Amitriptyline for pain and migraine
1. About amitriptyline for pain and migraine
Amitriptyline is a medicine used for treating pain. You can take it:
Amitriptyline is available on prescription. It comes as tablets and as a liquid that you drink.
Amitriptyline is also used to treat depression.
Read about amitriptyline for depression.
2. Key facts
- It's best to take your amitriptyline in the evening or before you go to bed. This is because it can make you feel sleepy.
- You may start to feel better after 1 or 2 weeks, but it can take 6 weeks for amitriptyline to work as a painkiller.
- Amitriptyline can cause extra side effects if you stop taking it suddenly. Talk to your doctor if you want to stop taking it.
- Amitriptyline is also used to treat depression, but at lower doses it's very good for treating pain.
3. Who can and cannot take amitriptyline
Most adults (aged 18 and over) can take amitriptyline. Children aged 2 years and older can take it for some types of nerve pain.
Amitriptyline is not suitable for some people. Check with your doctor before starting to take amitriptyline if you:
- have ever had an allergic reaction to amitriptyline or any other medicine
- have a heart problem – amitriptyline can make some heart problems worse
- have a rare blood disorder called porphyria
- have liver or kidney problems
- have epilepsy – amitriptyline can increase seizures or fits
- have ever taken any medicines for depression – some antidepressants used rarely can affect the way amitriptyline works
- are pregnant, trying to become pregnant, or breastfeeding
- have an eye problem called glaucoma – amitriptyline can increase the pressure in your eye
- have thoughts about harming yourself or ending your life
- have type 1 or type 2 diabetes
If you have diabetes, amitriptyline may change your blood sugar level. If you usually test your blood sugar levels, you may have to do this more often for the first few weeks of treatment. Talk to your diabetes doctor if the reading goes too high or low.
4. How and when to take amitriptyline
It's usual to take amitriptyline once a day. It's best to take it before bedtime because it can make you feel sleepy. If you find that you are still feeling drowsy in the morning you could try taking it earlier in the evening.
This medicine does not usually upset your stomach. You can take it with or without food.
Swallow the tablets whole, with a drink of water. If you chew them, they taste bitter.
The liquid comes with a plastic syringe or spoon to help you measure out the right dose. If you don't have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give the right amount.
Amitriptyline tablets come in 3 different strengths – 10mg, 25mg or 50mg.
The liquid also comes in 3 different strengths – containing 10mg, 25mg or 50mg of amitriptyline in a 5ml spoonful.
The usual starting dose for adults and older children (aged 12 to 17 years) is 10mg a day. This dose can be increased by your doctor if you need better pain relief.
The starting dose for younger children depends on their weight and symptoms. The doctor will tell you how much to give them.
The maximum dose of amitriptyline for treating pain is 75mg a day. Your doctor may give you a higher dose if you're taking it to prevent migraine.
What if I forget to take it?
If you forget to take your amitriptyline, take it as soon as you remember, unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next one as normal.
If amitriptyline usually makes you sleepy and you need to drive, cycle or use tools or machinery, skip the missed dose and then take the next dose as normal.
Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.
If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
What if I take too much?
Urgent advice: Contact 111 for advice now if:
- you take more than your usual dose of amitriptyline
Go to 111.nhs.uk or call 111
Taking too much amitriptyline can cause serious side effects such as a change in your heartbeat, seizures or fits.
You can report any suspected side effect using the Yellow Card safety scheme.
Visit Yellow Card for further information.
7. Pregnancy and breastfeeding
Amitriptyline and pregnancy
Amitriptyline is generally not recommended in pregnancy. This is because it has been linked to a small risk of problems for your baby if you take it in early or late pregnancy.
Talk to your doctor as there may be other painkillers you can take instead of amitriptyline. Paracetamol is usually the first choice of painkiller if you're pregnant or breastfeeding.
Your doctor will only prescribe amitriptyline for your pain while you're pregnant if the benefits of taking the medicine outweigh the risks.
Amitriptyline and breastfeeding
Amitriptyline is not usually recommended if you're breastfeeding.
Amitriptyline gets into breast milk. It's been linked with side effects like sleepiness in breastfed babies.
Talk to your doctor if you want to breastfeed. There may be other medicines that you can take instead of amitriptyline.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
For more information about how this medicine can affect you and your baby during pregnancy, read this leaflet about amitriptyline on the Best Use of Medicines in Pregnancy (BUMPs) website.
You can also read more about paracetamol in pregnancy on the NHS website.
8. Cautions with other medicines
Many medicines and amitriptyline can affect each other and increase the chances of side effects.
Always check with your doctor or a pharmacist before starting any new medicine while you are taking amitriptyline.
Taking opioid-based medicines, like codeine, morphine or oxycodone, together with amitriptyline can increase your risk of becoming very drowsy and having breathing problems.
Tell your doctor if you have ever taken any medicines for depression. Some antidepressants can affect the way amitriptyline works to cause very high blood pressure. This can happen even after you have stopped taking them.
Mixing amitriptyline with herbal remedies and supplements
Do not take St John's wort, a herbal remedy often taken for depression, while you are being treated with amitriptyline. It will increase your risk of side effects.
There’s very little information about taking amitriptyline with other herbal remedies and supplements. They are not tested in the same way as medicines.
Important: Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions about amitriptyline
What is amitriptyline?
Amitriptyline (a-muh-trip-tuh-leen) is a drug that can reduce your pain and discomfort, and help you get a good night’s sleep.
You can discuss the benefits and risks of taking amitriptyline with healthcare professionals before you start treatment, so you’re able to make an informed decision.
Amitriptyline is a type of drug called a tricyclic antidepressant. These drugs were originally developed to treat anxiety and depression, but when taken at a low dose they can reduce or stop pain.
