.

I don't know if you can see but there are multiple holes punched through both sides that will have to be patched. It appears as though this cabinet was converted from a Donkey Kong to a Nintendo Vs. cabinet at some point. The vertical Donkey Kong monitor would have to be turned on its side (or replaced) because the Nintendo Vs. games all ran on two(!) horizontal monitors stacked on top of one another. The holes are for the various supports for the monitors. The original Donkey Kong cab had two bolts on each side in order to support a monitor bracket - right through the side art! Even though I'm going for authenticity, I think I'm going to make some minor design "improvements" along the way and this will be one of them - no bolts through the side panels!

Finally, here is a shot of the back of the cabinet. I really should take some head-on pictures of the front and back but this will have to do for now. You can see the two holes cut out near the top - this was for transporting it around. There are two casters on the bottom so all you have to do is tip it back onto the wheels and grab it by the two openings. It is quite easy to move around.

I will post some close-up shots later but I can already tell that the back part is going to be the toughest to restore - plus, the back door was missing when I picked it up so I'll have to make an entirely new one!

More later.

Tuesday, January 13, 2009

Getting Some Help

Over the holidays I asked my dad if he wanted to help me restore the Donkey Kong and he agreed! He is very handy and I think it will be a lot of fun to spend time working together. We are planning to set aside a few Saturdays in the Spring once the weather gets better. The first steps will be:

1. Fill all holes on the exterior and sand
2. Mask off sides and front and paint interior black
3. Apply 3-4 coats of white primer (sanding in between)
4. Apply 2 top coats of powder blue paint (sanding in between)

Once all that is finished we will be well on our way. I can't wait to get started!

Tuesday, January 6, 2009

Back Door Operation Sheet

Since I'm going for authenticity I will be including the "Back Door Operation Sheet" that was stapled to the inside of the back door of an original Donkey Kong cabinet. Here is a pic of what it looks like:

I'm not sure if I'll be using the same monitor or even running a Donkey Kong board on the inside so the operation sheet might be a little misleading but hey, no one will know except me... the goal is to restore the cabinet to be as "authentic" as possible so every little detail matters...


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St. Edward's CE Primary School (Dorrington)

Welcome to Kingfisher Class

Year 1, 2 and 3

Class Teacher: Miss Lumley

Please help the children to remember the following items for school every day:

  • Reading Record and reading book
  • Water bottle
  • Healthy snack (fruit is available in school for morning break)
  • P.E kits (P.E kits can stay in school Monday-Friday)

Homework expectations:

Year 1: Daily reading at home and weekly spellings (new spellings are given every Friday with testing on the following Thursday).

Year 2 and 3: Daily reading at home, weekly spellings and a Literacy and/or Maths task (new spellings and tasks are given every Friday with testing/homework due on the following Thursday).

All spellings and tasks are explained to the class, however if they are finding them tricky then please encourage your child to ask me for help at the start of the week.

Kingfisher Class Start of Term Letter 12.9.17.pdfDownload
Showing 1-1 of 1

This term our main theme is ANIMALS.

Through Literacy, Science, History and Geography we will be learning about the animals found in the vast range of environments around the world.

During R.E we will be studying the Gospel and the kind of world that Jesus wanted.

Useful websites and resources to continue learning at home:

ICT Games (A great selection of Literacy and Maths Games (including 'Save the Whale'))

Dance Mat Typing (Become familiar with the computer keyboard and increase your typing speed)

KS1 BBC Bitesize (KS1 Maths, Literacy and Science Learning Games)

KS2 BBC Bitesize (KS2 Maths, Literacy and Science Learning Games)

Phase 2, 3 and 5 Sounds Mat.pdfDownload
Complex Sounds Chart.pdf.13k0nvj.partialDownload
Year 1-4 Key Words (read then spell).pdfDownload
Bloom's Reading Question Starters.pdfDownload
Reading and Writing Apps and Websites.pdfDownload
Showing 1-5 of 5


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Opportunities for Schools

Coaching in Schools

Dorset is very fortunate to have a large number of experienced coaches confident and keen to coach in local schools.  This can be to support PE in the curriculum or to deliver blocks of after-school club coaching.

Pathways for Players10675524_10154713742935018_8178519330085070213_n[1]

If you have players that enjoy playing table tennis in your school, there are a number of excellent opportunities for them to further their game. I would personally recommend Saturday Morning Coaching at the Centre or the Dorset Table Tennis Academy Sessions on a Tuesday evening.

Satellite Clubsttp

These are a fantastic new creation set up in partnership with Active Dorset, Table Tennis England, Dorset Table Tennis Centre and the local schools. These are set up in local schools for both the school and the wider community.  Coaches from Dorset Table Tennis Centre and local young leaders aim to provide a stimulating environment for all participants taking part. The target age range is between 14-25 years old but ALL ARE WECOME TO ATTEND.

At present we have 10 Satellite Clubs up and running in Dorset. These take place at The Grange School and Highcliffe School in Christchurch; Bournemouth and Poole College, Harewood College and St Peters School in Bournemouth; Poole High School in Poole; Dorchester Middle School in Dorchester; and in Weymouth at Budmouth College, All Saints and Wey Valley School.

Competition for Schools

National Champions 2014

Under 11 Girls National Champions 2014

We are very fortunate to have a fantastic relationship with Active Dorset and the County School Games Organisers. During the year there are termly competitons open to Dorset Primary and Secondary Schools. In the Autumn term we hold three events linked with the English Schools Table Tennis Association. These events consist of teams of 4 players in the U11,U13,U16 and U19 age groups. The winners of each competition has the opportunity to then represent Dorset against other county teams first locally and then nationally.

INSET Training for STAFF

Dorset Table Tennis Centre has been delivering Staff Training to teachers around the county for over 5 years. Matt Ware is a UKCC Level 2 Coach and heads up the sessions.   INSET days can take place after school or during Staff INSET days. These also support team building amongst the staff and provide many fun activities which can be incorporated easily into KS2,KS3 or KS4 curriculum lessons.

GCSE and A-Level Teaching

Matt Ware a wealth of experience teaching a variety of modules for GCSE.  Particular success has been seen by schools in using Table Tennis as it’s sport for the officiating module with pleasing results.

If you would be interested in discussing this opportunity, please contact James Lewis by email at DorsetTableTennisCentre@gmail.com or on his mobile: 07720286036.


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Getting Creative With Experts Advice

How to Find a Plumber.

Plumbing is the process of using pipes, tanks, and valves to covey fluids from one place to another. This work is done by professionals known as plumbers with use of required equipment. To compete the system of fluid transportation, plumbers join tanks, pipes and valves. The amount of work done manually is decreased by plumbing by making the work more easier with less manpower needed. Plumbing also increases the efficiency of liquid transport since this liquids and gases are readily available at any time. The dependence of trucks in transportation of either of the liquids especially petroleum is eliminated by use of pipelines which is part of plumbing. This also minimizes the chances of accident caused by trucks especially those conveying petroleum products. The knowledge and experience of the plumber determines the efficiency of plumbing.

Plumbing services are offered at affordable prices depending on the plumber being hired and the amount of work being offered. There are many plumbers who are ready to offer the plumbing services at a cost. Plumbing companies are established by some agents who bring these plumber together. Finding a plumber becomes easier by use of these companies since they are sure they are can find good plumbers who are well experienced. Advanced services may be introduced by the plumbing companies which enables people to easily find plumbers online. To hire plumbers online without wasting time of moving around to look for plumbers is made possible since contacts of plumbers found in the websites. Agents also offer their contacts to guide the clients interested on how to find a plumber and the prices required for a certain amount of job.

It is favorable to the customers to look for plumbers through the website since they can view websites and know the services and prices of different plumbing companies. Plumbers who fit the clients job are easily found since they can be accessed from those websites. Some plumbers may also provide services with their own materials thus increasing the ease of a client to accomplish the job without having to go and look for the materials required for the job. Professional plumbers who have a lot of skills may also be needed to guide and help those who are not highly skilled. These professionals are mostly required especially practiced in construction of pipes and tanks that convey petroleum products. They make sure the dimensions required for the pipes to be placed under the ground are as required. They also help to create awareness of the dangerous outcomes that may happen if the rules of plumbing are not followed. Hiring a good plumber makes a client receive services that are of good quality. Plumbers should be allowed to do work at their own pace to avoid mistakes that could come up due to pressure from those supervising the work.

