Amitriptyline

Generic name: Amitriptyline
Drug class: Tricyclic antidepressants

Usage of Amitriptyline

Amitriptyline is a tricyclic antidepressant with sedative effects. Amitriptyline affects certain chemical messengers (neurotransmitters) that communicate between brain cells and help regulate mood.

Amitriptyline is a prescription medicine used to treat symptoms of depression.

Amitriptyline may also be used for purposes not listed in this medication guide.

Amitriptyline side effects

Get emergency medical help if you have signs of an allergic reaction to amitriptyline: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

  • signs of a blood clot - sudden numbness or weakness, problems with vision or speech, swelling or redness in an arm or leg;
  • unusual thoughts or behavior;
  • a light-headed feeling, like you might pass out;
  • chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating;
  • pounding heartbeats or fluttering in your chest;
  • confusion, hallucinations;
  • a seizure (convulsions);
  • painful or difficult urination;
  • severe constipation;
  • easy bruising, unusual bleeding; or
  • fever, chills, sore throat, mouth sores.

    • Common amitriptyline side effects may include:

  • constipation, diarrhea;
  • nausea, vomiting, upset stomach;
  • mouth pain, unusual taste, black tongue;
  • appetite or weight changes;
  • urinating less than usual;
  • itching or rash;
  • breast swelling (in men or women); or
  • decreased sex drive, impotence, or difficulty having an orgasm.

    • This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

    Before taking Amitriptyline

    You should not use this medicine if you are allergic to amitriptyline, or:

  • if you have recently had a heart attack.

    • Do not use amitriptyline if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

    Tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone.

    To make sure amitriptyline is safe for you, tell your doctor if you have ever had:

  • bipolar disorder (manic-depression) or schizophrenia;
  • mental illness or psychosis;
  • liver disease;
  • heart disease;
  • a heart attack, stroke, or seizures;
  • diabetes (amitriptyline may raise or lower blood sugar);
  • glaucoma; or
  • problems with urination.

    • Some young people have thoughts about suicide when first taking an antidepressant. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

    Tell your doctor if you are pregnant or breastfeeding.

    Amitriptyline is not approved for use by anyone younger than 12 years old.

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    How to use Amitriptyline

    Usual Adult Dose for Depression:

    OUTPATIENTS: -Initial dose: 75 mg orally per day in divided doses; this may be increased to 150 mg/day (if needed) -Maintenance dose: 40 to 100 mg orally per day -Maximum dose: 150 mg/day Alternate outpatient treatment regimen: 50 to 100 mg orally as a single dose at bedtime; this may be increased by 25 or 50 mg as needed at bedtime to a total of 150 mg/day INPATIENTS: -Initial dose: 100 mg orally per day -Maintenance dose: 40 to 100 mg orally as a single dose at bedtime -Maximum dose: 300 mg/day Comments: -Dose increases should preferably be made in the late afternoon or at bedtime due to the sedative effect. -The full therapeutic effect may take as long as 30 days to develop. -Maintenance doses should be reduced to the lowest amount that will maintain relief of symptoms when satisfactory improvement has been obtained. -Maintenance therapy should be continued for 3 months or longer to lessen the possibility of relapse. Use: Relief of symptoms of depression

    Usual Geriatric Dose for Depression:

    10 mg orally 3 times a day AND 20 mg orally once a day at bedtime Comments: -The full therapeutic effect may take as long as 30 days to develop. -Elderly patients should be monitored carefully and serum levels obtained as clinically appropriate. -Dose adjustments should be made according to clinical response. Use: Relief of symptoms of depression

    Usual Pediatric Dose for Depression:

    12 years or older: 10 mg orally 3 times a day AND 20 mg orally once a day at bedtime Comments: -The full therapeutic effect may take as long as 30 days to develop. -Dose adjustments should be made according to clinical response. Use: Relief of symptoms of depression

    Warnings

    You should not use amitriptyline if you have recently had a heart attack.

    Do not use amitriptyline if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine.

    You may have thoughts about suicide when you first start taking an antidepressant such as amitriptyline, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

    Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

    What other drugs will affect Amitriptyline

    Taking amitriptyline with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking amitriptyline with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

    Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.

