Amitriptyline

Amitriptyline is a tricyclic antidepressant. Although it was originally licensed as an antidepressant, like many drugs, new uses began to be found.

In the UK it is no longer used as an antidepressant but in the US and Australia it is still used for major depressive disorder and anxiety, brands include, Endep and Elavil.

In the UK it is widely used off label for neuropathic pain, abdominal pain, insomnia due to pain and migraine prophylaxis (prevention). It has a very long half-life of 12-24 hours which means that it only needs to be taken once a day.

The fact that amitriptyline stays in the blood for this long also means that you will have left over side effects in the morning.

Possible Side Effects

Drowsiness

Postural hypotension (dizziness/ faint feeling when getting up)

Dry mouth

Blurred vision

Anxiety

Constipation

Arrhythmias

Tachycardia (racing heart beat)

Convulsions

Confusion

Weight loss or gain

Cautions

There is a high rate of fatality in overdosage.

Do not use this drug if you are already taking:

MAOI e.g phenelzine (this may cause seizures or even death).

Drugs which effect the heart such as gabapentin.

SSRI antidepressants such as fluoxetine and sertraline.

Do not take amitriptyline if you:

Are recovering from a myocardial infarction

Are in the manic phase of bipolar disorder

Suffer from arrhythmias

Suffer from hyperthyroidism

Have suicidal thoughts

Have a history of psychosis or bipolar disorder (amitriptyline may aggravate this)

Are susceptible to glaucoma

You will feel drowsy when taking amitriptyline so do not drive or operate machinery whilst under the influence of amitriptyline.

Check the advice given from the relevant competent body in your country of residence for further advice. For residents of the UK please see this guide.

How to Use?

Neuropathic Pain – Start by taking 10mg at night then gradually increase, if necessary, to 75mg.

Abdominal pain and insomnia due to pain – Initially 5-10mg at night increased in steps of 10mg at least every 2 weeks as needed to a maximum of 30mg.

Migraine Prevention – Start by taking 10mg at night then gradually increase, if necessary, to 50m- 75mg.

For the first 7 days you may feel drowsy the next day. To reduce the effects of this, take your dose as early as possible in the evening and remember to increase the dose very gradually.

You may prefer to start on only half a tablet. When coming off amitriptyline, consult your doctor first and reduce your dose gradually or you will experience withdrawal effects (flu like symptoms, nausea, headache and tiredness)