Indications
Amitriptyline is a tricyclic antidepressant. It is used to treat depression, and at lower doses to relieve long-term nerve pain (such as from diabetes or shingles), to prevent migraine and tension headaches, and for some other chronic pain conditions. Some products combine it with Chlordiazepoxide (a sedative) for depression with anxiety, or with Perphenazine.
How It Works
Amitriptyline increases the amounts of serotonin and noradrenaline, two chemical messengers in the brain and spinal cord. This can lift mood and also reduces the way pain signals are passed along nerves. It also has a sedating effect, which can help sleep.
Dosage and Administration
The dose depends on the condition and is set by your doctor, as prescribed. It is usually started at a low dose, often taken in the evening because it causes drowsiness, and increased slowly. For pain and headache prevention, low doses are often enough. It may take 2 to 6 weeks to feel the full effect. Do not stop suddenly; your doctor will reduce the dose gradually.
Interactions
Do not take with MAO inhibitors (such as Selegiline or Moclobemide) or within 14 days of stopping them. Taking it with SSRIs such as Fluoxetine, or with Tramadol or Linezolid, can cause serotonin syndrome. Alcohol, sleeping pills, antihistamines and opioids increase drowsiness. Medicines that prolong the QT interval (such as some antipsychotics and Erythromycin) should be avoided. Fluoxetine, Paroxetine and Cimetidine raise its level. Tell your doctor about all medicines you take.
Contraindications
- Allergy to amitriptyline
- Recent heart attack, heart block or serious heart rhythm problems
- Use of MAO inhibitors within the last 14 days
- Mania
- Severe liver disease
- Children under 6 years (and under 16 for depression)
Side Effects
Common effects include drowsiness, dry mouth, constipation, blurred vision, difficulty passing urine, dizziness on standing, weight gain, sweating and a fast heartbeat. These often lessen after the first weeks.
Get urgent medical help for thoughts of self-harm or suicide (especially in young people and when starting or changing the dose), fainting or an irregular heartbeat, eye pain with blurred vision, inability to pass urine, fits, confusion with high fever and stiff muscles, or a serious allergic reaction.
Pregnancy and Lactation
Use in pregnancy only if your doctor advises; if used near delivery, the baby may have withdrawal symptoms. Small amounts pass into breast milk; it is sometimes used during breastfeeding with the baby watched for drowsiness, but ask your doctor.
Precautions and Warnings
Use with care in heart disease, epilepsy, glaucoma, enlarged prostate, diabetes, thyroid disease, and in older people (higher risk of falls and confusion). It may cause drowsiness: do not drive or operate machines if affected. Avoid alcohol. Keep tablets out of reach, as overdose is dangerous.
Overdose
Overdose is very dangerous and can cause seizures, heart rhythm problems, coma and death. Call for emergency help at once, even if the person seems well.
Therapeutic Class
Tricyclic antidepressant
Storage
Store below 30°C in a dry place, away from light and 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.