Table of ContentsView AllTable of ContentsUsesDosageContraindicationsHow to Take and StoreSide EffectsOverdoseFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Uses
Dosage
Contraindications
How to Take and Store
Side Effects
Overdose
Frequently Asked Questions
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What is Amitriptyline Used For?
Antidepressants are effective at treating pain because of their impact onneurotransmitters(chemical messengers in the brain and nervous system). They’re believed to change the activity of the neurotransmittersserotoninandnorepinephrine, which are involved in pain processing. Antidepressants may be prescribed alone or alongside traditional painkillers.
Chronic Back or Neck Pain
Healthcare products may opt to prescribe amitriptyline for other causes of pain, as well, including chronic back andneck paindue to disease or injury. Antidepressants like amitriptyline are not typically the first medications healthcare providers prescribe for these types of pain, but they’re often used when other treatments haven’t been successful.
While a fair amount of research supports the use of amitriptyline and other tricyclic antidepressants for neuropathic pain and migraine, evidence thus far is lacking when it comes to chronic neck or back pain.
A review of studies published in 2021 found that tricyclics in general haven’t been shown to alleviate back pain. However, the reviewers considered the evidence of generally low quality, so much work remains to be done on this topic.
Other Off-Label Uses
Additional off-label uses of amitriptyline include:
The appropriate dosages of amitriptyline for treating chronic back or neck pain haven’t been determined, but healthcare providers can use those that have been established for pain conditions as a guideline. As a general rule, the dosage for pain is lower than it is for depression.
Elavil Dosage Guide
Amitriptyline treatment is typically titrated, meaning that you start with a smaller dose and gradually increase the dose until the desired effect is achieved, which can help avoid significantside effects.
When used for the treatment of neuropathic pain, many healthcare providers will start at a dose of 25 milligrams (mg) and gradually increase the amount over the course of several weeks or months. People who are smaller or frail may be started at 10 mg.
Can Suboxone (Buprenorphine-Naloxone) Help Treat Pain?
Warnings and Contraindications
Older adults may have a strong response to amitriptyline and, therefore, need smaller doses. Amitriptyline is often avoided in people over age 60 because the drug may increase their risk ofcardiac arrhythmia(abnormal heart rhythm).
Amitriptyline is also contraindicated for use in people with a known allergy to the drug or any inactive ingredient in it. It should also never be used in people who takemonoamine oxidase inhibitors (MAOIs)for depression.
All antidepressants carry aboxed warningadvising consumers of the risk of suicidal thoughts in children, adolescents, and young adults who take the drug. For this reason, they’re only used to treat pain in younger people if the benefits are believed to outweigh the risks. However, studies show amitriptyline may be one of the least likely antidepressants to cause this side effect.
Amitriptyline comes in tablet form. The drug is generally taken at night to avoid dizziness, drowsiness, and other central nervous system side effects.
The pill should be swallowed whole. Do not break, split, crush, or chew the tablet as it can affect its absorption of the drug in the gut. There are no food restrictions; amitriptyline can be taken with or without food.
If you miss a dose, take it as soon as you remember. If it is near the time of your next dose, simply skip the original dose and continue as normal. Do not double the dose to catch up.
Amitriptyline can be stored safely at room temperature.Keep the tablets in their original light-resistant container, and avoid storing them on a sunny windowsill, bathroom, or in your glove compartment. Discard any medications that have expired.
Physical Therapy for the Treatment of Chronic Pain
Amitriptyline Side Effects
You should not stop taking amitriptyline without talking to your healthcare provider first. Because the drug builds up in your system, the sudden discontinuation can lead to withdrawal symptoms, sometimes severe. These include:
To avoid withdrawal, your healthcare provider may gradually taper the drug over the course of weeks or months, depending on the dose and how long you’ve been taking amitriptyline.
A Deep Dive Into Fibromyalgia Pain
As with any medication, the risk of an amitriptyline overdose is real. One of the best ways to avoid an overdose is to recognize the signs.
Symptoms of amitriptyline overdose include:
If you think you or someone you know has overdosed on amitryptiline, contact Poison Control immediately at 1-800-222-1222.
How should I increase my Elavil dosage?
What should I know about Elavil and suicide?
Elavil, and all antidepressants, may increase the risk of suicidal thoughts and behaviors. While this risk appears to be highest in people under age 24, it may impact the mental health of anyone who takes it. The risk is greatest when you first start the drug, whenever you increase your Elavil dosage, and whenever you reduce your dosage.
If you are having suicidal thoughts, dial988to contact the988 Suicide & Crisis Lifelineand connect with a trained counselor. If you or a loved one are in immediate danger, call911.
What is the average dosage range for Elavil?
For depression, the average Elavil dosage range is 50 mg to 100 mg per day. For most pain conditions, it’s 25 mg to 100 mg or 125 mg a day, while for fibromyalgia it’s lower—10 mg to 50 mg a day. The maximum dosage is considered 150 mg daily.