    Tell your doctor about all your other medicines, especially:

  • other antidepressants;
  • medicine to treat depression, anxiety, mood disorders, or mental illness;
  • cold or allergy medicine (Benadryl and others);
  • medicine to treat Parkinson's disease;
  • medicine to treat stomach problems, motion sickness, or irritable bowel syndrome;
  • medicine to treat overactive bladder; or
  • bronchodilator asthma medication.

    • This list is not complete. Other drugs may affect amitriptyline, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

    Popular FAQ

    In the treatment of depression, you should feel some relief from amitriptyline in 2 to 4 weeks, but it may take up to 8 to 12 weeks to feel the full therapeutic effects. For nerve-related (neuropathic) pain, lower doses of amitriptyline are typically used and it also may take up to 6 weeks to feel the full effects. If you have concerns about how well your medicine is working, contact your doctor for further advice.

    Yes, weight gain has been reported as a common side effect with amitriptyline and may occur in 1% to 10% of patients. Amitriptyline is a tricyclic antidepressant (TCA) and other drugs in this class have been associated with weight gain. TCAs block histamine receptors which may be responsible for increased appetite and weight gain.

    Yes, amitriptyline, an oral tricyclic antidepressant, has been reported to cause high blood pressure (hypertension), but how often this occurs was not reported. Other heart side effects, like fast heart beat, orthostatic hypotension (low blood pressure upon standing), fainting, heart rhythm changes and heart attack have also been reported. Some side effects, like orthostatic hypotension and heart rhythm changes, are common to the tricyclic antidepressant class.

    Amitriptyline will stay in your system for about 2 to 6 days after your last dose, but its clinical effect may wear off before this time. Amitriptyline has a half-life ranging from 10 to 28 hours. The half-life of a drug is the time it takes for the blood concentration of a drug to reduce by one-half. It takes about 5 half-lives for a drug to be fully eliminated from your body. So, after about 50 to 140 hours (about 2 to 6 days), most of amitriptyline is gone from your body.

    Amitriptyline is not addictive or habit-forming, but it may cause sudden withdrawal symptoms if you stop treatment abruptly. Side effects from rapid withdrawal can include headache, nausea, trouble sleeping, abnormal dreams, irritability, and restlessness. Talk to your doctor about the best way to stop treatment.

    Common antidepressants used for orthopedic pain relief may include SSRIs like fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft), SNRIs such as duloxetine (Cymbalta), or tricyclic antidepressants (TCAs) like amitriptyline (Elavil) or nortriptyline (Pamelor). Continue reading

    In the treatment of depression, you should feel some relief from amitriptyline in 2 to 4 weeks, but it may take up to 8 to 12 weeks to feel the full therapeutic effects. For nerve-related (neuropathic) pain, lower doses of amitriptyline are typically used and it also may take up to 6 weeks to feel the full effects. If you have concerns about how well your medicine is working, contact your doctor for further advice.

    Yes, weight gain has been reported as a common side effect with amitriptyline and may occur in 1% to 10% of patients. Amitriptyline is a tricyclic antidepressant (TCA) and other drugs in this class have been associated with weight gain. TCAs block histamine receptors which may be responsible for increased appetite and weight gain.

    Yes, amitriptyline, an oral tricyclic antidepressant, has been reported to cause high blood pressure (hypertension), but how often this occurs was not reported. Other heart side effects, like fast heart beat, orthostatic hypotension (low blood pressure upon standing), fainting, heart rhythm changes and heart attack have also been reported. Some side effects, like orthostatic hypotension and heart rhythm changes, are common to the tricyclic antidepressant class.

    Amitriptyline will stay in your system for about 2 to 6 days after your last dose, but its clinical effect may wear off before this time. Amitriptyline has a half-life ranging from 10 to 28 hours. The half-life of a drug is the time it takes for the blood concentration of a drug to reduce by one-half. It takes about 5 half-lives for a drug to be fully eliminated from your body. So, after about 50 to 140 hours (about 2 to 6 days), most of amitriptyline is gone from your body.

    Amitriptyline is not addictive or habit-forming, but it may cause sudden withdrawal symptoms if you stop treatment abruptly. Side effects from rapid withdrawal can include headache, nausea, trouble sleeping, abnormal dreams, irritability, and restlessness. Talk to your doctor about the best way to stop treatment.

    Common antidepressants used for orthopedic pain relief may include SSRIs like fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft), SNRIs such as duloxetine (Cymbalta), or tricyclic antidepressants (TCAs) like amitriptyline (Elavil) or nortriptyline (Pamelor). Continue reading

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