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Objective: The aim of this paper is to critically re-appraise the published trials assessing amitriptyline for migraine prophylaxis. Methods: We report our methods and results following the Preferred Reporting Items for Systematic Reviews (PRISMA), by searching MEDLINE, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov for randomized trials of pharmacologic treatments for migraine prophylaxis. We included randomized trials that compared amitriptyline with placebo for migraine prophylaxis in adults. Our outcomes of interest were informed by the Outcome Set for preventive intervention trials in chronic and episodic migraine (COSMIG) and include the proportion of patients who experience a 50% or more reduction in migraine days per month, migraine days per month, and adverse events leading to discontinuation. We assessed risk of bias by using a modified Cochrane RoB 2.0 tool and the certainty of evidence by using the GRADE approach. Results: Our search yielded 10.826 unique records, of which three trials (n = 622) were eligible for data synthesis and analysis. We found moderate certainty evidence that amitriptyline increases the proportion of patients who experience a 50% or more reduction in monthly migraine days, compared to placebo (relative risk: 1.60 (95% CI 1.17 to 2.19); absolute risk difference: 165 more per 1,000 (95% CI 47 more to 327 more). We found moderate certainty evidence that amitriptyline increases the proportion of patients who discontinue due to adverse events compared to placebo (risk difference: 0.05 (95% CI 0.01 to 0.10); absolute risk difference: 50 more per 1,000 (95% CI 10 more to 100 more). Conclusions: Our meta-analysis showed that amitriptyline may have a prophylactic role in migraine patients, however these results are far from robust. This warrants further large-scale research to evaluate the role of amitriptyline in migraine prevention. [ABSTRACT FROM AUTHOR]

We developed a procedure for determining tricyclic antidepressant amitriptyline using fluorescence polarization immunoassay against the background of a buffer solution, urine, and breast milk with a relative standard deviation of no more than 5%. Tracers were synthesized by the noncovalent adsorption of amitriptyline on the surface of silicate nanoparticles doped with ruthenium(II) complexes. For the practical application of the proposed method, we selected the optimal concentrations of the tracer and antibodies by dilution. The amounts of reagents were selected based on fluorescence intensity and fluorescence polarization. According to the sensitivity requirements of the tracer, a dilution of 1 : 2 was selected, the fluorescence intensity of which was ten times higher than the background value, while the optimal fluorescence polarization value was fixed at 32. The optimal dilution of antibodies, corresponding to 70% of the fluorescence polarization value from the maximum signal, was 1 : 200. The range of working concentrations of amitriptyline was 1 × 10–10–1 × 10–5 M; the lower limits of determination were at a level of (7–8) × 10–11 M. The results are promising for monitoring the concentration of amitriptyline both in the pharmaceutical preparation and biological fluids to determine the effectiveness of ongoing therapeutic treatments and for medical and forensic purposes. [ABSTRACT FROM AUTHOR]