Amitriptyline works by increasing the amount of serotonin your brain makes. Serotonin is a chemical, called a neurotransmitter, that the brain sends out to nerves in the body. It’s thought to improve your mood, emotional state, sleep and the way your body responds to pain.
By raising your serotonin levels, amitriptyline should change your body’s reaction to pain. The low dose won’t treat depression, but it should reduce your pain, relax your muscles and improve your sleep.
It’s safe to be prescribed to adults or children. It should help you sleep as soon as you start taking it, but significant changes to your pain and mood can take up to six weeks.
Amitriptyline is prescribed for many painful, long-term conditions that affect your muscles or bones. These include:
- arthritis (arth-rye-tus)
- back pain
- fibromyalgia (fie-bruh-my-al-juh)
- tension headaches and migraines
- damage to nerve endings in limbs, which may be described to you as peripheral neuropathy (pe-rif-er-ul new-ro-pa-thee).
You may not be able to take amitriptyline if:
- you’ve had an allergic reaction to a medication in the past
- you have heart problems, as it can make them worse
- you have uncontrolled bipolar disorder
- you have the rare inherent blood disorder porphyria (por-fear-ee-ya) which affects the nervous system
- you have liver or kidney problems
- you have epilepsy, as it can increase the risk of seizures
- you’ve had or are having treatment for depression, as some medicines can interact badly with it
- you have glaucoma (glor-co-ma), as it can increase the pressure in your eye
- you have extreme mood swings, thoughts of self-harming or suicide.
If you’re pregnant, breastfeeding, or want to try for a baby, you may be prescribed another medicine instead of amitriptyline.
How is it taken?
Amitriptyline can be prescribed as a tablet or liquid. You’ll need to take it every day an hour or two before your usual bedtime, as it can make you sleepy. If you find you’re still feeling sleepy when you wake in the morning, try taking it earlier in the evening.
Amitriptyline is taken at lower doses for pain relief than when it's used for depression. Your doctor will usually start you on the lowest dose possible and may increase it if you're still experiencing pain after several weeks. Doses for children aged under 12 are worked out according to their weight and symptoms. It can take up to six weeks for you to see the benefits, so try to stick with it.
You’ll probably take it for as long as it helps your condition. Some people take it for many months, even years, without having any negative effects.
It isn’t an addictive medication, but you may get unpleasant side effects if you suddenly stop taking it. You should talk to your doctor before making any changes to your treatment. They’ll probably recommend that you reduce the dose slowly over several weeks or more, depending on how long you’ve been taking it.
What if I forget to take it?
Try to take your missed dose as soon as you remember – unless it’s almost time for your next dose, or you are going to be driving, cycling or using machinery. In these cases, leave out the missed dose and take your next one as usual.
Never take two doses at the same time, or take an extra dose, to make up for a missed one.
If you are having problems remembering when to take your medication, try setting an alarm to remind yourself.
What if I take too much?
Taking more than your prescribed dose can cause potentially serious symptoms and side effects, such as:
- changes to your heartbeat
If you think you’ve taken too much amitriptyline, you must contact your doctor or a healthcare professional immediately for advice.
Side-effects and risks
Many people take amitriptyline without experiencing any problems - but, like any medication, it can cause side effects. Many of the more common ones go, once your body has adjusted to the treatment.
If they trouble you or don’t improve over the first few weeks of taking it, speak to your doctor or pharmacist.
Common side effects include:
- dry mouth
- feeling sleepy
- difficulty weeing
Some people also find their appetite and weight changes when they start taking it. Talk to your doctor or pharmacist if your weight changes worry you.
Because amitriptyline can make you drowsy, you should not cycle, drive or use machinery for the first few days of taking it, until you know how it affects you.
It may also be best to try it out when you don’t have to get up for work the next day.
In rare cases, people can have serious side effects. Get medical help straight away if you experience:
- weakness on one side of your body
- blurred eyesight
- trouble speaking, thinking or balancing.
These could be signs of a stroke and you need to call 999 to ask for an ambulance.
Other rare side effects, you should tell a doctor about urgently, include:
- a fast or irregular heart beat
- yellowing of the skin or the whites of your eyes – these can be signs of liver problems
- a headache, confusion, muscle cramps, generally feel weak or experience a seizure – these can be signs of low sodium levels in your blood
- low blood pressure
- thoughts of hurting yourself in any way
- eye pain, changes in your sight, swelling or redness in or around your eye
- severe constipation or you feel unable to wee and you’re in pain.
As with any medication, there is a very small risk you may be allergic to it. You should contact a doctor immediately if:
- you suddenly get a rash – your skin may become itchy, red, swollen, blistered or begin to peel
- you begin to wheeze
- feel a tightness across your chest or throat
- you’re having trouble breathing or talking
- your mouth, lips, tongue, face or throat become swollen.
These are symptoms of a serious allergic reaction and you must seek medical help straight away.
Other conditions it may affect
- Diabetes - it can affect your blood sugar levels, so you should check your blood sugar more often for the first few weeks. If your levels become too high or too low, talk to your diabetes doctor.
- Epilepsy – it can make you more likely to have seizures.
- Heart problems – it can make some conditions worse.
- Glaucoma – it can affect the pressure in your eye and you’d need regular eye tests.
- Overactive thyroid gland.
- Severe liver disease.
- Depression – it can react with MAOI antidepressant drugs (monoamine oxidase inhibitors).
Effects on other treatments
Amitriptyline is safe to take with most other drugs prescribed for your condition, but some may interact with it. Always check with the doctor or healthcare professional you’re seeing to make sure any new medication is safe to take with amitriptyline.
- Painkillers, such as codeine or tramadol, could react with it to make you sleepy and less alert.
- Antidepressants – some antidepressant treatments, such as serotonin re-uptake inhibitors (SSRIs) or MAOI drugs, can interfere with it, causing high blood pressure or heart problems.
