Elavil (Amitriptyline)

Amitriptyline is a prescription drug for various mental health conditions. It is a tricyclic antidepressant that alters the levels of serotonin and norepinephrine in the brain.

Amitriptyline is available as 10mg, 25mg, 50mg, 75mg, 100mg or 150mg tablets. 

What does amitriptyline treat?

Amitriptyline treats a variety of conditions, including:

• Depression

• Anxiety

• Migraines

• Chronic pain

Amitriptyline is a tricyclic antidepressant (TCA), FDA-approved in 1961¹. It increases levels of serotonin and norepinephrine, two neurotransmitters that play a role in mood regulation. 

How do you take amitriptyline?

You will usually take a single pill of amitriptyline once a day. Taking it before bedtime is ideal because it can make you drowsy. If you are still sleepy in the morning, consider taking it earlier in the evening. 

Seeing results

Most people see results within the first few weeks of taking amitriptyline. However, it can take up to two months for the medication to reach its full potential. Side effects such as drowsiness and dry mouth usually improve as your body adjusts to the drug.

If you don't see any improvement after a couple of months, talk to your doctor about increasing your dosage or trying a different medication. Don't stop taking amitriptyline suddenly, as this can cause withdrawal symptoms.

Potential side effects of amitriptyline

Common side effects of amitriptyline include:

• Drowsiness

• Weight gain

• Constipation

• Dry mouth

Other side effects include:

• Blurred vision

• Changes in sex drive or ability

• Clumsiness

• Urinary retention

If you experience any of these side effects, contact your doctor.

Amitriptyline may also cause more severe side effects. These include:

• Difficulty urinating

• Seizures

• Irregular heartbeat

• Fainting

• Jaundice

If you experience any of these side effects, seek medical attention immediately.

Most people tolerate amitriptyline well, but it is essential to be aware of the potential side effects and risks before starting treatment. If you are concerned about any of these, speak to your doctor.

Long-term use of amitriptyline

Amitriptyline is a highly regarded medicine that is relatively safe over long periods. There do not appear to be any detrimental effects associated with using it for lengthy periods.

Amitriptyline is not addictive. However, if you stop taking it suddenly, you might experience withdrawal symptoms.

Long-term use of amitriptyline can result in dependence, where your body relies on the substance and develops a tolerance. It is essential to take the medication exactly as prescribed, and do not stop taking the medication without consulting your doctor.

Missed doses

You can take amitriptyline with or without food. If you miss a dose of amitriptyline, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not take two doses of amitriptyline together unless directed to do so by your healthcare provider.

Overdose

An amitriptyline overdose can be deadly, and you should always treat it as a medical emergency. Symptoms of an amitriptyline overdose may include:

• Extreme drowsiness

• Confusion

• Seizures

• Coma

If you or someone you know has overdosed on amitriptyline, call 911 or immediately go to the nearest emergency room.

Things to discuss with your doctor before you start taking amitriptyline

Have a discussion with your doctor before taking any new medication. This is especially important with amitriptyline because it can have serious side effects. Some of the things you should discuss with your doctor are:

• Your medical history

• Any other medications you are taking

• Any allergies you have

• If you are pregnant or breastfeeding

• Your alcohol use

• Your drug use

Your doctor will also want to know if you have ever had a heart attack, seizures, glaucoma, or any mental health conditions like depression, bipolar disorder, or schizophrenia. You must tell your doctor about all of these things to determine if amitriptyline is right for you.

What You Need To Know About Mental Health

Stopping amitriptyline

You should always taper off amitriptyline slowly under the supervision of your doctor to avoid withdrawal symptoms. Symptoms of stopping too quickly can include:

• Nausea

• Vomiting

• Diarrhea

• Headache

• Dizziness

• Trouble sleeping

Amitriptyline and pregnancy

Taking amitriptyline during pregnancy does not usually require any additional monitoring of your baby. If you took amitriptyline around the time of delivery, your newborn might require closer observation after birth because of the potential danger of neonatal abstinence syndrome (NAS). NAS is where your baby experiences withdrawal from the drug you were taking. 

