Table of ContentsView AllTable of ContentsUsesBefore TakingWarnings and InteractionsDosageSide Effects

Table of ContentsView All

View All

Table of Contents

Uses

Before Taking

Warnings and Interactions

Dosage

Side Effects

If your healthcare provider has prescribed amitriptyline, it’s important to know about possible drug interactions.

Amitriptylineis a prescription oral antidepressant medication that is also sometimes used off-label (for a different purpose outside of its FDA approval) for treating a variety of conditions including anxiety, obsessive-compulsive disorder, and prevention ofneuropathic pain.

This article looks at amitriptyline and why it may be prescribed. It also discusses precautions, dosage, warnings, and side effects.

What Is Amitriptyline Used For?

This medication is meant to be taken every day for the prevention of depressive symptoms. People usually have to take it for four to six weeks before seeing improvement.

Symptoms of depression can include:

Amitriptyline for Anxiety

Amitriptyline isn’t usually a first-line treatment for anxiety. Your healthcare provider will probably want to try other medications before prescribing amitriptyline.

What Is Severe Anxiety?

Other Off-Label Uses

Amitriptyline is commonly prescribed off-label for several other uses, such as chronic conditions that require consistent, long-term management andpalliative care.

Conditions that are often treated with amitriptyline include:

As with the treatment of depression, amitriptyline is not expected to alleviate any of these conditions immediately when it is used off label. It may take weeks for symptoms to begin to improve.

What to Know Before Taking Amitriptyline

Amitriptyline drug interactions, as well as certain medical conditions, need to be taken into account when considering treatment with this drug.

Precautions and Contraindications

Amitriptyline can cause sleepiness. As you are adjusting to the medication, it’s important that you avoid driving or using dangerous equipment until you can assess the effect it is having on you during the day.

Amitriptyline is not FDA-approved for children under age 12. It also may increase suicide ideation and suicidality of people up to age 24. People of all ages who start antidepressant medication should be monitored for suicidality and unusual changes in behavior.

Amitriptyline should not be used if you:

Your healthcare provider will weigh the pros and cons of this medication before prescribing it to you if you:

Other Tricyclic Antidepressants

Due to its molecular structure, amitriptyline is described as a tricyclic antidepressant.

Some other tricyclic antidepressants include:

Other Antidepressants

Other antidepressant classes include monoamine oxidase inhibitors (MAOIs), such as selegiline and rasagiline, and selective serotonin reuptake inhibitors (SSRIs), such as sertraline, fluoxetine, and paroxetine.

In general, it is not always safe to combine different classes of antidepressants, but your healthcare provider may prescribe more than one antidepressant for you under exceptional circumstances.

Withdrawal from this drug can cause nausea, headaches, irritability, and sleep disturbances. Rarely, mania can occur after abruptly stopping this medication.If you are going to stop taking amitriptyline, it’s important that you discuss a tapering schedule with your healthcare provider.

Amitriptyline can interact with a number of prescription medications. This medication is especially dangerous when combined with other antidepressants, such as other tricyclic antidepressants or MAOIs. If you are replacing one antidepressant with another, your healthcare provider will give you detailed instructions regarding decreasing or stopping the medication you are already taking before you start the other.

Some common medications that interact with amitriptyline include medications that increase serotonin:

Opioid-based medications should also be avoided, such as:

Dangerous interactions can occur with sedatives and muscle relaxants, such as:

Other common medications that interact with amitriptyline include:

Alcohol and antihistamines like Benadryl have a depressant effect and shouldn’t be consumed when taking amitriptyline. Combining the two may make side effects more severe.

When you are taking amitriptyline, it’s also important that you tell your healthcare provider and pharmacist about any other medications you are taking to prevent interactions between medications.

Amitriptyline comes in tablet form and is available in doses of 10 milligrams (mg), 25 mg, 50 mg, 75 mg, 100 mg, and 150 mg.For treatment of depression, the medication is usually started at a dose between 50 mg and 100 mg per day.

The standard maintenance dose of amitriptyline for the treatment of depression is 75 mg per day, either once at bedtime, or divided into two doses per day.

Modifications

According to the package label, hospitalized patients may require 100 mg a day initially. This can be increased gradually to 200 mg or 300 mg per day if necessary.

Older adults should start at a lower dose of approximately 30 mg per day, with a target dose of 60 mg per day.

If you have liver disease, your healthcare provider may prescribe a lower dose of amitriptyline for you.

Off-Label Dose

When used off-label, amitriptyline is started at a lower dose than when it is used as an antidepressant—typically at a dose of 10 mg or 20 mg per day. If needed, this dose can be slowly increased under the guidance of your healthcare provider.

The amitriptyline dosage for anxiety may also be modified in light of amitriptyline drug interactions.

Sometimes amitriptyline is used when you have depression and pain. In these situations, the dosing would follow the recommendations for treatment of depression, rather than treatment of pain.

Can Depression Make You Physically Sick?

How to Take and Store

Amitriptyline should be stored in the original container at 68 to 77 degrees. If necessary, you can place your medication in a pillbox to help you manage your medication schedule.

Amitriptyline can cause side effects when it is used for the treatment of depression or for an off-label indication. Sometimes the side effects are temporary and may resolve after a few weeks, but you might continue to have side effects even after months of using it. Rarely, side effects emerge after months or even years of using this drug without side effects.

Some side effects are dose-related and might improve if your healthcare provider reduces your dose.