Herbal remedies and supplements, especially St John’s wort, can increase your risk of side effects. Don’t take herbal remedies or supplements without first talking to your healthcare team.
It’s important you tell your doctor about any medications, vitamins, supplements, over-the-counter drugs or herbal treatments you’re using before you start or while you’re taking amitriptyline.
You should also tell them if any existing treatment is being stopped while you’re taking amitriptyline.
Amitriptyline shouldn’t interfere with any vaccinations - just make sure the healthcare professional treating you knows that you’re taking it.
You can drink alcohol while you’re taking amitriptyline but it could make you feel drowsy. It’s best not to drink while you’re getting used to the medication and work out how it affects you.
Alcohol and amitriptyline can also interact to cause high blood pressure.
Amitriptyline hasn’t been properly tested when taken with recreational drugs, but some drugs are known to react with it.
Cannabis can make you feel very sleepy and can also make your heart beat very fast.
Drugs with potentially dangerous interactions include:
- stimulants like MDMA, ecstasy or cocaine
- hallucinogens like LSD
- novel psychoactive substances – the new term for ‘legal highs’ – like mephedrone.
Speak to your doctor before starting amitriptyline if you use a recreational drug that may interact with it.
Fertility, pregnancy and breastfeeding
Amitriptyline doesn’t affect fertility. However, some people have been known to experience sex-related problems early in their treatment, such as:
- men and women having swollen breasts
- women having some vaginal bleeding
- men having erectile and ejaculation problems.
These are quite uncommon and should settle down after the first few weeks of treatment. If they don’t, and this concerns you, speak to your doctor to see if another drug may work better.
Post-menopausal women should contact their doctor as soon as possible if they experience any vaginal bleeding.
Amitriptyline doesn’t affect any type of contraception, including contraceptive pills and the morning after pill. If you are pregnant, amitriptyline will only be recommended if your doctor thinks you’ll benefit from taking it. If they don’t think it’s right for you, they will suggest another treatment.
It has been linked to a small risk of problems for unborn babies when it’s been taken in early or late pregnancy. Some babies exposed to the drug during the last three months of pregnancy have also shown withdrawal symptoms.
Like a lot of drugs, your doctor will compare the benefits and risks before prescribing it.
Do speak to your doctor if you become pregnant, or want to try for a baby, while on amitriptyline. Don’t stop taking amitriptyline suddenly or without speaking to your doctor first.
Breastfeeding while taking amitriptyline is unlikely to be harmful to your baby, as the amount of the drug that passes into breastmilk is very small. However, it’s advisable to speak to your doctor first if you do want to breastfeed.
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Amitriptyline, oral tablet
Highlights for amitriptyline
- Amitriptyline oral tablet is available as a generic drug. It’s not available as a brand-name drug.
- Amitriptyline comes only as a tablet you take by mouth.
- Amitriptyline oral tablet is used to help relieve symptoms of depression.
What is amitriptyline?
Amitriptyline is a prescription drug. It comes as a tablet you take by mouth.
Amitriptyline oral tablet is not available as a brand-name drug. It’s only available as a generic drug. Generic drugs typically cost less than brand-name drugs.
Why it’s used
Amitriptyline is used to help relieve symptoms of depression.
How it works
Amitriptyline belongs to a class of drugs called tricyclic antidepressants. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.
Amitriptyline works on your central nervous system to increase the level of certain chemicals in your brain, which improves your depression.
Amitriptyline side effects
Amitriptyline can cause dizziness and drowsiness during the first few hours after you take it. If you notice drowsiness while you take this drug, your doctor may have you take your dose at bedtime.
Amitriptyline can also cause other side effects.
More common side effects
The more common side effects of amitriptyline can include:
- numbness and tingling in your arms and legs
- constipation or diarrhea
- blurred vision
- skin rash
- swelling of your face and tongue
- unexpected weight gain or loss
- dry mouth
If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist.
Serious side effects
Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:
- Heart attack. Symptoms can include:
- chest pain
- shortness of breath
- pain or pressure in your chest or upper body
- Stroke. Symptoms can include:
- weakness in one part or side of your body
- slurred speech
- Withdrawal (if you suddenly stop taking this drug). Symptoms can include:
- trouble sleeping
- mood swings
- Increases or decreases in blood sugar
- Suicidal thoughts or actions
- Orthostatic hypotension (sudden drop in blood pressure when standing)
Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare professional who knows your medical history.
Amitriptyline may interact with other medications
Amitriptyline oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.
To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk with your doctor or pharmacist.
Examples of drugs that can cause interactions with amitriptyline are listed below.
Drugs you should not take with amitriptyline
Taking certain drugs with amitriptyline may cause serious side effects. You should not take these drugs and amitriptyline at the same time. Examples of these drugs include:
- Monoamine oxidase inhibitors (MAOIs). Examples of these drugs include:
Using an MAOI with amitriptyline can lead to seizures or even death. Do not take an MAOI within two weeks of stopping amitriptyline, unless told to do so by your doctor. Also, do not start taking amitriptyline if you stopped taking a MAOI in the last two weeks, unless told to do so by your doctor. If you aren’t sure whether any of the drugs you take is an MAOI, ask your doctor or pharmacist.
- Quinidine. Taking this drug with amitriptyline could increase the amount of amitriptyline in your body. This could lead to dangerous side effects.
Drugs that cause more negative effects
Taking amitriptyline with certain drugs raises your risk of negative effects. Examples of these drugs include:
- Topiramate. Taking this drug with amitriptyline could increase the amount of amitriptyline in your body. This raises your risk of side effects. Your doctor may adjust your dosage of amitriptyline if you take it with topiramate.
- Sertraline, fluoxetine, and paroxetine. These drugs can increase the dangerous side effects of amitriptyline.