Amitriptyline and breastfeeding

Amitriptyline excretes into human milk. If you take amitriptyline and breastfeed, your baby may experience drowsiness, poor feeding, or weight gain. Speak to your doctor about this. 

Amitriptyline and alcohol

You should avoid drinking alcohol while taking amitriptyline because it can increase the effects of alcohol. This can make you more likely to experience side effects such as drowsiness, dry mouth, blurred vision, constipation, and difficulty urinating. It can also worsen depression.

If you must drink alcohol while taking amitriptyline, drink plenty of fluids to avoid dehydration.

Interactions with other drugs

You should avoid taking amitriptyline with other drugs that can cause drowsiness, such as:

• Sleeping pills

• Antipsychotics

• Antidepressants

• Antihistamines

• Anticonvulsants

• Muscle relaxants

• Narcotic pain relievers

Taking amitriptyline with these drugs can increase the risk of side effects such as:

• Drowsiness

• Dry mouth

• Blurred vision

• Constipation

• Difficulty urinating

Amitriptyline can also interact with other medications such as:

• Blood thinners (e.g., warfarin)

• Heart rhythm medications (e.g., quinidine)

• MAO inhibitors (e.g., tranylcypromine)

• High blood pressure medications (e.g., beta-blockers such as atenolol)

• Seizure medications (e.g., carbamazepine)

• Diabetes medications (e.g., insulin)

• Thyroid medications (e.g., levothyroxine)

Amitriptyline can also interact with other drugs that are not listed here. Tell your doctor about all the medicines you take, including over-the-counter and herbal medications. Do not start or stop taking any medication without first talking to your doctor.

Amitriptyline may cause a condition called serotonin syndrome when taken with other drugs such as:

• Selective serotonin reuptake inhibitors (SSRIs)

• Serotonin and norepinephrine reuptake inhibitors (SNRIs)

• Tricyclic antidepressants (TCAs)

• Monoamine oxidase inhibitors (MAOIs)

Symptoms of serotonin syndrome may include:

• Agitation

• Hallucinations

• Overactive reflexes

• Seizures

• Shivering or shaking

• Sweating

The risk of serotonin syndrome increases when you take these drugs together. You should avoid taking amitriptyline with other medications that can cause serotonin syndrome. If you experience any of the symptoms listed above, stop taking amitriptyline and call your doctor immediately.

Allergy information

Amitriptyline may cause a severe reaction called anaphylaxis, which can be life-threatening. It requires immediate medical attention. Tell your doctor if you are allergic to amitriptyline or any other medications.

Do not take this medication if you are allergic to amitriptyline or if you have:

• A history of heart attack, stroke, or blood clots

• Coronary artery disease

• High blood pressure

• History of seizures

If you have any of these conditions, you may need a dose adjustment or special tests to take this medication safely.

Clinical trial history

According to one study², low back pain is a primary clinical and public health concern, with limited evidence-based therapies available. Doctors often use low-dose antidepressants to treat chronic low back discomfort. However, their effectiveness is unproven. This pragmatic, double-blind, placebo-controlled study aimed to see whether low-dose amitriptyline was more effective than a placebo in reducing pain in those with chronic persistent back discomfort.

Researchers found that among the sample of 146 participants with chronic low back pain, low-dose amitriptyline did not help improve pain, disability, or work at six months. Still, it reduced disability at the 3-month mark and improved pain intensity³. Additionally, there were minimal adverse effects reported among participants who used amitriptyline. 

Amitriptyline is considered a good alternative to prescription pain medications³, like opioids, since it is safer and has fewer adverse side effects.

Tips and advice for taking amitriptyline

When it comes to medications, everyone is different. What works for one person might not work for another. When it comes to amitriptyline, keep a few things in mind before taking it.

First and foremost, always consult with your doctor before starting any new medication. They will tell you if amitriptyline is the proper medication for you and what dosage best suits your needs.

Second, make sure you take amitriptyline precisely as your doctor prescribed. Do not increase or decrease the dosage without talking to your doctor first. Doing so could lead to unpleasant side effects.

Finally, give amitriptyline time to work. It might take a few weeks before you start to feel the full effects of the medication. Be patient, and don't give up. With time, amitriptyline can improve your quality of life.