What Do You Know About Experts

The 10 Best Resources For Services


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domingo, 10 de junio de 2012

La apatía de los hispanos preocupa a Chicago

The New York Times:

The nation’s rapidly growing Latino population is one of the most powerful forces working in President Obama’s favor in many of the states that will determine his contest with Mitt Romney. But Latinos are not registering or voting in numbers that fully reflect their potential strength, leaving Hispanic leaders frustrated and Democrats worried as they increase efforts to rally Latino support.
Interviews with Latino voters across the country suggested a range of reasons for what has become, over a decade, an entrenched pattern of nonparticipation, ranging from a distrust of government to a fear of what many see as an intimidating effort by law enforcement and political leaders to crack down on immigrants, legal or not.
(...) More than 21 million Latinos will be eligible to vote this November, clustered in pockets from Colorado to Florida, as well as in less obvious states like Illinois, Iowa, North Carolina and Virginia. Yet just over 10 million of them are registered, and even fewer turn out to vote.
In the 2008 presidential election, when a record 10 million Latinos showed up at the polls nationwide, that amounted to just half of the eligible voters. By contrast, 66 percent of eligible whites and 65 percent of eligible blacks voted, according to a study by the Pew Hispanic Center.
That disparity is echoed in swing states across the country. In Nevada, 42 percent of eligible Hispanics are registered, while just 35 percent are registered in Virginia, according to Latino Decisions, which studies Latino voting trends.
(...)  Jim Messina, Mr. Obama’s campaign manager, said Latino voters were a critical factor in the president’s re-election hopes. “Look, if we do our job right and have a good ground game, I absolutely believe that Latino voters can be one of the big reasons we win this election,” he said.
Officials in Mr. Romney’s campaign argued that he would cut into Mr. Obama’s Latino support by challenging his record on the economy, and how, they said, it had been particularly harmful to Latinos. Last week, the Romney campaign posted a Spanish-language advertisement on its Web site pointing to rising unemployment among Latinos.
“Understand the dynamic of this election: it’s about the economy and it’s about jobs,” said Joshua Baca, who is responsible for the Romney campaign’s Hispanic outreach. “Whatever the Obama campaign wants to do with regards to targeting Hispanic voters, that’s fine. Our message is going to be, ‘It doesn’t matter if you are Hispanic, if you’re a woman, if you’re African-American: it’s the economy.’ ”
(...) Evidence of the lack of participation can be found across the West, and particularly in Colorado, a state that could be one of the most contested in November. In 2010, 114,000 of the 455,000 Latinos eligible to vote in the state turned out, a study by Latino Decisions found; 47 percent of eligible voters are registered today.
The number of Latinos eligible to vote nationally may overstate their actual influence. Of the 21 million, nearly 10 million live in California or Texas, which are unlikely to be in play in November.
And while an influx of younger voters is helping to push up the overall number, younger voters have historically been disproportionately uninterested in politics, a particular challenge in Colorado given that the Latino population is younger than the overall population. A Pew study found that one-third of the nation’s eligible Hispanic voters are between 18 and 29; but they make up just 22 percent of the overall population.

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Log in

Community toy drive was a success for many children in our community

Sponsored by ChanceyBanner Aug17

Community toy drive was a success for many children in our community Submitted photo

Citizens in Douglas and Coffee County helped spread joy to children in the community by raising over an estimated of $8,000 and donating hundreds of toys for the Community Toy Drive. The City of Douglas, along with many local community agencies, hosted Community Toy Drives for boys and girls, ages 0–12 years, during the months of November and December. The Community Holiday Spectacular, an annual event that Mayor Tony Paulk envisioned in 2016, kicks off the toy drive and brings the community together during the holidays.

“Local citizens and businesses really came through and helped to make sure this Christmas was special for these kids and their families,” says Mayor Tony Paulk. “We hope to see more participation next year since we are planning to begin the Toy Drive earlier in the fall of 2018.”

Beginning Nov. 18 through Dec. 6, 2017, local community agencies held various toy drives. All monetary donations collected were used to purchase gifts for the children of qualifying families. Together with the donation of toys and monetary donations, the Community Toy Drive provided toys for approximately 465 children in our community. Toys collected at the toy drives were distributed on Dec. 16 from 9 a.m.- noon at Central Square Complex. Monetary donations were used to purchase gifts for the children.

Due to the combined efforts of several toy drives in the community, Southwire’s Project Gift raised an estimated $2,000.00 in toys; the Community Holiday Spectacular organized by Commissioner Kentaiwon Durham raised $1,130.00; Douglas Police Department, Douglas Fire Department, and Georgia State Patrol toy drives raised approximately $3,100.00. Additional thanks to our monetary sponsors: Thompson Machine, Anvil Trailer, Perpetual Praise & Worship Ministries, Georgia Millwright, Thomas Pump & Machinery, Don’s Body Barn, Walmart Distribution, Walmart Logistics, Jerry’s Sport Shop, Prince Auto, Charles Lewis Construction, Blondale Thomas, Cynergy Cargo, ESG Operations, Asa Whitfield, Douglas Lions Club, Malphus Electric, Southwire, CSRA Probation Services, Broxton Police Department, Broxton Dollar General, Walmart Store, William Minkema/The Martin Centre, Pastor Dawn Jones/Beth’el Worship Center, CHS HOSA volunteers, CHS NJROTC volunteers, and the entire Douglas community for contributions to this successful event.

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Last modified onTuesday, 02 January 2018 11:04

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 Get Let's create! Pottery HD 1.73 for iOS iPhone Windows Phone Android
Home New Apps Free Music Apps Weather channel app

Download Let's create! Pottery HD 1.73 for iPhone & iPad

Let's create! Pottery HD
  • Category: Entertainment, Games, Family,
  • Name: Let's create! Pottery HD
  • Version: 1.73
  • Download size: 168.61 MB
  • Date: 2010-07-16T07:00:00Z
  • Publisher: Infinite Dreams
  • Rating: 4+
  • License: $4.99
  • Compatible devices: iPadMini3-iPadMini3, iPhoneSE-iPhoneSE, iPadMini3Cellular-iPadMini3Cellular, iPadThirdGen4G-iPadThirdGen4G, iPhone5s-iPhone5s, iPadAir2Cellular-iPadAir2Cellular, iPadPro-iPadPro, iPadAirCellular-iPadAirCellular, iPadMini-iPadMini, iPadProCellular-iPadProCellular, iPadThirdGen-iPadThirdGen, iPad73-iPad73, iPhone6Plus-iPhone6Plus, iPhone8Plus-iPhone8Plus, iPad2Wifi-iPad2Wifi, iPad612-iPad612, iPadMini4-iPadMini4, iPadFourthGen4G-iPadFourthGen4G, iPhone6s-iPhone6s, iPad71-iPad71, iPhone7Plus-iPhone7Plus, iPadFourthGen-iPadFourthGen, iPodTouchFifthGen-iPodTouchFifthGen, iPadPro97-iPadPro97, iPadPro97Cellular-iPadPro97Cellular, iPhone5-iPhone5, iPhone6-iPhone6, iPad611-iPad611, iPad23G-iPad23G, iPadAir2-iPadAir2, iPadMiniRetinaCellular-iPadMiniRetinaCellular, iPad74-iPad74, iPadAir-iPadAir, iPodTouchSixthGen-iPodTouchSixthGen, iPhone5c-iPhone5c, iPadMini4G-iPadMini4G, iPhoneX-iPhoneX, iPhone6sPlus-iPhone6sPlus, iPhone7-iPhone7, iPhone8-iPhone8, iPadMiniRetina-iPadMiniRetina, iPadMini4Cellular-iPadMini4Cellular, iPad72-iPad72, iPhone4S-iPhone4S
  • Note: If you are using device with Windows Phone or Android operation system, please scan the qr code
qr code
Use your smartphone to scan the QR CODE above to download this application

Screenshot of Let's create! Pottery HD

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What is new in Let's create! Pottery HD?

"A must have app to help you relax." - Robin Rhys, AppAdvice Daily
"Totally worth a look. The entire game is a very unique experience." - Touch Arcade
"Worth picking up for something different that is plenty engaging and time well spent." - AppAdvice
"Visually, the game’s 3D presentation is stunning" - Gamezebo

Free your creativity! Making ceramics has never been more simple and fun! Become a true artist and create "one of a kind" pottery items. Throw the clay on the wheel, release all your artistic talents and take benefit of dozens of materials available in order to create your own design! Even when you glaze and fire your very first pot you will feel accomplished and relaxed as pottery is the best way to relieve your everyday stress and find your inner peace. An amazing, therapeutic and uplifting experience you can enjoy with your family and friends!

Join the Pottery Community

Finish all quests, build your own palette of colors and brushes and let your creativity flow freely. Then bigger challenges are waiting for you on the LCP Portal (www.potterygame.com) where you can post your first pot and join the amazing community of potters. Climb in the rankings, compete with talented LCP artist and share your own creations to surprise your friends.

Convert pots into real things!

Now you can imagine, create and then 3D print your own pot and order it straight from the app! Convert virtual pots into real objects which can be displayed on a shelf or be given to family or friends.