- Cimetidine. Taking this drug with amitriptyline could increase the amount of amitriptyline in your body. This raises your risk of side effects.
- Anticholinergic drugs. Examples include diphenhydramine, oxybutynin, solifenacin, and olanzapine. Taking these drugs with amitriptyline raises your risk of side effects such as fever, especially during hot weather.
- Neuroleptic drugs. Examples include clozapine, risperidone, and haloperidol. Taking these drugs with amitriptyline raises your risk of side effects such as fever, especially during hot weather.
How to take amitriptyline
All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:
- your age
- the condition being treated
- the severity of your condition
- other medical conditions you have
- how you react to the first dose
Forms and strengths
- Form: oral tablet
- Strengths: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg
Dosage for depression
Adult dosage (ages 18–64 years)
- Typical starting dosage: 75 mg per day, usually in divided doses.
- Dosage increases: Your doctor will slowly increase your dosage if needed.
- Maximum dosage: 150 mg per day.
- Alternative dosage regimen: Start with 50 to 100 mg at bedtime. This may be increased by 25 or 50 mg as needed in the bedtime dose, for a total of 150 mg per day.
Child dosage (ages 12–17 years)
Typical starting dosage: 10 mg three times a day with 20 mg at bedtime, for a total of 50 mg per day.
Child dosage (ages 0–11 years)
It hasn’t been confirmed that amitriptyline is safe and effective for use in children younger than 17 years.
Senior dosage (ages 65 years and older)
The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.
Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.
Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.
Worsening depression warning
You might experience an initial worsening of your depression, thoughts of suicide, and behavioral changes when you first start taking amitriptyline. This risk may last until the drug starts working for you.
Withdrawal symptoms warning
If you’ve been taking this medication for a long time, you should not stop taking it suddenly. Stopping it suddenly may cause side effects such as nausea, headache, and tiredness. Do not stop taking this drug without talking with your doctor. They will tell you how to slowly lower your dosage over time.
This drug can cause a severe allergic reaction. Symptoms can include:
- skin rash or hives
- trouble breathing
- swelling of your face or tongue
If you develop these symptoms, call 911 or go to the nearest emergency room.
Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).
Alcohol interaction warning
The use of drinks that contain alcohol while taking amitriptyline raises your risk of serious side effects, including extreme drowsiness.
Warnings for people with certain health conditions
For people with heart disorders: Taking this drug could cause heart problems, such as irregular heart rhythm, heart attack, and stroke. Do not take this drug if you’re recovering from a recent heart attack.
For people with bipolar disorder: Before starting you on treatment with antidepressants such as amitriptyline, it’s important for your doctor to check your risk of bipolar disorder. Your doctor should do this because a major depressive episode is usually the first symptom noticed in people with bipolar disorder. This drug should not be used in people with bipolar disorder.
For people with a history of seizures: Taking this drug raises your risk of seizures. If you have a history of seizures, your doctor will monitor you closely while you’re taking this drug. If you have a seizure while taking this drug, stop taking it and call your doctor right away.
For people with a history of glaucoma or increased eye pressure: Taking this drug could increase the pressure in your eyes. If you have a history of glaucoma or increased eye pressure, your doctor will monitor you closely while you’re taking this drug.
For people who have schizophrenia: This drug can worsen certain symptoms of schizophrenia. If you have this condition, let your doctor know before starting this drug.
For people who have urinary retention (difficulty emptying your bladder completely): Taking this drug can worsen urinary retention. If you have this condition, let your doctor know before starting this drug.
Warnings for other groups
For pregnant women: Amitriptyline is a category C pregnancy drug. That means two things:
- Research in animals has shown adverse effects to the fetus when the mother takes the drug.
- There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.
Talk with your doctor if you’re pregnant or planning to become pregnant. This drug should only be used if the potential benefit justifies the potential risk to the fetus.
For women who are breastfeeding: Amitriptyline passes into breast milk and may cause side effects in a child who is breastfed. Talk with your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.
For seniors: The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects. These side effects include fast heart rate, difficulty urinating, constipation, dry mouth, and blurred vision.
For children: It has not been confirmed that this drug is safe and effective for use in children younger than 12 years. Use of this drug in children must balance the potential risks with the clinical need.
Take as directed
Amitriptyline oral tablet is used for long-term treatment. It comes with risks if you don’t take it as prescribed.
If you stop taking the drug suddenly or don’t take it at all: If you don’t take amitriptyline, your depression may worsen. If you stop taking this medication suddenly you may have withdrawal side effects such as nausea, headache, and tiredness.
If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.
If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:
- irregular heart rhythm
- severely low heart rate
- stiff muscles
If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 1-800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.
What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.
How to tell if the drug is working: Over time you should notice an improvement in your symptoms of depression. This can take more than a month.
Important considerations for taking amitriptyline
Keep these considerations in mind if your doctor prescribes amitriptyline for you.
- You can take amitriptyline with or without food.
- You can cut or crush the tablet.
- Store amitriptyline at room temperature between 68°F and 77°F (20°C and 25°C). It can be kept for brief periods between 59°F and 86°F (15°C and 30°C).
- Keep this drug away from light.
- Don’t store this drug in moist or damp areas, such as bathrooms.
A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.
When traveling with your medication:
- Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
- Don’t worry about airport X-ray machines. They can’t hurt your medication.
- You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
- Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.
Your doctor will monitor your mental health while you take this drug. Be sure to tell your doctor about any unusual changes in your behavior and mood.
Are there any alternatives?
There are other drugs available to treat your condition. Some may be better suited for you than others. Talk with your doctor about other drug options that may work for you.