Common

Common side effects of amitriptyline include:

Using amitriptyline at night may alleviate sleepiness, but some people continue to feel drowsy during the day, even after a full night’s sleep.

Severe

Amitriptyline may cause severe adverse effects. If you experience serious side effects, your healthcare provider will likely give you instructions to discontinue taking amitriptyline.

Severe side effects of amitriptyline include:

Black Box WarningAll people being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy.

Black Box Warning

All people being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy.

Rare Side Effects

Amitriptyline has also been associated with severe side effects that occur very infrequently.

Rare side effects include:

How to Take Amitriptyline for Pain

Summary

Amitriptyline can cause drug interactions and side effects, some of them severe. Make sure you tell your healthcare provider about any other medications you are taking and keep them informed if you experience side effects like suicidal thoughts, seizures, or sleep disturbances.

9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Dean L.Amitriptyline therapy andCYP2D6andCYP2C19genotype. In: Pratt VM, McLeod HL, Rubinstein WS, et al., eds.Medical Genetics Summaries. Bethesda (MD): National Center for Biotechnology Information (US); 2017.World Health Organization.Model list of essential medicines: 21st list.Food and Drug Administration.FDA-Approved Drugs.Federal Register. The Daily Journal of the United States Government.Determination that ELAVIL (amitriptyline hydrochloride) oral tablets, 10, 25, 50, 75, 100, and 150 milligrams, were not withdrawn from sale for reasons of safety or effectiveness. October 23, 2017.DailyMed.Amitriptyline hydrochloride tablet, film coated.Antidepressant agents. In:LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2018.Food and Drug Administration.Amitriptyline label.Arthritis Foundation.Amitriptyline hydrochloride.Tse L, Barr AM, Scarapicchia V, Vila-rodriguez F.Neuroleptic malignant syndrome: a review from a clinically oriented perspective.Curr Neuropharmacol. 2015;13(3):395-406.doi:10.2174/1570159X13999150424113345Additional ReadingFood and Drug Administration.Amitriptyline label.

9 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Dean L.Amitriptyline therapy andCYP2D6andCYP2C19genotype. In: Pratt VM, McLeod HL, Rubinstein WS, et al., eds.Medical Genetics Summaries. Bethesda (MD): National Center for Biotechnology Information (US); 2017.World Health Organization.Model list of essential medicines: 21st list.Food and Drug Administration.FDA-Approved Drugs.Federal Register. The Daily Journal of the United States Government.Determination that ELAVIL (amitriptyline hydrochloride) oral tablets, 10, 25, 50, 75, 100, and 150 milligrams, were not withdrawn from sale for reasons of safety or effectiveness. October 23, 2017.DailyMed.Amitriptyline hydrochloride tablet, film coated.Antidepressant agents. In:LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2018.Food and Drug Administration.Amitriptyline label.Arthritis Foundation.Amitriptyline hydrochloride.Tse L, Barr AM, Scarapicchia V, Vila-rodriguez F.Neuroleptic malignant syndrome: a review from a clinically oriented perspective.Curr Neuropharmacol. 2015;13(3):395-406.doi:10.2174/1570159X13999150424113345Additional ReadingFood and Drug Administration.Amitriptyline label.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Dean L.Amitriptyline therapy andCYP2D6andCYP2C19genotype. In: Pratt VM, McLeod HL, Rubinstein WS, et al., eds.Medical Genetics Summaries. Bethesda (MD): National Center for Biotechnology Information (US); 2017.World Health Organization.Model list of essential medicines: 21st list.Food and Drug Administration.FDA-Approved Drugs.Federal Register. The Daily Journal of the United States Government.Determination that ELAVIL (amitriptyline hydrochloride) oral tablets, 10, 25, 50, 75, 100, and 150 milligrams, were not withdrawn from sale for reasons of safety or effectiveness. October 23, 2017.DailyMed.Amitriptyline hydrochloride tablet, film coated.Antidepressant agents. In:LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2018.Food and Drug Administration.Amitriptyline label.Arthritis Foundation.Amitriptyline hydrochloride.Tse L, Barr AM, Scarapicchia V, Vila-rodriguez F.Neuroleptic malignant syndrome: a review from a clinically oriented perspective.Curr Neuropharmacol. 2015;13(3):395-406.doi:10.2174/1570159X13999150424113345

Dean L.Amitriptyline therapy andCYP2D6andCYP2C19genotype. In: Pratt VM, McLeod HL, Rubinstein WS, et al., eds.Medical Genetics Summaries. Bethesda (MD): National Center for Biotechnology Information (US); 2017.

World Health Organization.Model list of essential medicines: 21st list.

Food and Drug Administration.FDA-Approved Drugs.

Federal Register. The Daily Journal of the United States Government.Determination that ELAVIL (amitriptyline hydrochloride) oral tablets, 10, 25, 50, 75, 100, and 150 milligrams, were not withdrawn from sale for reasons of safety or effectiveness. October 23, 2017.

DailyMed.Amitriptyline hydrochloride tablet, film coated.

Antidepressant agents. In:LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2018.

Food and Drug Administration.Amitriptyline label.

Arthritis Foundation.Amitriptyline hydrochloride.

Tse L, Barr AM, Scarapicchia V, Vila-rodriguez F.Neuroleptic malignant syndrome: a review from a clinically oriented perspective.Curr Neuropharmacol. 2015;13(3):395-406.doi:10.2174/1570159X13999150424113345

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