Videos worth a watch

Official game trailer - http://youtu.be/53t0sG03UUo
Gameplay trailer - http://youtu.be/4Myr4kw8QMM

Tag: Let's create! Pottery HD , Let's create! Pottery HD

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text:
 ModCom now FREE. Download newest version 10.9

ModCom 10.9

Download Download Now   Buy Now Buy Now
Size: 11 MB Buy Now License: Freeware

ModCom is a Development::Other software developed by Weeder Technologies. After our trial and test, the software was found to be official, secure and free. Here is the official description for ModCom: Free Windows software for Data Acquisition & Control, HMI / SCADA, Industrial Automation, Home Automation, Process Control, Test & Measurement, Data Logging, etc. ModCom is a GUI-based HMI development platform created with the non-programmer in mind. Custom screens such as what's shown in the picture can be setup very quickly and easily with little or no programming skills. Ready to run, built-in features include the following:

Instrument-Gauges and Data-Windows can read external sensors and show voltage, temperature, pressure, RPM, rotary encoder position, etc. Push-Buttons can turn on/off external electrical devices or can operate their own buttons and switches. Slider-Controls can adjust output voltages by sliding the knob up or down with the mouse. Event-Counters can count pulses, external contact closures, or internal events. Event-Timers can measure the time between external switch or contact closures. On-Screen-Lights can be triggered by external contact closures or internal alarms. Chart-Recorders can plot the data from any of the screen objects onto a graph. Log-to-File function can send the data from any of the screen objects to a file which can then be imported to a spreadsheet. Log-to-Web function can upload the contents of the log file to a web page to be viewed using a smart phone. Custom program Scripts can be written by the user to perform complex tasks in the background. Conditional-Statements can watch for and act upon specific conditions. Keypad-Entry allows the operator to input data using a touchscreen or mouse. Send emails containing the current value of any Screen Objects. Print labels containing the current value of any Screen Objects and include a bar-code if needed. you can download ModCom 10.9 free now.

What's New in ModCom 10.9 [see older]

User-defined Variables which are hidden from view and can operate as Counters, Timers, Text Storage, or Numerical Storage including digits to the right of the decimal point. The Variables can be used in mathematical calculations, program Scripts, Conditio

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Tuesday, December 21, 2004

I'm on vacation for the next 2weeks. After that, I don't know right now. I'm of the belief that, right now, the most important quality for a teacher is to be flexible. The employment situation is tight, improvements in class sizes or pay seem unlikely, and most districts are operating in no-frills modes.

On the positive side, it's nearly Christmas. My kids are nearby or staying with us for the holidays, my extended family is healthy, and I'm baking cookies with my daughters today.

Merry Christmas to all, and to all, a Good Night!


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Wednesday, December 21, 2005

All I want for Christmas is....

I know that I can't effortlessly count in binary, the language of this clock, but I want one.

Amazon has a really good idea. They organized their gift suggestions by magazine - each editor has a clickable picture of the magazine that leads to gift ideas for the readers. I checked it out, and it's nice. Good idea for that hard-to-buy-for person - as long as you know what magazines he/she reads.

Tsunami X Blaster Motorized Water Gun

Or, even better:

The Robo Raptor - hey, it's only $99.00! I was playing around with it last Friday, and it is a pretty good toy.

The above available at Radio Shack.


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Mar 19, 2008

QOTD: Favorite Room

Today in CSF the QOTD was What is your Favorite Room in your House? We've lived in our new house since August so about 6 months. My answer...I LOVE THIS HOUSE! I just love every room. So I thought a few pictures would be neat.

This is where I am right now. My computer area. If you look to the left is Jeremiah's playstation area. We love being able to sit this close while doing the things we both enjoy.

Don't mind the blanket on the couch. My dog is hiding under it. LOL Guess he didn't want his pictures taken. So you can see my lamp that sits beside me. There is also these awesome overhead lights in my ceiling. The table holds all the things I might need right away. Also if you see the ottoman it has storage in it. So it's full of stitching related items too.
Gotta say in my living room is also one of my favorite things. My big TV LOL. I love TV so gotta have a huge TV to watch things on right?

This is Jeremiah's school room. LOVE IT. Everything is organized and we can find it easily. j even helped paint it light green which green is his favorite color so that helps him learn better I'm sure.
When it gets warmer outside our favorite room is the POOL in the backyard. Our own 30ft pool with a GORGEOUS deck built around it. Love it! Never in my DREAMS would I thought we could have our own pool.

Also we finally have a yard. We own 1.6 acres. This house is 3,900 square feet. It's HUGE. It's perfect for a big family like we have in it of 5 people. My mom's living room is the whole length of the house away. It's PERFECT. I love every square inch of it.

  1. Katie, your house is beautiful. Call it new for as long as you want to! Keep on enjoying!!!!!!

  2. I can see why you like your house. And that is going to be one gorgeous back yard, come summer. Emjoy! Wanda in Edmonton (from i-love-cross-stitch group)

Thanks for stopping by my blog. I appreciate comments and Thank you for taking time out of your life to care whats going on in mine.


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Photo Observation

  1.  Found on, photo manipulation by Sarolta Ban;
  2.  Theme: Surreal
  3.  I found this picture to be fitting for the theme because, much like the definition of the word ‘surreal’, it is a very unnatural photograph.  More importantly though, the lighting used to create the image really sold the surreal aspect of the picture; had the tree been front-lit, I think it would have produced a more serene and happy image.  However, because of the way the lighting casts shadows and darkness onto the water, and the way the tree and the boat are highlighted through the backlight, it gives a truly unique feeling that the image and situation is absurd; it gives the feeling that something is definitely off, but in a captivating and almost mesmerizing way.

Be the first to leave a comment. Don’t be shy.

You must be logged in to post a comment.


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Sunday, April 4, 2010

Civil War Series on Sunday - Albert Sydney Johnston

In my Thursday Ancestor Approved Award posting I mentioned Confederate General Albert Sydney Johnston in the Civil War. This is, in brief, his story.
He was born in Washington, Kentucky, the youngest son of Dr. John and Abigail Harris Johnston

Johnston was first educated at Transylvania University in Lexington, Kentucky, where he met fellow student Jefferson Davis. Both were appointed to the United States Military Academy, Davis two years behind Johnston. Johnston served as an officer in Black Hawk War in 1832. However, he resigned his commission in 1834 to return to Kentucky to care for his dying wife. They had one son, Col. William Preston Johnston, who would also serve in the Confederate Army. After farming for a time, in Texas, Johnston enlisted as a private in the Texas Army during the Texas War of Independence. Later he was promoted through the ranks and in 1837, be became senior brigadier general in command of the Texas Army. He lost that position after a duel, but was appointed Secretary of War by the second president of the Republic of Texas. In Feb 1840, he resigned and returned to Kentucky, where he remarried. They settled on a large plantation he named China Grove in Brazoria County, Texas.

He returned to the Texas Army during the Mexican-American War under General Zachary Taylor as a colonel of the 1st Texas Rifle Volunteers. He returned to his plantation after the war until appointed by President Taylor to the U.S. Army. He became a key figure in the Utah War, leading the U.S. troops who established a non-Mormon government in the formerly Mormon territory. He received brevet promotion to brigadier general in 1857 for his service in Utah. He spent 1860 in Kentucky (see census data, below) until December 21, when he sailed for California to take command of the Department of the Pacific.

At the outbreak of the Civil War, he was approached to take his Union forces east. However, when he heard of the secession of Texas, he resigned his commission on 9 April 1861. He managed to work his way east, reaching Richmond, Virginia, about the first of September, 1861. There Johnston was appointed a full general by his friend, Jefferson Davis. On May 30, 1861, Johnston became the second highest ranking Confederate general as commander of the Western Department.

Johnston used his concentrated forces to launch a surprise attack against Grant at the Battle of Shiloh on 5 Apr 1862 that resulted in a back and forth across the battlefield with some of the highest casualties for both sides of any battle of the war.  Just after mid-day, as he was personally leading and rallying his troops, Johnston took a bullet behind his right knee. Not thinking it serious, he sent his personal physician off to serve other wounded. The bullet had clipped his popliteal artery and his boot was filling up with blood. It may be that the injury in his earlier duel prevented him from realizing the numbness in his leg. When asked again, if he was injured, he is said to have replied, "Yes, and I fear seriously." Taken to a small ravine, he bled to death in minutes. (*)

*The above information is based mostly on, paraphrased and edited for this presentation.

Johnston was my fourth cousin, twice removed. Albert's mother was Abigail Harris. Her father was Edward Harris. His mother was Abigail Presbury, daughter of Edward Presbury, whose parents were William Prebury and Priscilla Randall the common ancestors. Edward's brother was William Presson who married Mary Raymond. Their son William Preston married Hannah Healey. Their son was William Preston who married Elizabeth Cynthia Lord; they were the parent of William Preston, the Old Sheriff of Williams County, my second great-grandfather. Researching this set of lines, with the many name changes has been a challenge for our family, over a number of years. None of these are the major Preston lines in New England (we had to work around them!) ...  ;-)

1860 U. S. Census on
Name: A S Jonston
[Albert S Johnston]

Age in 1860: 57
Birth Year: abt 1803
Birthplace: Kentucky
Home in 1860: Louisville Ward 7, Jefferson, Kentucky
Gender: Male
Post Office: Louisville

Household Members:
Name, Age
A S Jonston, 57
Eliza Jonston, 38
A S Jonston, 15
Hancock Jonston, 12
Margrett Jonston, 8
Griffin Jonston, 3
Briggett Barey, 28, servant, born in Ireland

Families are Forever!  ;-)

  1. Thanks for this bit of history. Very interesting.

  2. I marvel that you are able to put this all together and follow through on the various family lines.

  3. You have been awarded (again!) the "Ancestor Approved Award." Please pick it up at:


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DR CONTRACTORS has been painting in Indianapolis for five years and believe we have done our homework when it comes to this service. Whether it's interior or exterior the only supplier we use is Sherwin Williams.