Disclaimer:Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
medicine used to treat depression and a variety of pain syndromes
|Trade names||Elavil, others|
|By mouth, intramuscular injection|
|Drug class||Tricyclic antidepressant (TCA)|
|Metabolism||Liver (CYP2D6, CYP2C19, CYP3A4)|
|Elimination half-life||21 hours|
|Excretion||Urine: 12-80% after 48 hours; feces: not studied|
|Molar mass||277.411 g·mol−1|
|3D model (JSmol)|
|Melting point||197.5 °C (387.5 °F)|
Amitriptyline, sold under the brand name Elavil among others, is a tricyclic antidepressant primarily used to treat major depressive disorder and a variety of pain syndromes from neuropathic pain to fibromyalgia to migraine and tension headaches. Due to the frequency and prominence of side effects, amitriptyline is generally considered a second-line therapy for these indications.
The most common side effects are dry mouth, drowsiness, dizziness, constipation, and weight gain. Of note is sexual dysfunction, observed primarily in males. Glaucoma, liver toxicity and abnormal heart rhythms are rare but serious side effects. Blood levels of amitriptyline vary significantly from one person to another, and amitriptyline interacts with many other medications potentially aggravating its side effects.
Amitriptyline was discovered in the late 1950s by scientists at Merck and approved by the US Food and Drug Administration (FDA) in 1961. It is on the World Health Organization's List of Essential Medicines. It is available as a generic medication. In 2018, it was the 79th most commonly prescribed medication in the United States, with more than 10 million prescriptions.
Amitriptyline is indicated for the treatment of major depressive disorder and neuropathic pain and for the prevention of migraine and chronic tension headache. It can be used for the treatment of nocturnal enuresis in children older than 6 after other treatments have failed.
Amitriptyline is effective for depression, but it is rarely used as a first-line antidepressant due to its higher toxicity in overdose and generally poorer tolerability. It can be tried for depression as a second-line therapy, after the failure of other treatments. For treatment-resistant adolescent depression or for cancer-related depression amitriptyline is no better than placebo. It is sometimes used for the treatment of depression in Parkinson disease, but supporting evidence for that is lacking.
Amitriptyline alleviates painful diabetic neuropathy. It is recommended by a variety of guidelines as a first or second line treatment. It is as effective for this indication as gabapentin or pregabalin but less well tolerated.
Low doses of amitriptyline moderately improve sleep disturbances and reduce pain and fatigue associated with fibromyalgia. It is recommended for fibromyalgia accompanied by depression by Association of the Scientific Medical Societies in Germany and as a second-line option for fibromyalgia, with exercise being the first line option, by European League Against Rheumatism. Combinations of amitriptyline and fluoxetine or melatonin may reduce fibromyalgia pain better than either medication alone.
There is some (low-quality) evidence that amitriptyline may reduce pain in cancer patients. It is recommended only as a second line therapy for non-chemotherapy-induced neuropathic or mixed neuropathic pain, if opioids did not provide the desired effect.
Moderate evidence exists in favor of amitriptyline use for atypical facial pain. Amitriptyline is ineffective for HIV-associated neuropathy.
Amitriptyline is probably effective for the prevention of periodic migraine in adults. Amitriptyline is similar in efficacy to venlafaxine and topiramate but carries a higher burden of adverse effects than topiramate. For many patients, even very small doses of amitriptyline are helpful, which may allow to minimize the side effects. Amitriptyline is not significantly different from placebo when used for the prevention of migraine in children.
Amitriptyline may reduce the frequency and duration of chronic tension headache, but it is associated with worse adverse effects than mirtazapine. Overall, amitriptyline is recommended for tension headache prophylaxis, along with lifestyle advice, which should include avoidance of analgesia and caffeine.
Amitriptyline is effective for the treatment of irritable bowel syndrome; however, because of its side effects, it should be reserved for select patients for whom other agents do not work. There is insufficient evidence to support its use for abdominal pain in children with functional gastrointestinal disorders.
Tricyclic antidepressants decrease the frequency, severity, and duration of cyclic vomiting syndrome episodes. Amitriptyline, as the most commonly used of them, is recommended as a first-line agent for its therapy.
Amitriptyline may improve pain and urgency intensity associated with bladder pain syndrome and can be used in the management of this syndrome. Amitriptyline can be used in the treatment of nocturnal enuresis in children. However, its effect is not sustained after the treatment ends. Alarm therapy gives better short- and long-term results.
In the US, amitriptyline is commonly used in children with ADHD as an adjunct to stimulant medications without any evidence or guideline supporting this practice. Many physicians in the UK commonly prescribe amitriptyline for insomnia; however, Cochrane reviewers were not able to find any randomized controlled studies that would support or refute this practice.
Contraindications and precautions
The known contraindications of amitriptyline are:
Amitriptyline should be used with caution in patients with epilepsy, impaired liver function, pheochromocytoma, urinary retention, prostate enlargement, hyperthyroidism, and pyloric stenosis.
In patients with the rare condition of shallow anterior chamber of eyeball and narrow anterior chamber angle, amitriptyline may provoke attacks of acute glaucoma due to dilation of the pupil. It may aggravate psychosis, if used for depression with schizophrenia, or precipitate the switch to mania in those with bipolar disorder.
CYP2D6 poor metabolizers should avoid amitriptyline due to increased side effects. If it is necessary to use it, half dose is recommended. Amitriptyline can be used during pregnancy and lactation, in the cases when SSRI do not work.
The most frequent side effects, occurring in 20% or more of users, are dry mouth, drowsiness, dizziness, constipation, and weight gain (on average 1.8 kg). Other common side effects (in 10% or more) are vision problems (amblyopia, blurred vision), tachycardia, increased appetite, tremor, fatigue/asthenia/feeling slowed down, and dyspepsia.
A less common side effect of amitriptyline is urination problems (8.7%).
Amitriptyline-associated sexual dysfunction (occurring at a frequency of 6.9%) seems to be mostly confined to males with depression and is expressed predominantly as erectile dysfunction and low libido disorder, with lesser frequency of ejaculatory and orgasmic problems. The rate of sexual dysfunction in males treated for indications other that depression and in females is not significantly different from placebo.
