Indications
Amitriptyline is used to treat depression. In lower doses it is widely used for long-lasting nerve pain (for example diabetic nerve pain or pain after shingles), to prevent migraine and tension-type headaches, and for some other long-term pain conditions.
How It Works
It increases the levels of two natural brain chemicals, serotonin and noradrenaline, which helps lift mood and also reduces how strongly pain signals are felt. Its calming effect can improve sleep.
Dosage and Administration
- Depression, adults: often started at 25 mg two or three times a day, or 50 to 75 mg once at night, and increased slowly by the doctor if needed (usually not more than 150 mg a day outside hospital).
- Nerve pain and headache prevention, adults: usually 10 mg at night, increased slowly to 25 to 75 mg at night if needed.
- Older people: lower starting doses are used.
- Children: only as prescribed.
Take it in the evening, because it causes drowsiness. It may take 2 to 6 weeks to show the full effect. Do not stop suddenly; the doctor will reduce the dose slowly.
Interactions
Do not take it with, or within 14 days of, MAO inhibitor antidepressants. Taking it with Fluoxetine, Paroxetine, Sertraline, Tramadol or similar medicines can raise its level or cause a serious reaction called serotonin syndrome. Alcohol, sleeping tablets, antihistamines and strong painkillers increase drowsiness. Some medicines for heart rhythm, antipsychotics and certain antibiotics can add to its effects on the heart. Tell your doctor about all medicines you take.
Contraindications
- A recent heart attack, heart block or irregular heart rhythm.
- Use of an MAO inhibitor in the last 14 days.
- Mania (a phase of bipolar disorder) or severe liver disease.
- Allergy to amitriptyline or any ingredient.
Side Effects
Common: dry mouth, drowsiness, constipation, blurred vision, dizziness when standing up, weight gain, sweating and difficulty passing urine. These often ease after the first few weeks. Get urgent medical help for a fast, pounding or irregular heartbeat, fainting, fits (seizures), severe confusion, sudden eye pain with blurred vision, being unable to pass urine, or thoughts of harming yourself.
Pregnancy and Lactation
Use in pregnancy only if the doctor decides it is needed; using it near delivery can cause temporary withdrawal symptoms in the newborn. Small amounts pass into breast milk; the doctor will decide whether it is suitable while breastfeeding.
Precautions and Warnings
Use with care if you have heart disease, glaucoma, an enlarged prostate, epilepsy, diabetes, thyroid problems or bipolar disorder. In young people especially, mood may worsen at the start of treatment, so family members should watch for changes. It can make you sleepy and unsteady; do not drive until you know how it affects you, and older people should take care to avoid falls.
Overdose
Overdose is very dangerous, even a few tablets for a child. It can cause irregular heartbeat, fits, very low blood pressure and coma. Take the person to an emergency department immediately.
Therapeutic Class
Tricyclic antidepressant.
Storage
Store below 30°C in a dry place, away from light and well out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.