The most common exterior line we recommend is Duration. We recommend this product because of it's durability and performance. The most common interior line we use is promar-200, 0-VOC's. We only use Sherwin Williams because they are the only paint supplier that mills their own product from start to finish. This means from the oil out of the ground to create the product to the can off the shelf it is all handled by the same company. DR Contractors Painting Indianapolis

Also Sherwin Williams is the largest manufacturer of paint in the world. We have worked very closely with Sherwin Williams Reps in the last five years asking questions about product recommendations, preparation techniques coverage amounts and application specifications.

We believe after the research completed by DR CONTRACTORS we can offer the highest quality of service to our customers. We strongly believe sixty percent of a quality paint job is completed prior to the topcoat. This means from the prep work to the sealants used by DR CONTRACTORS we believe we can greatly extend the longevity of your home life. One of the differences with our company is the use of Shermax Sealant in place of latex caulk, we use this product extend the longevity of the topcoat. The topcoat, Duration is a "Life time" acrylic but again we believe nothing lasts forever on your home and recommend you visit our supplier's site for warranty information. DR CONTRACTORS recommends potential clients to stay away from "Life time" coating companies that charge thousands more to complete the same paint job. Many of these permanent coating companies are using Sherwin William's products with a bonding primer as an additional step. Painting Indianapolis

These companies simply change the manufacturer's labels to sell the client on their own product, but in reality the product they are using many times is Sherwin Williams. Also just ask or do the research to see if the "permanent" coating company you may potentially use has had a lawsuit in the last ten years. Many of them have had judgments.

This email address is being protected from spambots. You need JavaScript enabled to view it.

Live Estimate


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All posts by admin

Dream Riders Biking For Children is a non-profit organization that is 100% committed to helping kids in need with medical needs that the family is struggling to provide. We concentrate our helping hands on children from the ages of 0-18. Our assistance can vary from building wheel chair ramps, helping with meds, and/or fund raisers to help with bills.

Day @ the Lake

Day @ the Lake

July 23rd, Dream Riders will be celebrating another year of fellowship and fun @ Sardis Lake. There will be fire trucks spaying the kids “and adults” with water.  Water Guns will be also be available along with watermelon, food and bouncy slides.
Open to friends and family of Dream Riders that we have helped in the past and to those that want to be part of the Dream Rider family.

Enjoy our pics from last year cause we look forward to posting lots of new pics from this year…,

Thanks for reading

Beloved Brother Gone But Not Forgotten

James Arthur Holland aka “Crash”

James Arthur "Crash" Holland
James Arthur “Crash” Holland

Dream Riders lost a beloved Brother James Arthur Holland “Crash” to cancer June 28th 2016.

Crash was Vice-President of Chapter E out of Melbourne, Ar.

He will be greatly missed by friends, family and all of his Dream Riders family.

Clear Creak Coach
Clear Creak Coach

Craw-fish Boil in Hardy, AR

Craw-Fish Boil, Hardy, AR 2016June 26th, 2016. It was hot let me tell you…

Hardy, AR, Griffin Park was the pace to be. Chapter H from Houston, MS met up with Chapter I, from Flippin, AR and E, from Melbourne, AR, we all met up and worked together to do the best we could at cooking those “mud-bugs”.  They turned out great!..

It was a lot of fun getting to fellowship with friends that live so far away. It is also an awesome feeling knowing there are so many of us that pull together as 1 big family. The support from the community was just amazing. Most of the visitors where out-of-towner’s also but when word got around that “Dream Riders” where there, well the support was amazing…

Thank you my Arkansas friends for letting us be a part of and awesome day

Submitted by: Chapter H

Some times it’s tough…

Some times it’s tough being a Dream Rider.  This week we had the honor of standing guard as family left the Funeral Home heading to the Cemetery.  Lil Oliver never saw the light of day, his mother was only 8 months pregnant when she began hurting and knew something was wrong.  When she got to the hospital it was to late.  The doctors had to deliver the bad news that her precious angel was no longer living.

After hours of agonizing labor, the terrified mother delivered a beautiful 4 lb  baby boy.  On the outside he was tiny but perfect.  There will be many sleepless nights for this mother wondering “why”.   But all of God’s glory and time he will have answers for her that no one but her can understand.

The very next day we were asked to escort the funeral procession of a 9 year old angel from the church where they had her farewell goodbys, to the cemetery where her lil body was laid to rest.

9 year old Anna Carol had a surgery that took a good bit of intestine and bowel.  Scar tissue had wrapped severely around her intestine. the doctors had to leave her intestine out of her body to heal.  Her liver and kidneys were in the process of shutting down it was so severe.  Only a few hours after the surgery she passed away.  Her family, friends, class mates, cheer leader squad mates, teachers, preachers, and Dream Riders all shed tears of sorrow for the family’s loss.

But you can bet it was a true honor and privilege to stand with these families and comfort them in the best way we know how and that’s through love , support, and kindness.  We, Dream Riders wouldn’t want that any other way.

Sometimes it may be tough being a Dream Rider, but it sure is rewarding to the heart and soul.


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Debra Ruben
Associate Professor
Program Director, Interior Design

UBRN Center, 410B

Debra Ruben is an assistant professor in the Department of Architecture and Interiors at Drexel University, and teaches both lecture and studio courses in the graduate and undergraduate Interior Design Programs. Current curriculum development includes integrating sustainable design and environmental theory into Drexel’s CIDA-accredited Interior Design Program and the development of a new minor: Sustainability in the Built Environment. Debra’s research incorporates interdisciplinary design thinking, sustainability issues and participatory practices as they relate to community building. She has run several courses in social sustainability and community design and was the primary investigator for three foundation grants that resulted in the recent development of an 85,000 sf. barren schoolyard into a new playground. Debra is an NCIDQ certificate holder and a LEED accredited professional. An interior design practitioner for 18 years, her work has won several awards including Best of Show for the IDEC 2005 juried Interior Design Competition. Currently she is working on the interior design for a 6000 square foot sustainable residence in Mallorca Spain.

MS, Interior Design, Drexel University
BA, Art History/French, University of Richmond


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ADA Accessibility Information
Call 425-310-5789

Dentures are a permanent solution to replacing teeth that are either severely damaged or missing due to tooth decay, genetic disease, or gum disease. Dentures can provide a heightened sense of confidence for someone who is used to having teeth missing or not able to smile due to extreme gum disease or tooth decay. Dentures are a sure way to get your smile back and boost your confidence. If you think dentures are right for you, contact us today to set up a consultation.

Types of Dentures

There are two main types of dentures that we use at Dr. Liu’s office - partial dentures and complete dentures. Every case is different and depends on the needs of the individual. We will help you decide at your consultation, which option is right for you.

Partial Dentures

Partial dentures are ideal for those who only need a few teeth replaced. Partial dentures are made of either a plastic or metal removable base. They are a great alternative for those who don’t qualify for a bridge or a fixed denture. Partial dentures are easy to insert and remove if you choose that option, but we can also make them “fixed”, which means they are not removable by you, only by us in the office if the need arises. There are several classes of partial dentures available; each patient will be classified individually on a case-by-case basis. Depending on the proper dental hygiene, wear and tear, and maintenance of partial dentures, they should last at least five years.

Complete Dentures

When some or all of the teeth are missing, the natural muscle tissue begins to sag and droop. Complete dentures can help rectify that issue and keep your face looking natural. Complete dentures are usually made of plastic bases and are meant to replace all of the teeth and take several appointments to finish the procedure. Complete dentures take quite a bit of time to get used to because chewing food, speaking, and even smiling can take a lot of practice before the patient is completely comfortable with dentures. Complete dentures can last at least five years with proper hygiene and professional maintenance.

Implanted Anchors

Complete dentures can also be permanently placed in your mouth with implants. This is a type of complete denture that requires implants to be placed into the jawbone. This helps secure the dentures into a solid post instead of having to use adhesive. Implanted anchors are for those individuals that have substantial bone structure remaining giving the posts solid base to anchor to for a secure fit.

The Procedure

If you are interested in dentures for replacing your missing teeth, we can provide you with a full consultation to see what type of dentures are right for your individual needs. A full exam and X-rays will show us exactly what the problem is so that we can discuss your options with you. Any remaining problematic teeth will have to be removed and healed properly for the process to begin. Molds and impressions will be made of your arches, mouth, and jaw to ensure proper shape and color. Following this procedure, the dentures are properly fitted and adjustments made to ensure a proper overall fit.