Liver tests abnormalities occur in 10-12% of patients on amitriptyline, but are usually mild, asymptomatic and transient, with consistently elevated alanine transaminase in 3% of all patients. The increases of the enzymes above the 3-fold threshold of liver toxicity are uncommon, and cases of clinically apparent liver toxicity are rare; nevertheless, amitriptyline is placed in the group of antidepressants with greater risks of hepatic toxicity.
Amitriptyline prolongs the QT interval. This prolongation is relatively small at therapeutic doses but becomes severe in overdose.
Main article: Tricyclic antidepressant overdose
The symptoms and the treatment of an overdose are largely the same as for the other TCAs, including the presentation of serotonin syndrome and adverse cardiac effects. The British National Formulary notes that amitriptyline can be particularly dangerous in overdose, thus it and other TCAs are no longer recommended as first-line therapy for depression. The treatment of overdose is mostly supportive as no specific antidote for amitriptyline overdose is available. Activated charcoal may reduce absorption if given within 1–2 hours of ingestion. If the affected person is unconscious or has an impaired gag reflex, a nasogastric tube may be used to deliver the activated charcoal into the stomach. ECG monitoring for cardiac conduction abnormalities is essential and if one is found close monitoring of cardiac function is advised. Body temperature should be regulated with measures such as heating blankets if necessary. Cardiac monitoring is advised for at least five days after the overdose. Benzodiazepines are recommended to control seizures. Dialysis is of no use due to the high degree of protein binding with amitriptyline.
Since amitriptyline and its active metabolite nortriptyline are primarily metabolized by cytochromes CYP2D6 and CYP2C19 (see Amitriptyline#Pharmacology), the inhibitors of these enzymes are expected to exhibit pharmacokinetic interactions with amitriptyline. According to the prescribing information, the interaction with CYP2D6 inhibitors may increase the plasma level of amitriptyline. However, the results in the other literature are inconsistent: the co-administration of amitriptyline with a potent CYP2D6 inhibitor paroxetine does increase the plasma levels of amitriptyline two-fold and of the main active metabolite nortriptyline 1.5-fold, but combination with less potent CYP2D6 inhibitors thioridazine or levomepromazine does not affect the levels of amitriptyline and increases nortriptyline by about 1.5-fold; a moderate CYP2D6 inhibitor fluoxetine does not seem to have a significant effect on the levels of amitriptyline or nortriptyline. A case of clinically significant interaction with potent CYP2D6 inhibitor terbinafine has been reported.
A potent inhibitor of CYP2C19 and other cytochromes fluvoxamine increases the level of amitriptyline two-fold while slightly decreasing the level of nortriptyline. Similar changes occur with a moderate inhibitor of CYP2C19 and other cytochromes cimetidine: amitriptyline level increases by about 70%, while nortriptyline decreases by 50%.CYP3A4 inhibitor ketoconazole elevates amitriptyline level by about a quarter. On the other hand, cytochrome P450 inducers such as carbamazepine and St. John's Wort decrease the levels of both amitriptyline and nortriptyline
Oral contraceptives may increase the blood level of amitriptyline by as high as 90%. Valproate moderately increases the levels of amitriptyline and nortriptyline through an unclear mechanism.
The prescribing information warns that the combination of amitriptyline with monoamine oxidase inhibitors may cause potentially lethal serotonin syndrome; however, this has been disputed. The prescribing information cautions that some patients may experience a large increase in amitriptyline concentration in the presence of topiramate. However, other literature states that there is little or no interaction: in a pharmacokinetic study topiramate only increased the level of amitriptyline by 20% and nortriptyline by 33%.
Amitriptiline counteracts the antihypertensive action of guanethidine. When given with amitriptyline, other anticholinergic agents may result in hyperpyrexia or paralytic ileus. Co-administration of amitriptyline and disulfiram is not recommended due to the potential for the development of toxic delirium. Amitriptyline causes an unusual type of interaction with the anticoagulantphenprocoumon during which great fluctuations of the prothrombin time have been observed.
See also: Pharmacology of antidepressants and Tricyclic antidepressant § Binding profiles
|Values are Ki (nM), unless otherwise noted. The smaller the value, the more strongly the drug binds to the site.|
Amitriptyline inhibits serotonin transporter (SERT) and norepinephrine transporter (NET). It is metabolized to nortriptyline, a stronger norepinephrine reuptake inhibitor, further augmenting amitriptyline's effects on norepinephrine reuptake (see the Table on the right).
Amitriptyline additionally acts as a potent inhibitor of the serotonin5-HT2A, 5-HT2C, the α1A-adrenergic, the histamineH1 and the M1-M5muscarinic acetylcholine receptors (see the Table on the right).
Amitriptyline is a non-selective blocker of multiple ion channels, in particular, voltage-gated sodium channelsNav1.3, Nav1.5, Nav1.6, Nav1.7, and Nav1.8,voltage-gated potassium channelsKv7.2/ Kv7.3,Kv7.1, Kv7.1/KCNE1, and hERG.
Mechanism of action
Inhibition of serotonin and norepinephrine transporters by amitriptyline results in interference with neuronal reuptake of serotonin and norepinephrine. Since the reuptake process is important physiologically in terminating transmitting activity, this action may potentiate or prolong activity of serotonergic and adrenergic neurons and is believed to underlie the antidepressant activity of amitriptyline.
Inhibition of norepinephrine reuptake leading to increased concentration of norepinephrine in the posterior grey column of the spinal cord appears to be mostly responsible for the analgesic action of amitriptyline. Increased level of norepinephrine increases the basal activity of alpha-2 adrenergic receptors, which mediate an analgesic effect by increasing gamma-aminobutyric acid transmission among spinal interneurons. The blocking effect of amitriptyline on sodium channels may also contribute to its efficacy in pain conditions.
