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Amitriptyline: Uses, Dosage, and Side Effects Overview
Summary of Key Points
Amitriptyline is a prescription medication commonly used to treat conditions such as depression, anxiety, chronic pain, and migraines. It belongs to a class of drugs known as tricyclic antidepressants (TCAs) and works by affecting certain chemicals in the brain to improve mood and alleviate pain. Always consult a healthcare provider before starting or adjusting your dosage. Our telemedicine providers are available to assist with managing your treatment plan.
Names of Medication
US Brand Name: Elavil
Generic Name: Amitriptyline
The generic name refers to the active ingredient, while the brand name is assigned by the manufacturer. In this article, the generic name is listed in parentheses.
Pharmacologic Category
Tricyclic Antidepressants (TCAs)
Other medications in this category include nortriptyline, imipramine, and doxepin.
Amitriptyline Dosage
Amitriptyline is used to treat a variety of conditions, with the dosage and duration of treatment depending on the specific condition being addressed. Always consult your healthcare provider before making any changes to your dosage. You can also schedule a telemedicine appointment with one of our providers to discuss your treatment plan.
Amitriptyline for Depression
Initial Dose: 25-50 mg once daily at bedtime.
Maintenance Dose: Gradually increase to 100-300 mg per day, depending on your response to the medication.
Duration: Long-term use may be necessary for managing chronic depression. Consult your doctor for personalized guidance.
Amitriptyline for Anxiety Disorders
Initial Dose: 10-25 mg once daily at bedtime.
Maintenance Dose: Gradually increase to 75-150 mg per day.
Duration: The length of treatment varies based on individual needs. Consult your healthcare provider for advice.
Amitriptyline for Chronic Pain
Initial Dose: 10-25 mg once daily at bedtime.
Maintenance Dose: Gradually increase to 50-100 mg per day.
Duration: Long-term treatment may be required for effective chronic pain management.
Amitriptyline for Fibromyalgia
Initial Dose: 10-25 mg once daily at bedtime.
Maintenance Dose: Gradually increase to 50-100 mg per day.
Duration: The duration of treatment depends on how well symptoms are controlled. Consult your doctor for recommendations.
Amitriptyline for Migraine Prevention
Initial Dose: 10-25 mg once daily at bedtime.
Maintenance Dose: Gradually increase to 50-100 mg per day.
Duration: Long-term use may be necessary to prevent migraines. Discuss your options with your healthcare provider.
Amitriptyline 10mg for Sleep (Insomnia)
Initial Dose: 10-25 mg once daily at bedtime.
Maintenance Dose: Gradually increase to 50 mg per day.
Duration: Short-term use is typical, but consult your doctor if long-term management is needed.
Amitriptyline for Neuropathic Pain
Initial Dose: 10-25 mg once daily at bedtime.
Maintenance Dose: Gradually increase to 50-100 mg per day.
Duration: Long-term treatment may be required for managing chronic neuropathic pain.
Amitriptyline for Irritable Bowel Syndrome (IBS)
Initial Dose: 10-25 mg once daily at bedtime.
Maintenance Dose: Gradually increase to 50 mg per day.
Duration: The duration of treatment depends on symptom control. Consult your doctor for further advice.
Amitriptyline for Post-Traumatic Stress Disorder (PTSD)
Initial Dose: 10-25 mg once daily at bedtime.
Maintenance Dose: Gradually increase to 50-150 mg per day.
Duration: Long-term treatment may be necessary. Consult your healthcare provider for a tailored plan.
Amitriptyline for Tension-Type Headaches
Initial Dose: 10-25 mg once daily at bedtime.
Maintenance Dose: Gradually increase to 50-100 mg per day.
Duration: Long-term use may be required to prevent tension-type headaches.
Dosage Forms and Strengths
Tablet: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg
Injection (for hospital use): 10 mg/mL
Administration Instructions
Amitriptyline is typically taken once daily, preferably at bedtime, as it can cause drowsiness. It can be taken with or without food. Swallow the tablet whole with water—do not crush or chew it. If you miss a dose, take it as soon as you remember unless it’s close to your next scheduled dose. In that case, skip the missed dose and continue with your regular schedule. Do not take two doses at once.