Benefits of Dentures

There are some great benefits to getting dentures. Besides a boost of self-confidence, dentures can provide a sturdy structure for the jaw, reduce further issues with gums or decay, and can reduce jaw problems or other tooth pressure.

After Care

The care of your dentures is one of the most important components of successful tooth replacement. Proper hygiene is a must to maintain the solidity and structure of dentures and ensure that they are working properly. Dentures must be completely removed at night time or while sleeping to ensure proper healing and airing of the gums. This will also prevent any type of infection starting or some other type of fungal abnormality from developing. It is also important to get your dentures checked periodically for proper fit, wear and tear, or any other issue that may arise from the wearing of your dentures. Doing these few things can help ensure the lifetime of your dentures is as long as possible, reducing future unnecessary costs.

Cost of Dentures

The cost of dentures will depend on the type of procedure that you may need. Insurance companies may or may not cover a partial or all of the costs needed to get dentures. Consult your particular insurance company and see what they are willing to cover. Please read and review our Financial Policy to ensure a full understanding of how our payment process works. If you have any questions about our Financial Policy or how your insurance works, please call or stop by our office for further clarification.

We look forward to assisting you with all your dental needs! For more information on the different ways we can help replace missing teeth, contact our Edmonds office at: (425) 310-5789
Dr. Raymond Liu, Dentist Edmonds, WA

21600 Washington 99, Suite 100
Edmonds, WA 98026
Call (425) 310-5789

Office Hours:
Mon-Tues 8:30 am - 6:00 pm
Wed-Thurs 7:30 am - 5:00 pm

Visit us on Google+ READ OUR REVIEWS

Welcome  | Our Office  | New Patients  | Dental Services  | Smile Club  | Contact  | Raymond Liu, DDS  | Meet the Team  | Testimonials  | Dental Blog  | Cosmetic Dentistry  | Preventive Dentistry  | Restorative Dentistry  | Invisalign®  | Six Month Smiles®

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 AMITRIPTYLINE HYDROCHLORIDE  - amitriptyline hydrochloride tablet, film coated  - Prescription (RX) Marketed Drugs Encyclopedia
You are here: Home > Prescription(RX) Drugs > A > Amitriptyline Hydrochloride (Blenheim Pharmacal, Inc.)

Name:Amitriptyline Hydrochloride
Manufacturer:Blenheim Pharmacal, Inc.
Category:Prescription Marketed Drugs

Amitriptyline Hydrochloride Tablets, USP

AMITRIPTYLINE HYDROCHLORIDE  - amitriptyline hydrochloride tablet, film coated
Blenheim Pharmacal, Inc.

Amitriptyline Hydrochloride Tablets, USP

Suicidality and Antidepressant Drugs:

Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of amitriptyline hydrochloride tablets or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Amitriptyline hydrochloride is not approved for use in pediatric patients. (See WARNINGS: Clinical Worsening and Suicide Risk, PRECAUTIONS: Information for Patients, and PRECAUTIONS: Pediatric Use)

Amitriptyline HCl, a dibenzocycloheptadiene derivative, is a white, or practically white, odorless, crystalline compound which is freely soluble in water and alcohol.

It is designated chemically as 10,11-Dihydro-N,N-dimethyl-5H-dibenzo[a,d] cycloheptene-Δ5, γ-propylamine hydrochloride. It has the following structural formula:

amitriptyline HCl chemical structure

Each tablet for oral administration contains 10, 25, 50, 75, 100, or 150 mg amitriptyline hydrochloride. Inactive ingredients include colloidal silicon dioxide, hydroxypropyl cellulose, hydroxypropyl methylcellulose, lactose (monohydrate), magnesium stearate, microcrystalline cellulose, polyethylene glycol, pregelatinized starch (corn) and titanium dioxide. The 10 mg also includes D&C Red #27 Aluminum Lake, D&C Yellow #10 Aluminum Lake and FD&C Blue #1 Aluminum Lake; 25 mg – D&C Yellow #10 Aluminum Lake, FD&C Blue #1 Aluminum Lake and FD&C Red #40 Aluminum Lake; 50 mg – FD&C Blue #2 Aluminum Lake and FD&C Red #40 Aluminum Lake; 75 mg – D&C Red #7 Calcium Lake and FD&C Blue #2 Aluminum Lake; 100 mg – D&C Red #30 Aluminum Lake and D&C Yellow #10 Aluminum Lake; 150 mg – D&C Yellow #10 Aluminum Lake, FD&C Blue #1 Aluminum Lake and FD&C Red #40 Aluminum Lake.

Amitriptyline HCl is an antidepressant with sedative effects. Its mechanism of action in man is not known. It is not a monoamine oxidase inhibitor and it does not act primarily by stimulation of the central nervous system.

Amitriptyline inhibits the membrane pump mechanism responsible for uptake of norepinephrine and serotonin in adrenergic and serotonergic neurons. Pharmacologically, this action may potentiate or prolong neuronal activity since reuptake of these biogenic amines is important physiologically in terminating transmitting activity. This interference with reuptake of norepinephrine and/or serotonin is believed by some to underlie the antidepressant activity of amitriptyline.

For the relief of symptoms of depression. Endogenous depression is more likely to be alleviated than are other depressive states.

Amitriptyline hydrochloride is contraindicated in patients who have shown prior hypersensitivity to it.

It should not be given concomitantly with monoamine oxidase inhibitors. Hyperpyretic crises, severe convulsions, and deaths have occurred in patients receiving tricyclic antidepressant and monoamine oxidase inhibiting drugs simultaneously. When it is desired to replace a monoamine oxidase inhibitor with amitriptyline hydrochloride, a minimum of 14 days should be allowed to elapse after the former is discontinued. Amitriptyline hydrochloride should then be initiated cautiously with gradual increase in dosage until optimum response is achieved.

Amitriptyline hydrochloride should not be given with cisapride due to the potential for increased QT interval and increased risk for arrhythmia.

This drug is not recommended for use during the acute recovery phase following myocardial infarction.

Clinical Worsening and Suicide Risk

Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. There has been a long-standing concern, however, that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment. Pooled analyses of short-term placebo-controlled trials of antidepressant drugs (SSRIs and others) showed that these drugs increase the risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults (ages 18 to 24) with major depressive disorder (MDD) and other psychiatric disorders. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction with antidepressants compared to placebo in adults aged 65 and older.

The pooled analyses of placebo-controlled trials in children and adolescents with MDD, obsessive compulsive disorder (OCD), or other psychiatric disorders included a total of 24 short-term trials of 9 antidepressant drugs in over 4400 patients. The pooled analyses of placebo-controlled trials in adults with MDD or other psychiatric disorders included a total of 295 short-term trials (median duration of 2 months) of 11 antidepressant drugs in over 77,000 patients. There was considerable variation in risk of suicidality among drugs, but a tendency toward an increase in the younger patients for almost all drugs studied. There were differences in absolute risk of suicidality across the different indications, with the highest incidence in MDD. The risk differences (drug vs placebo), however, were relatively stable within age strata and across indications. These risk differences (drug-placebo difference in the number of cases of suicidality per 1000 patients treated) are provided in Table 1.

Table 1
Age Range

Drug-Placebo Difference in

Number of Cases of Suicidality

per 1000 Patients Treated
Increases Compared to Placebo
<18 14 additional cases
18-24 5 additional cases
Decreases Compared to Placebo
25-64 1 fewer case
≥65 6 fewer cases

No suicides occurred in any of the pediatric trials. There were suicides in the adult trials, but the number was not sufficient to reach any conclusion about drug effect on suicide.

It is unknown whether the suicidality risk extends to longer-term use, i.e., beyond several months. However, there is substantial evidence from placebo-controlled maintenance trials in adults with depression that the use of antidepressants can delay the recurrence of depression.

All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases.

The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. Although a causal link between the emergence of such symptoms and either the worsening of depression and/or the emergence of suicidal impulses has not been established, there is concern that such symptoms may represent precursors to emerging suicidality.

Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse, or who are experiencing emergent suicidality or symptoms that might be precursors to worsening depression or suicidality, especially if these symptoms are severe, abrupt in onset, or were not part of the patient’s presenting symptoms.

Families and caregivers of patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and nonpsychiatric, should be alerted about the need to monitor patients for the emergence of agitation, irritability, unusual changes in behavior, and the other symptoms described above, as well as the emergence of suicidality, and to report such symptoms immediately to health care providers. Such monitoring should include daily observation by families and caregivers. Prescriptions for amitriptyline hydrochloride should be written for the smallest quantity of tablets consistent with good patient management, in order to reduce the risk of overdose.

Screening Patients for Bipolar Disorder

A major depressive episode may be the initial presentation of bipolar disorder. It is generally believed (though not established in controlled trials) that treating such an episode with an antidepressant alone may increase the likelihood of precipitation of a mixed/manic episode in patients at risk for bipolar disorder. Whether any of the symptoms described above represent such a conversion is unknown. However, prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that amitriptyline hydrochloride is not approved for use in treating bipolar depression.

Amitriptyline hydrochloride may block the antihypertensive action of guanethidine or similarly acting compounds.