Amitriptyline is readily absorbed from the gastrointestinal tract (90-95%). Absorption is gradual with the peak concentration in blood plasma reached after about 4 hours. Extensive metabolism on the first pass through the liver leads to average bioavailability of about 50% (45%-53%). Amitriptyline is metabolized mostly by CYP2C19 into nortriptyline and by CYP2D6 leading to a variety of hydroxylated metabolites, with the principal one among them being (E)-10-hydroxynortriptyline (see metabolism scheme), and to a lesser degree, by CYP3A4.
Nortriptyline, the main active metabolite of amitriptyline, is an antidepressant on its own right. Nortriptyline reaches 10% higher level in the blood plasma than the parent drug amitriptyline and 40% greater area under the curve, and its action is an important part of the overall action of amitriptyline.
Another active metabolite is (E)-10-hydroxynortiptyline, which is a norepinephrine uptake inhibitor four times weaker than nortriptyline. (E)-10-hydroxynortiptyline blood level is comparable to that of nortriptyline, but its cerebrospinal fluid level, which is a close proxy of the brain concentration of a drug, is twice higher than notriptyline's. Based on this, (E)-10-hydroxynortiptyline was suggested to significantly contribute to antidepressant effects of amitriptyline.
Blood levels of amitriptyline and nortriptyline and pharmacokinetics of amitriptyline in general, with clearance difference of up to 10-fold, vary widely between individuals. Variability of the area under the curve in steady state is also high, which makes a slow upward titration of the dose necessary.
In the blood, amitriptyline is 96% bound to plasma proteins; nortriptyline is 93–95% bound, and (E)-10-hydroxynortiptyline is about 60% bound. Amitriptyline has an elimination half life of 21 hours, nortriptyline - 23–31 hours, and (E)-10-hydroxynortiptyline - 8–10 hours. Within 48 hours, 12-80% of amitriptyline is eliminated in the urine, mostly as metabolites. 2% of the unchanged drug is excreted in the urine. Elimination in the feces, apparently, have not been studied.
Therapeutic levels of amitriptyline range from 75 to 175 ng/mL (270–631 nM), or 80–250 ng/mL of both amitriptyline and its metabolite nortriptyline.
Since amitriptyline is primarily metabolized by CYP2D6 and CYP2C19, genetic variations within the genes coding for these enzymes can affect its metabolism, leading to changes in the concentrations of the drug in the body. Increased concentrations of amitriptyline may increase the risk for side effects, including anticholinergic and nervous system adverse effects, while decreased concentrations may reduce the drug's efficacy.
Individuals can be categorized into different types of CYP2D6 or CYP2C19 metabolizers depending on which genetic variations they carry. These metabolizer types include poor, intermediate, extensive, and ultrarapid metabolizers. Most individuals (about 77–92%) are extensive metabolizers, and have "normal" metabolism of amitriptyline. Poor and intermediate metabolizers have reduced metabolism of the drug as compared to extensive metabolizers; patients with these metabolizer types may have an increased probability of experiencing side effects. Ultrarapid metabolizers use amitriptyline much faster than extensive metabolizers; patients with this metabolizer type may have a greater chance of experiencing pharmacological failure.
The Clinical Pharmacogenetics Implementation Consortium recommends avoiding amitriptyline in patients who are CYP2D6 ultrarapid or poor metabolizers, due to the risk for a lack of efficacy and side effects, respectively. The consortium also recommends considering an alternative drug not metabolized by CYP2C19 in patients who are CYP2C19 ultrarapid metabolizers. A reduction in starting dose is recommended for patients who are CYP2D6 intermediate metabolizers and CYP2C19 poor metabolizers. If use of amitriptyline is warranted, therapeutic drug monitoring is recommended to guide dose adjustments. The Dutch Pharmacogenetics Working Group also recommends selecting an alternative drug or monitoring plasma concentrations of amitriptyline in patients who are CYP2D6 poor or ultrarapid metabolizers, and selecting an alternative drug or reducing initial dose in patients who are CYP2D6 intermediate metabolizers.
Amitriptyline is a highly lipophilic molecule having an octanol-water partition coefficient (pH 7.4) of 3.0, while the log P of the free base was reported as 4.92. Solubility of the free base amitriptyline in water is 14 mg/L. Amitriptyline is prepared by reacting benzosuberone with 3-(dimethylamino)propylmagnesium chloride and then heating the resulting intermediate product with hydrochloric acid to eliminate water.
Amitriptyline was first developed by the American pharmaceutical company Merck in the late 1950s. In 1958, Merck approached a number of clinical investigators proposing to conduct clinical trials of amitriptyline for schizophrenia. One of these researchers, Frank Ayd, instead, suggested using amitriptyline for depression. Ayd treated 130 patients and, in 1960, reported that amitriptyline had antidepressant properties similar to another, and the only known at the time, tricyclic antidepressant imipramine. Following this, the US Food and Drug Administration approved amitriptyline for depression in 1961.
In Europe, due to a quirk of the patent law at the time allowing patents only on the chemical synthesis but not on the drug itself, Roche and Lundbeck were able to independently develop and market amitriptyline in the early 1960s.
According to research by the historian of psychopharmacology David Healy, amitriptyline became a much bigger selling drug than its precursor imipramine because of two factors. First, amitriptyline has much stronger anxiolytic effect. Second, Merck conducted a marketing campaign raising clinicians' awareness of depression as a clinical entity.
Society and culture
English folk singer Nick Drake died from an overdose of Tryptizol in 1974.
Senteni Masango, wife of Swaziland King Mswati, died on April 5, 2019 after committing suicide by overdosing 40 amytriptyline capsules.
In the 2021 film The Many Saints of Newark, amitriptyline (referred to by the brand name Elavil) is part of the plot line of the movie.