Amitriptyline Side Effects and Adverse Reactions
Like all medications, amitriptyline can cause side effects. Some are more common, while others are rare but potentially serious. If you experience any side effects, contact your healthcare provider. You can also schedule a telemedicine visit with one of our providers to discuss your symptoms.
Common Amitriptyline Side Effects
Drowsiness: Feeling unusually sleepy or fatigued, especially when first starting the medication.
Dry mouth: A frequent side effect where your mouth may feel unusually dry.
Constipation: Difficulty with bowel movements, which can often be managed with dietary changes or over-the-counter remedies.
Weight gain: Some patients may notice an increase in weight over time.
Less Common but Serious Side Effects
Irregular heartbeat: If you experience a fast or irregular pulse, seek medical attention immediately.
Seizures: Though rare, seizures can occur. Contact your doctor if you experience any seizure activity.
Severe allergic reactions: Symptoms may include rash, itching, swelling, or difficulty breathing. Seek emergency care if these occur.
Contraindications for Amitriptyline
A contraindication is a specific condition or situation in which a particular medication should not be used because it may cause harm. If you have any of the following conditions, inform your healthcare provider before starting amitriptyline.
Recent Heart Attack (Myocardial Infarction): Amitriptyline can affect heart rhythm and may worsen heart conditions, particularly in those who have recently experienced a heart attack.
Heart Rhythm Disorders (Arrhythmias): Amitriptyline can cause or exacerbate irregular heartbeats, which can be dangerous for individuals with pre-existing heart rhythm issues.
Severe Liver Disease: Since the liver processes amitriptyline, impaired liver function can lead to the medication accumulating in the body, potentially causing harmful effects.
Allergy to Amitriptyline: If you have had an allergic reaction to amitriptyline or similar medications, you should avoid taking it again, as it could trigger a serious allergic response.
Use of Monoamine Oxidase Inhibitors (MAOIs): Combining amitriptyline with MAOIs (another class of antidepressants) can lead to dangerous interactions, including a life-threatening condition called serotonin syndrome. You should wait at least 14 days after stopping an MAOI before starting amitriptyline.
Glaucoma: Amitriptyline can increase pressure in the eyes, which may worsen certain types of glaucoma.
Urinary Retention: Amitriptyline can make it difficult to urinate, which can be problematic for individuals with conditions such as an enlarged prostate or bladder issues.
Drug to Drug Interactions
Amitriptyline can interact with other medications, potentially increasing the risk of side effects or reducing the effectiveness of either drug. It’s important to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements. Some key drug interactions include:
Monoamine Oxidase Inhibitors (MAOIs) (e.g., phenelzine [Nardil], tranylcypromine [Parnate]): Combining MAOIs with amitriptyline can lead to dangerously high serotonin levels, which may result in serotonin syndrome, a potentially life-threatening condition.
Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., fluoxetine [Prozac], sertraline [Zoloft]): Taking SSRIs alongside amitriptyline also increases the risk of serotonin syndrome.
Anticholinergic Drugs (e.g., diphenhydramine [Benadryl]): Amitriptyline has anticholinergic properties, and combining it with other anticholinergic medications can intensify side effects such as dry mouth, constipation, and confusion.
Blood Thinners (e.g., warfarin [Coumadin]): Amitriptyline may enhance the effects of blood thinners, which could increase the risk of bleeding.
Alcohol: Drinking alcohol while taking amitriptyline can amplify side effects like drowsiness and dizziness, and may increase the risk of overdose.
Anti-seizure Medications (e.g., phenytoin [Dilantin]): Amitriptyline may reduce the effectiveness of anti-seizure medications, potentially raising the risk of seizures.
Amitriptyline in Pregnancy
Is it safe to take amitriptyline during pregnancy?