It should be used with caution in patients with a history of seizures and, because of its atropine-like action, in patients with a history of urinary retention, angle-closure glaucoma or increased intraocular pressure. In patients with angle-closure glaucoma, even average doses may precipitate an attack.

Patients with cardiovascular disorders should be watched closely. Tricyclic antidepressant drugs, including amitriptyline hydrochloride, particularly when given in high doses, have been reported to produce arrhythmias, sinus tachycardia, and prolongation of the conduction time. Myocardial infarction and stroke have been reported with drugs of this class.

Close supervision is required when amitriptyline hydrochloride is given to hyperthyroid patients or those receiving thyroid medication.

Amitriptyline may enhance the response to alcohol and the effects of barbiturates and other CNS depressants. In patients who may use alcohol excessively, it should be borne in mind that the potentiation may increase the danger inherent in any suicide attempt or overdosage. Delirium has been reported with concurrent administration of amitriptyline and disulfiram.

Usage in Pregnancy

Pregnancy Category C

Teratogenic effects were not observed in mice, rats, or rabbits when amitriptyline was given orally at doses of 2 to 40 mg/kg/day (up to 13 times the maximum recommended human dose). Studies in literature have shown amitriptyline to be teratogenic in mice and hamsters when given by various routes of administration at doses of 28 to 100 mg/kg/day (9 to 33 times the maximum recommended human dose), producing multiple malformations. Another study in the rat reported that an oral dose of 25 mg/kg/day (8 times the maximum recommended human dose) produced delays in ossification of fetal vertebral bodies without other signs of embryotoxicity. In rabbits, an oral dose of 60 mg/kg/day (20 times the maximum recommended human dose) was reported to cause incomplete ossification of cranial bones.

Amitriptyline has been shown to cross the placenta. Although a causal relationship has not been established, there have been a few reports of adverse events, including CNS effects, limb deformities, or developmental delay, in infants whose mothers had taken amitriptyline during pregnancy.

There are no adequate and well-controlled studies in pregnant women. Amitriptyline hydrochloride should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the fetus.

Nursing Mothers

Amitriptyline is excreted into breast milk. In one report in which a patient received amitriptyline 100 mg/day while nursing her infant, levels of 83 to 141 ng/mL were detected in the mother’s serum. Levels of 135 to 151 ng/mL were found in the breast milk, but no trace of the drug could be detected in the infant’s serum.

Because of the potential for serious adverse reactions in nursing infants from amitriptyline, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Usage in Pediatric Patients

In view of the lack of experience with the use of this drug in pediatric patients, it is not recommended at the present time for patients under 12 years of age.

Schizophrenic patients may develop increased symptoms of psychosis; patients with paranoid symptomatology may have an exaggeration of such symptoms. Depressed patients, particularly those with known manic-depressive illness, may experience a shift to mania or hypomania. In these circumstances the dose of amitriptyline may be reduced or a major tranquilizer such as perphenazine may be administered concurrently.

The possibility of suicide in depressed patients remains until significant remission occurs. Potentially suicidal patients should not have access to large quantities of this drug. Prescriptions should be written for the smallest amount feasible.

Concurrent administration of amitriptyline hydrochloride and electroshock therapy may increase the hazards associated with such therapy. Such treatment should be limited to patients for whom it is essential.

When possible, the drug should be discontinued several days before elective surgery.

Both elevation and lowering of blood sugar levels have been reported.

Amitriptyline hydrochloride should be used with caution in patients with impaired liver function.

Information for Patients

Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with amitriptyline hydrochloride and should counsel them in its appropriate use. A patient Medication Guide about “Antidepressant Medicines, Depression and other Serious Mental Illnesses, and Suicidal Thoughts or Actions” is available for amitriptyline hydrochloride. The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is reprinted at the end of this document.

Patients should be advised of the following issues and asked to alert their prescriber if these occur while taking amitriptyline hydrochloride.

Clinical Worsening and Suicide Risk

Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should be advised to look for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt. Such symptoms should be reported to the patient’s prescriber or health professional, especially if they are severe, abrupt in onset, or were not part of the patient’s presenting symptoms. Symptoms such as these may be associated with an increased risk for suicidal thinking and behavior and indicate a need for very close monitoring and possibly changes in the medication.

While on therapy with amitriptyline hydrochloride, patients should be advised as to the possible impairment of mental and/or physical abilities required for performance of hazardous tasks, such as operating machinery or driving a motor vehicle.

Drug Interactions

Drugs Metabolized by P450 2D6

The biochemical activity of the drug metabolizing isozyme cytochrome P450 2D6 (debrisoquin hydroxylase) is reduced in a subset of the caucasian population (about 7 to 10% of Caucasians are so called “poor metabolizers”); reliable estimates of the prevalence of reduced P450 2D6 isozyme activity among Asian, African and other populations are not yet available. Poor metabolizers have higher than expected plasma concentrations of tricyclic antidepressants (TCAs) when given usual doses. Depending on the fraction of drug metabolized by P450 2D6, the increase in plasma concentration may be small, or quite large (8 fold increase in plasma AUC of the TCA).

In addition, certain drugs inhibit the activity of this isozyme and make normal metabolizers resemble poor metabolizers. An individual who is stable on a given dose of TCA may become abruptly toxic when given one of these inhibiting drugs as concomitant therapy. The drugs that inhibit cytochrome P450 2D6 include some that are not metabolized by the enzyme (quinidine; cimetidine) and many that are substrates for P450 2D6 (many other antidepressants, phenothiazines, and the Type 1C antiarrhythmics propafenone and flecainide). While all the selective serotonin reuptake inhibitors (SSRIs), e.g., fluoxetine, sertraline, and paroxetine, inhibit P450 2D6, they may vary in the extent of inhibition. The extent to which SSRI-TCA interactions may pose clinical problems will depend on the degree of inhibition and the pharmacokinetics of the SSRI involved. Nevertheless, caution is indicated in the coadministration of TCAs with any of the SSRIs and also in switching from one class to the other. Of particular importance, sufficient time must elapse before initiating TCA treatment in a patient being withdrawn from fluoxetine, given the long half-life of the parent and active metabolite (at least 5 weeks may be necessary).

Concomitant use of tricyclic antidepressants with drugs that can inhibit cytochrome P450 2D6 may require lower doses than usually prescribed for either the tricyclic antidepressant or the other drug. Furthermore, whenever one of these other drugs is withdrawn from co-therapy, an increased dose of tricyclic antidepressant may be required. It is desirable to monitor TCA plasma levels whenever a TCA is going to be coadministered with another drug known to be an inhibitor of P450 2D6.

Monoamine oxidase inhibitors – see CONTRAINDICATIONS section. Guanethidine or similarly acting compounds; thyroid medication; alcohol, barbiturates and other CNS depressants; and disulfiram – see WARNINGS section.

When amitriptyline is given with anticholinergic agents or sympathomimetic drugs, including epinephrine combined with local anesthetics, close supervision and careful adjustment of dosages are required.

Hyperpyrexia has been reported when amitriptyline is administered with anticholinergic agents or with neuroleptic drugs, particularly during hot weather.

Paralytic ileus may occur in patients taking tricyclic antidepressants in combination with anticholinergic-type drugs.

Cimetidine is reported to reduce hepatic metabolism of certain tricyclic antidepressants, thereby delaying elimination and increasing steady-state concentrations of these drugs. Clinically significant effects have been reported with the tricyclic antidepressants when used concomitantly with cimetidine. Increases in plasma levels of tricyclic antidepressants, and in the frequency and severity of side effects, particularly anticholinergic, have been reported when cimetidine was added to the drug regimen. Discontinuation of cimetidine in well-controlled patients receiving tricyclic antidepressants and cimetidine may decrease the plasma levels and efficacy of the antidepressants.

Caution is advised if patients receive large doses of ethchlorvynol concurrently. Transient delirium has been reported in patients who were treated with one gram of ethchlorvynol and 75 to 150 mg of amitriptyline hydrochloride.

Geriatric Use

Clinical experience has not identified differences in responses between elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic function, concomitant disease and other drug therapy in elderly patients.

Geriatric patients are particularly sensitive to the anticholinergic side effects of tricyclic antidepressants including amitriptyline hydrochloride. Peripheral anticholinergic effects include tachycardia, urinary retention, constipation, dry mouth, blurred vision, and exacerbation of narrow-angle glaucoma. Central nervous system anticholinergic effects include cognitive impairment, psychomotor slowing, confusion, sedation, and delirium. Elderly patients taking amitriptyline hydrochloride may be at increased risk for falls. Elderly patients should be started on low doses of amitriptyline hydrochloride and observed closely (see DOSAGE AND ADMINISTRATION).

Pediatric Use

Safety and effectiveness in the pediatric population have not been established (see BOX WARNING and WARNINGS: Clinical Worsening and Suicide Risk). Anyone considering the use of amitriptyline in a child or adolescent must balance the potential risks with the clinical need.