Amitriptyline is the English and French generic name of the drug and its INN, BAN, and DCF, while amitriptyline hydrochloride is its USAN, USP, BANM, and JAN. Its generic name in Spanish and Italian and its DCIT are amitriptilina, in German is Amitriptylin, and in Latin is amitriptylinum. The embonate salt is known as amitriptyline embonate, which is its BANM, or as amitriptyline pamoate unofficially.
The few randomized controlled trials investigating amitriptyline efficacy in eating disorder have been discouraging.
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Drug class amitriptyline
pronounced as (a mee trip' ti leen)
A small number of children, teenagers, and young adults (up to 24 years of age) who took antidepressants ('mood elevators') such as amitriptyline during clinical studies became suicidal (thinking about harming or killing oneself or planning or trying to do so). Children, teenagers, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions. However, experts are not sure about how great this risk is and how much it should be considered in deciding whether a child or teenager should take an antidepressant. Children younger than 18 years of age should not normally take amitriptyline, but in some cases, a doctor may decide that amitriptyline is the best medication to treat a child's condition.
You should know that your mental health may change in unexpected ways when you take amitriptyline or other antidepressants even if you are an adult over age 24. You may become suicidal, especially at the beginning of your treatment and any time that your dose is increased or decreased. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor when you are unable to seek treatment on your own.
Your healthcare provider will want to see you often while you are taking amitriptyline, especially at the beginning of your treatment. Be sure to keep all appointments for office visits with your doctor.
The doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with amitriptyline. Read the information carefully and ask your doctor or pharmacist if you have any questions. You also can obtain the Medication Guide from the FDA website: http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm.
No matter your age, before you take an antidepressant, you, your parent, or your caregiver should talk to your doctor about the risks and benefits of treating your condition with an antidepressant or with other treatments. You should also talk about the risks and benefits of not treating your condition. You should know that having depression or another mental illness greatly increases the risk that you will become suicidal. This risk is higher if you or anyone in your family has or has ever had bipolar disorder (mood that changes from depressed to abnormally excited) or mania (frenzied, abnormally excited mood) or has thought about or attempted suicide. Talk to your doctor about your condition, symptoms, and personal and family medical history. You and your doctor will decide what type of treatment is right for you.
Amitriptyline is used to treat symptoms of depression. Amitriptyline is in a class of medications called tricyclic antidepressants. It works by increasing the amounts of certain natural substances in the brain that are needed to maintain mental balance.
Amitriptyline comes as a tablet to take by mouth. It is usually taken one to four times a day. Take amitriptyline at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take amitriptyline exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Your doctor will probably start you on a low dose of amitriptyline and gradually increase your dose.
It may take a few weeks or longer before you feel the full benefit of amitriptyline. Continue to take amitriptyline even if you feel well. Do not stop taking amitriptyline without talking to your doctor. If you suddenly stop taking amitriptyline, you may experience withdrawal symptoms such as nausea, headache, and lack of energy. Your doctor will probably decrease your dose gradually.
Amitriptyline is also used to treat eating disorders, post-herpetic neuralgia (the burning, stabbing pains, or aches that may last for months or years after a shingles infection), and to prevent migraine headaches. Talk to your doctor about the possible risks of using this medication for your condition.
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
Before taking amitriptyline,
- tell your doctor and pharmacist if you are allergic to amitriptyline or any other medications.
- tell your doctor if you are taking cisapride (Propulsid) (not available in the U.S.) or monoamine oxidase (MAO) inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate), or if you have taken an MAO inhibitor during the past 14 days. Your doctor will probably tell you that you should not take amitriptyline.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: antihistamines; cimetidine (Tagamet); diet pills; disulfiram (Antabuse); guanethidine (Ismelin); ipratropium (Atrovent); quinidine (Quinidex); medications for irregular heartbeats such as flecainide (Tambocor) and propafenone (Rythmol); medications for anxiety, asthma, colds, irritable bowel disease, mental illness, nausea, Parkinson's disease, seizures, ulcers, or urinary problems; other antidepressants; phenobarbital (Bellatal, Solfoton); sedatives; selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft); sleeping pills; thyroid medications; and tranquilizers. Tell your doctor or pharmacist if you have stopped taking fluoxetine (Prozac, Sarafem) in the past 5 weeks.Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have recently had a heart attack. Your doctor will probably tell you not to take amitriptyline.
- tell your doctor if you drink large amounts of alcohol and if you have or have ever had glaucoma (an eye condition); an enlarged prostate (a male reproductive gland); difficulty urinating; seizures; an overactive thyroid gland (hyperthyroidism); diabetes; schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions); or liver, kidney, or heart disease.
- tell your doctor if you are pregnant or plan to become pregnant. If you become pregnant while taking amitriptyline, call your doctor. Do not breast-feed while you are taking amitriptyline.
- talk to your doctor about the risks and benefits of taking this medication if you are 65 years of age or older. Older adults should not usually take amitriptyline because it is not as safe or effective as other medication(s) that can be used to treat the same condition.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking amitriptyline.
- you should know that amitriptyline may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
- remember that alcohol can add to the drowsiness caused by this medication.
Unless your doctor tells you otherwise, continue your normal diet.
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.
It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.
Symptoms of overdose may include:
- irregular heartbeat
- coma (loss of consciousness for a period of time)
- problems concentrating
- hallucinating (seeing things or hearing voices that do not exist)
- rigid muscles
- cold body temperature
Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to amitriptyline.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
- Duo-Vil® (containing Amitriptyline, Perphenazine)¶
- Etrafon® (containing Amitriptyline, Perphenazine)¶
- Limbitrol® (containing Amitriptyline, Chlordiazepoxide)¶
- Triavil® (containing Amitriptyline, Perphenazine)¶
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