Amitriptyline (Elavil) 150 mg daily is prescribed for major depression. Which nursing consideration is appropriate?

• A. Instruct the client that the medication may cause dry mouth
• B. Administer only with alcohol
• C. Expect rapid weight loss
• D. Avoid giving with meals

Answer: (A)

Amitriptyline is a tricyclic antidepressant with anticholinergic effects, so dry mouth is a common and expected side effect from reduced saliva production caused by muscarinic receptor blockade in the salivary glands. The nursing approach focuses on mitigating discomfort and potential oral health issues: encourage sips of water, offer sugar-free gum or hard candies, promote good oral hygiene, and monitor hydration. Be attentive to other anticholinergic effects (constipation, urinary retention, blurred vision) and to orthostatic hypotension, especially in older adults. Alcohol should be avoided with TCAs because it can increase central nervous system depression and other adverse effects. Rapid weight loss is not expected with amitriptyline, and the medication can be given with meals if GI upset occurs, so those options aren’t appropriate.