Within each category the following adverse reactions are listed in order of decreasing severity. Included in the listing are a few adverse reactions which have not been reported with this specific drug. However, pharmacological similarities among the tricyclic antidepressant drugs require that each of the reactions be considered when amitriptyline is administered.

Cardiovascular: Myocardial infarction; stroke; nonspecific ECG changes and changes in AV conduction; heart block; arrhythmias; hypotension, particularly orthostatic hypotension; syncope; hypertension; tachycardia; palpitation.

CNS and Neuromuscular: Coma; seizures; hallucinations; delusions; confusional states; disorientation; incoordination; ataxia; tremors; peripheral neuropathy; numbness, tingling and paresthesias of the extremities; extrapyramidal symptoms including abnormal involuntary movements and tardive dyskinesia; dysarthria; disturbed concentration; excitement; anxiety; insomnia; restlessness; nightmares; drowsiness; dizziness; weakness; fatigue; headache; syndrome of inappropriate ADH (antidiuretic hormone) secretion; tinnitus; alteration in EEG patterns.

Anticholinergic: Paralytic ileus, hyperpyrexia; urinary retention, dilatation of the urinary tract; constipation; blurred vision, disturbance of accommodation, increased ocular pressure, mydriasis; dry mouth.

Allergic: Skin rash; urticaria; photosensitization; edema of face and tongue.

Hematologic: Bone marrow depression including agranulocytosis, leukopenia, thrombocytopenia; purpura; eosinophilia.

Gastrointestinal: Rarely hepatitis (including altered liver function and jaundice); nausea; epigastric distress; vomiting; anorexia; stomatitis; peculiar taste; diarrhea; parotid swelling; black tongue.

Endocrine: Testicular swelling and gynecomastia in the male; breast enlargement and galactorrhea in the female; increased or decreased libido; impotence; elevation and lowering of blood sugar levels.

Other: Alopecia; edema; weight gain or loss; urinary frequency; increased perspiration.

Withdrawal Symptoms

After prolonged administration, abrupt cessation of treatment may produce nausea, headache, and malaise. Gradual dosage reduction has been reported to produce, within two weeks, transient symptoms including irritability, restlessness, and dream and sleep disturbance.

These symptoms are not indicative of addiction. Rare instances have been reported of mania or hypomania occurring within 2 to 7 days following cessation of chronic therapy with tricyclic antidepressants.

Causal Relationship Unknown

Other reactions, reported under circumstances where a causal relationship could not be established, are listed to serve as alerting information to physicians:

Body as a Whole: Lupus-like syndrome (migratory arthritis, positive ANA and rheumatoid factor).

Digestive: Hepatic failure, ageusia.

Postmarketing Adverse Events

A syndrome resembling neuroleptic malignant syndrome (NMS) has been very rarely reported after starting or increasing the dose of amitriptyline hydrochloride, with and without concomitant medications known to cause NMS. Symptoms have included muscle rigidity, fever, mental status changes, diaphoresis, tachycardia, and tremor.

Very rare cases of serotonin syndrome (SS) have been reported with amitriptyline hydrochloride in combination with other drugs that have a recognized association with SS.

Deaths may occur from overdosage with this class of drugs. Multiple drug ingestion (including alcohol) is common in deliberate tricyclic antidepressant overdose. As the management is complex and changing, it is recommended that the physician contact a poison control center for current information on treatment. Signs and symptoms of toxicity develop rapidly after tricyclic antidepressant overdose, therefore, hospital monitoring is required as soon as possible.

Critical manifestations of overdose include: cardiac dysrhythmias, severe hypotension, convulsions, and CNS depression, including coma. Changes in the electrocardiogram particularly in QRS axis or width, are clinically significant indicators of tricyclic antidepressant toxicity. In addition, a rightward axis shift in the terminal QRS complex together with a prolonged QT interval and sinus tachycardia are specific and sensitive indicators of first generation tricyclic overdose. The absence of these findings is not exclusionary. Prolonged PR interval, ST-T wave changes, ventricular tachycardia and fibrillation may also occur.

Other signs of overdose may include: impaired myocardial contractility, confusion, disturbed concentration, transient visual hallucinations, dilated pupils, disorders of ocular motility, agitation, hyperactive reflexes polyradiculoneuropathy, stupor, drowsiness, muscle rigidity, vomiting, hypothermia, hyperpyrexia, or any of the symptoms listed under ADVERSE REACTIONS.

Obtain an ECG and immediately initiate cardiac monitoring. Protect the patient’s airway, establish an intravenous line and initiate gastric decontamination. A minimum of six hours of observation with cardiac monitoring and observation for signs of CNS or respiratory depression, hypotension, cardiac dysrhythmias and/or conduction blocks, and seizures is necessary. If signs of toxicity occur at any time during the period extended monitoring is required. There are case reports of patients succumbing to fatal dysrhythmias late after overdose; these patients had clinical evidence of significant poisoning prior to death and most received inadequate gastrointestinal decontamination. Monitoring of plasma drug levels should not guide management of the patient.

Gastrointestinal Decontamination

All patients suspected of tricyclic antidepressant overdose should receive gastrointestinal decontamination. This should include, large volume gastric lavage followed by activated charcoal. If consciousness is impaired, the airway should be secured prior to lavage. EMESIS IS CONTRAINDICATED.

A maximal limb-lead QRS duration of ≥0.10 seconds may be the best indication of the severity of the overdose. Intravenous sodium bicarbonate should be used to maintain the serum pH in the range of 7.45 to 7.55. If the pH response is inadequate, hyperventilation may also be used. Concomitant use of hyperventilation and sodium bicarbonate should be done with extreme caution, with frequent pH monitoring. A pH >7.60 or a pCO2 <20 mm Hg is undesirable. Dysrhythmias unresponsive to sodium bicarbonate therapy/hyperventilation may respond to lidocaine, bretylium or phenytoin. Type 1 A and 1 C antiarrhythmics are generally contraindicated (e.g., quinidine, disopyramide, and procainamide).

In rare instances, hemoperfusion may be beneficial in acute refractory cardiovascular instability in patients with acute toxicity. However, hemodialysis, peritoneal dialysis, exchange transfusions, and forced diuresis generally have been reported as ineffective in tricyclic antidepressant poisoning.

In patients with CNS depression early intubation is advised because of the potential for abrupt deterioration. Seizures should be controlled with benzodiazepines, or if these are ineffective, other anticonvulsants (e.g., phenobarbital, phenytoin).

Physostigmine is not recommended except to treat life-threatening symptoms that have been unresponsive to other therapies, and then only in consultation with a poison control center.

Psychiatric Follow-up

Since overdosage is often deliberate, patients may attempt suicide by other means during the recovery phase. Psychiatric referral may be appropriate.

Pediatric Management

The principles of management of pediatric and adult overdosages are similar. It is strongly recommended that the physician contact the local poison control center for specific pediatric treatment.

Oral Dosage

Dosage should be initiated at a low level and increased gradually, noting carefully the clinical response and any evidence of intolerance.

Initial Dosage for Adults

For outpatients, 75 mg of amitriptyline HCl a day in divided doses is usually satisfactory. If necessary, this may be increased to a total of 150 mg per day. Increases are made preferably in the late afternoon and/or bedtime doses. A sedative effect may be apparent before the antidepressant effect is noted, but an adequate therapeutic effect may take as long as 30 days to develop.

An alternate method of initiating therapy in outpatients is to begin with 50 to 100 mg amitriptyline HCl at bedtime. This may be increased by 25 or 50 mg as necessary in the bedtime dose to a total of 150 mg per day.

Hospitalized patients may require 100 mg a day initially. This can be increased gradually to 200 mg a day if necessary. A small number of hospitalized patients may need as much as 300 mg a day.

Adolescent and Elderly Patients

In general, lower dosages are recommended for these patients. Ten mg 3 times a day with 20 mg at bedtime may be satisfactory in adolescent and elderly patients who do not tolerate higher dosages.

The usual maintenance dosage of amitriptyline HCl is 50 to 100 mg per day. In some patients, 40 mg per day is sufficient. For maintenance therapy, the total daily dosage may be given in a single dose, preferably at bedtime. When satisfactory improvement has been reached, dosage should be reduced to the lowest amount that will maintain relief of symptoms. It is appropriate to continue maintenance therapy 3 months or longer to lessen the possibility of relapse.

Usage in Pediatric Patients

In view of the lack of experience with the use of this drug in pediatric patients, it is not recommended at the present time for patients under 12 years of age.

Plasma Levels

Because of the wide variation in the absorption and distribution of tricyclic antidepressants in body fluids, it is difficult to directly correlate plasma levels and therapeutic effect. However, determination of plasma levels may be useful in identifying patients who appear to have toxic effects and may have excessively high levels, or those in whom lack of absorption or noncompliance is suspected. Because of increased intestinal transit time and decreased hepatic metabolism in elderly patients, plasma levels are generally higher for a given oral dose of amitriptyline hydrochloride than in younger patients. Elderly patients should be monitored carefully and quantitative serum levels obtained as clinically appropriate. Adjustments in dosage should be made according to the patient’s clinical response and not on the basis of plasma levels.