Amitriptyline is classified as a Category C drug by the FDA for use during pregnancy. This means there is not enough well-controlled research in humans to determine its safety. While animal studies have shown some risk to the fetus, the potential benefits may outweigh the risks in certain situations. If you are pregnant or planning to become pregnant, it’s essential to discuss the risks and benefits of taking amitriptyline with your healthcare provider. They can help you decide whether this medication is appropriate during pregnancy.
Amitriptyline while Breastfeeding
Is it safe to take amitriptyline while breastfeeding?
Amitriptyline passes into breast milk in small amounts. While the risk to a breastfeeding infant is generally considered low, side effects such as drowsiness or irritability in the baby are possible. It’s important to discuss the risks and benefits of continuing amitriptyline while breastfeeding with your healthcare provider. They may recommend monitoring your baby for any unusual symptoms or suggest alternative treatments if necessary.
Estimated Cost of Amitriptyline Medication
The cost of a 30-day supply of amitriptyline without insurance can vary depending on the dosage and the pharmacy. Using a GoodRx coupon, the estimated cost for a 30-day supply of amitriptyline (25 mg) typically ranges from $5 to $15. Prices may fluctuate, so it’s a good idea to check with your local pharmacy or use a discount service like GoodRx to find the best price available.
Possible Alternatives to Amitriptyline
If amitriptyline is not suitable for you, there are alternative treatments and lifestyle changes that may help manage your condition. Always consult with your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to discuss these options further.
Depression: Alternatives include other antidepressants such as SSRIs (e.g., sertraline [Zoloft], escitalopram [Lexapro]) or serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor). Psychotherapy and lifestyle changes, such as regular exercise and mindfulness practices, can also be beneficial.
Anxiety Disorders: SSRIs, SNRIs, and benzodiazepines (e.g., lorazepam [Ativan]) are common alternatives. Cognitive-behavioral therapy (CBT) and relaxation techniques may also help manage symptoms.
Chronic Pain: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) or naproxen (Aleve), physical therapy, and acupuncture are potential alternatives for managing chronic pain.
Fibromyalgia: SNRIs (e.g., duloxetine [Cymbalta]) and anticonvulsants like pregabalin (Lyrica) are often used to treat fibromyalgia. Gentle exercise and stress management techniques can also provide relief.
Migraine Prevention: Beta-blockers (e.g., propranolol [Inderal]), anticonvulsants (e.g., topiramate [Topamax]), and lifestyle changes such as avoiding known triggers and maintaining a regular sleep schedule are common alternatives for preventing migraines.
Insomnia: Cognitive-behavioral therapy for insomnia (CBT-I), melatonin supplements, and practicing good sleep hygiene can be effective alternatives for managing insomnia.
Neuropathic Pain: Alternatives include anticonvulsants like gabapentin (Neurontin) and topical treatments such as lidocaine patches.
Irritable Bowel Syndrome (IBS): Dietary changes, probiotics, and medications like hyoscyamine (Levsin) or linaclotide (Linzess) may help manage IBS symptoms.
Post-Traumatic Stress Disorder (PTSD): SSRIs (e.g., sertraline [Zoloft]) and trauma-focused psychotherapy are common treatments for PTSD.
Tension-Type Headaches: Over-the-counter pain relievers like acetaminophen (Tylenol) or NSAIDs, along with stress management techniques, can be effective for tension-type headaches.
Recent Updates on Amitriptyline Research
Recent studies have explored the use of amitriptyline in treating conditions beyond its traditional uses, such as chronic pain and migraines. Research indicates that low doses of amitriptyline can effectively manage neuropathic pain and fibromyalgia, even in patients who do not have depression. Additionally, ongoing studies are investigating the potential benefits of amitriptyline in treating irritable bowel syndrome (IBS) and other gastrointestinal disorders, as it appears to have a calming effect on the gut.
New research is also focusing on the long-term safety of amitriptyline, particularly in older adults, as the medication can increase the risk of falls and cognitive impairment in this population. If you are concerned about the risks of long-term use, it’s important to discuss them with your healthcare provider, who can help you weigh the benefits and risks specific to your situation.