Amitriptyline hydrochloride tablets, USP for oral administration are available as:

10 mg: Round, film-coated pink tablets, debossed GG 40 on one side and plain on the reverse side, and supplied as:

NDC 0781-1486-31 bottles of 30

NDC 0781-1486-01 bottles of 100

NDC 0781-1486-10 bottles of 1000

25 mg: Round, film-coated light green tablets, debossed GG 44 on one side and plain on the reverse side, and supplied as:

NDC 0781-1487-31 bottles of 30

NDC 0781-1487-01 bottles of 100

NDC 0781-1487-10 bottles of 1000

50 mg: Round, film-coated brown tablets, debossed GG 431 on one side and plain on the reverse side, and supplied as:

NDC 0781-1488-31 bottles of 30

NDC 0781-1488-01 bottles of 100

NDC 0781-1488-10 bottles of 1000

75 mg: Round, film-coated purple tablets, debossed GG 451 on one side and plain on the reverse side, and supplied as:

NDC 0781-1489-31 bottles of 30

NDC 0781-1489-01 bottles of 100

NDC 0781-1489-10 bottles of 1000

100 mg: Round, film-coated orange tablets, debossed GG 461 on one side and plain on the reverse side, and supplied as:

NDC 0781-1490-31 bottles of 30

NDC 0781-1490-01 bottles of 100

NDC 0781-1490-10 bottles of 1000

150 mg: Capsule shaped, film-coated light green tablets, debossed GG 450 on one side and plain on the reverse side, and supplied as:

NDC 0781-1491-31 bottles of 30

NDC 0781-1491-01 bottles of 100

NDC 0781-1491-10 bottles of 1000

Store at 20º-25ºC (68º-77ºF) (see USP Controlled Room Temperature).

Dispense in a tight, light-resistant container.

Studies in man following oral administration of 14C-labeled drug indicated that amitriptyline is rapidly absorbed and metabolized. Radioactivity of the plasma was practically negligible, although significant amounts of radioactivity appeared in the urine by 4 to 6 hours and one-half to one-third of the drug was excreted within 24 hours.

Amitriptyline is metabolized by N-demethylation and bridge hydroxylation in man, rabbit, and rat. Virtually the entire dose is excreted as glucuronide or sulfate conjugate of metabolites, with little unchanged drug appearing in the urine. Other metabolic pathways may be involved.

Ayd, F.J., Jr.: Amitriptyline therapy for depressive reactions, Psychosom. 1: 320-325, Nov.-Dec. 1960.

Diamond, S.: Human metabolization of amitriptyline tagged with carbon 14, Curr. Therap. Res. 7: 170-175, Mar. 1965.

Dorfman, W.: Clinical experiences with amitriptyline (A preliminary report), Psychosom. 1: 153-155, May-June 1960.

Fallette, J.M.; Stasney, C.R.; Mintz, A.A.: Amitriptyline poisoning treated with physostigmine, S. Med. J. 63: 1492-1493, Dec. 1970 (in Soc. Proc.).

Hollister, L.E.; Overall, J.E.; Johnson, M.; Pennington, V.; Katz, G.; Shelton, J.: Controlled comparison of amitriptyline, imipramine and placebo in hospitalized depressed patients, J. Nerv. and Ment. Dis. 139: 370-375, Oct. 1964.

Hordern, A.; Burt, C.G.; Holt, N.F.: Depressive states. A pharmacotherapeutic study, Springfield, Ill., Charles C. Thomas, 1965.

Jenike, M.A.: Treatment of Affective Illness in the Elderly with Drugs and Electroconvulsive Therapy, J. Geriatr. Psychiatry 1989;22(1).77-112.

Klerman, G.L.; Cole, J.O.: Clinical pharmacology of imipramine and related antidepressant compounds, Int. J. Psychiat. 3: 267-304, Apr. 1976.

Liu, B.; Anderson, C.; Mittman, N. et al: Use of selective serotonin-reuptake inhibitors or tricyclic antidepressants and risk of hip fractures in elderly people. Lancet 1998; 351 (91 12):1303-1307.

McConaghy, N.; Joffe, A.D.; Kingston, W.R.; Stevenson, H.G.; Atkinson, I.; Cole, E.; Fennessy, L.A.; Correlation of clinical features of depressed outpatients with response to amitriptyline and protriptyline, Brit. J. Psychiat. 114: 103-106, Jan. 1968.

McDonald, I.M.; Perkins, M.; Marjerrison, G.; Podilsky, M.: A controlled comparison of amitriptyline and electroconvulsive therapy in the treatment of depression, Amer. J. Psychiat. 122: 1427-1431. June 1966 (in Brief Communications).

Slovis, T.; Ott, J.; Teitelbaum, D.; Lipscomb, W.: Physostigmine therapy in acute tricyclic antidepressant poisoning, Clin. Toxicol. 4: 451-459, Sept. 1971.

Symposium on depression with special studies of a new antidepressant, amitriptyline, Dis. Nerv. Syst. 22: 5-56, May 1961 (Sect. 2).

Antidepressant Medicines, Depression and other Serious Mental Illnesses, and Suicidal Thoughts or Actions

Read the Medication Guide that comes with you or your family member’s antidepressant medicine. This Medication Guide is only about the risk of suicidal thoughts and actions with antidepressant medicines. Talk to your, or your family member’s, healthcare provider about:

  • all risks and benefits of treatment with antidepressant medicines
  • all treatment choices for depression or other serious mental illness

What is the most important information I should know about antidepressant medicines, depression and other serious mental illnesses, and suicidal thoughts or actions?

  1. Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment.
  2. Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Some people may have a particularly high risk of having suicidal thoughts or actions. These include people who have (or have a family history of) bipolar illness (also called manic-depressive illness) or suicidal thoughts or actions.
  3. How can I watch for and try to prevent suicidal thoughts and actions in myself or a family member?
    • Pay close attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings. This is very important when an antidepressant medicine is started or when the dose is changed.
    • Call the healthcare provider right away to report new or sudden changes in mood, behavior, thoughts, or feelings.
    • Keep all follow-up visits with the healthcare provider as scheduled. Call the healthcare provider between visits as needed, especially if you have concerns about symptoms.

Call a healthcare provider right away if you or your family member has any of the following symptoms, especially if they are new, worse, or worry you:

  • thoughts about suicide or dying
  • attempts to commit suicide
  • new or worse depression
  • new or worse anxiety
  • feeling very agitated or restless
  • panic attacks
  • trouble sleeping (insomnia)
  • new or worse irritability
  • acting aggressive, being angry, or violent
  • acting on dangerous impulses
  • an extreme increase in activity and talking (mania)
  • other unusual changes in behavior or mood

What else do I need to know about antidepressant medicines?

  • Never stop an antidepressant medicine without first talking to a healthcare provider. Stopping an antidepressant medicine suddenly can cause other symptoms.
  • Antidepressants are medicines used to treat depression and other illnesses. It is important to discuss all the risks of treating depression and also the risks of not treating it. Patients and their families or other caregivers should discuss all treatment choices with the healthcare provider, not just the use of antidepressants.
  • Antidepressant medicines have other side effects. Talk to the healthcare provider about the side effects of the medicine prescribed for you or your family member.
  • Antidepressant medicines can interact with other medicines. Know all of the medicines that you or your family member takes. Keep a list of all medicines to show the healthcare provider. Do not start new medicines without first checking with your healthcare provider.
  • Not all antidepressant medicines prescribed for children are FDA approved for use in children. Talk to your child’s healthcare provider for more information.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

This Medication Guide has been approved by the U.S. Food and Drug Administration for all antidepressants.

Sandoz Inc.,

Princeton, NJ 08540

10544-110-30 Bottle LabelBottle Label

amitriptyline hydrochloride tablet, film coated
Product Information
Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:10544-110(NDC:0781-1488)
Route of Administration ORAL DEA Schedule
Active Ingredient/Active Moiety
Ingredient Name Basis of Strength Strength
Inactive Ingredients
Ingredient Name Strength
FD&C RED NO. 40
Product Characteristics
Color brown Score no score
Shape ROUND Size 8mm
Flavor Imprint Code GG431
# Item Code Package Description Multilevel Packaging
1 NDC:10544-110-30 30 TABLET, FILM COATED ( TABLET) in 1 BOTTLE None
2 NDC:10544-110-60 60 TABLET, FILM COATED ( TABLET) in 1 BOTTLE None
3 NDC:10544-110-90 90 TABLET, FILM COATED ( TABLET) in 1 BOTTLE None

Marketing Information
Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date
ANDA ANDA085968 03/03/2010

Labeler - Blenheim Pharmacal, Inc. (171434587)
Registrant - Blenheim Pharmacal, Inc. (171434587)
Name Address ID/FEI Operations
Blenheim Pharmacal, Inc. 171434587 repack

Revised: 04/2010 Blenheim Pharmacal, Inc.

Source: http://dailymed.nlm.nih.gov
Reproduced with permission of U.S. National Library of Medicine

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