A Word From Verywell
13 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.Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ.Amitriptyline for neuropathic pain in adults.Cochrane Database System Rev.2015;7:CD008242. doi:10.1002/14651858.CD008242.pub3Prescribers' Digital Reference.Amitriptyline hydrochloride - Drug summary.National Institute of Diabetes and Digestive and Kidney Diseases.Diabetic neuropathy.Centers for Disease Control and Prevention.Shingles symptoms and complications.MedlinePlus.Migraine.MedlinePlus.Fibromyalgia.Harvard Medical School, Harvard Health Publishing.Are antidepressants also pain relievers?Ferreira GE, McLachlan AJ, Lin CC, et al.Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: Systematic review and meta-analysis.BMJ. 2021;372:m4825. doi:10.1136/bmj.m4825Strauss LD, Weizenbaum E, Loder EW, Rizzoli PB.Amitriptyline dose and treatment outcomes in specialty headache practice: A retrospective cohort study.Headache. 2016 Nov;56(10):1626-34. doi:10.1111/head.12987Sandoz Pharmaceutical.Package insert - amitriptyline.Coupland C, Hill T, Morriss R, Arthur A, Moore M, Hippisley-Cox J.Antidepressant use and risk of suicide and attempted suicide or self harm in people aged 20 to 64: Cohort study using a primary care database.BMJ. 2015;350:h517. doi:10.1136/bmj.h517MedlinePlus.Amitriptyline.Güloglu C, Orak M, Ustündag M, Altunci YA.Analysis of amitriptyline overdose in emergency medicine.Emerg Med J. 2011;28(4):296-9. doi:10.1136/emj.2009.076596Additional ReadingMaarrawi J, Abdel Hay J, Kobaiter-Maarrawi S, Tabet P, Peyron R, Garcia-Larrea L.Randomized double-blind controlled study of bedtime low-dose amitriptyline in chronic neck pain.Eur J Pain. 2018;22(6):1180-7. doi:10.1002/ejp.1206
13 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.Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ.Amitriptyline for neuropathic pain in adults.Cochrane Database System Rev.2015;7:CD008242. doi:10.1002/14651858.CD008242.pub3Prescribers' Digital Reference.Amitriptyline hydrochloride - Drug summary.National Institute of Diabetes and Digestive and Kidney Diseases.Diabetic neuropathy.Centers for Disease Control and Prevention.Shingles symptoms and complications.MedlinePlus.Migraine.MedlinePlus.Fibromyalgia.Harvard Medical School, Harvard Health Publishing.Are antidepressants also pain relievers?Ferreira GE, McLachlan AJ, Lin CC, et al.Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: Systematic review and meta-analysis.BMJ. 2021;372:m4825. doi:10.1136/bmj.m4825Strauss LD, Weizenbaum E, Loder EW, Rizzoli PB.Amitriptyline dose and treatment outcomes in specialty headache practice: A retrospective cohort study.Headache. 2016 Nov;56(10):1626-34. doi:10.1111/head.12987Sandoz Pharmaceutical.Package insert - amitriptyline.Coupland C, Hill T, Morriss R, Arthur A, Moore M, Hippisley-Cox J.Antidepressant use and risk of suicide and attempted suicide or self harm in people aged 20 to 64: Cohort study using a primary care database.BMJ. 2015;350:h517. doi:10.1136/bmj.h517MedlinePlus.Amitriptyline.Güloglu C, Orak M, Ustündag M, Altunci YA.Analysis of amitriptyline overdose in emergency medicine.Emerg Med J. 2011;28(4):296-9. doi:10.1136/emj.2009.076596Additional ReadingMaarrawi J, Abdel Hay J, Kobaiter-Maarrawi S, Tabet P, Peyron R, Garcia-Larrea L.Randomized double-blind controlled study of bedtime low-dose amitriptyline in chronic neck pain.Eur J Pain. 2018;22(6):1180-7. doi:10.1002/ejp.1206
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.
Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ.Amitriptyline for neuropathic pain in adults.Cochrane Database System Rev.2015;7:CD008242. doi:10.1002/14651858.CD008242.pub3Prescribers' Digital Reference.Amitriptyline hydrochloride - Drug summary.National Institute of Diabetes and Digestive and Kidney Diseases.Diabetic neuropathy.Centers for Disease Control and Prevention.Shingles symptoms and complications.MedlinePlus.Migraine.MedlinePlus.Fibromyalgia.Harvard Medical School, Harvard Health Publishing.Are antidepressants also pain relievers?Ferreira GE, McLachlan AJ, Lin CC, et al.Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: Systematic review and meta-analysis.BMJ. 2021;372:m4825. doi:10.1136/bmj.m4825Strauss LD, Weizenbaum E, Loder EW, Rizzoli PB.Amitriptyline dose and treatment outcomes in specialty headache practice: A retrospective cohort study.Headache. 2016 Nov;56(10):1626-34. doi:10.1111/head.12987Sandoz Pharmaceutical.Package insert - amitriptyline.Coupland C, Hill T, Morriss R, Arthur A, Moore M, Hippisley-Cox J.Antidepressant use and risk of suicide and attempted suicide or self harm in people aged 20 to 64: Cohort study using a primary care database.BMJ. 2015;350:h517. doi:10.1136/bmj.h517MedlinePlus.Amitriptyline.Güloglu C, Orak M, Ustündag M, Altunci YA.Analysis of amitriptyline overdose in emergency medicine.Emerg Med J. 2011;28(4):296-9. doi:10.1136/emj.2009.076596
Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ.Amitriptyline for neuropathic pain in adults.Cochrane Database System Rev.2015;7:CD008242. doi:10.1002/14651858.CD008242.pub3
Prescribers' Digital Reference.Amitriptyline hydrochloride - Drug summary.
National Institute of Diabetes and Digestive and Kidney Diseases.Diabetic neuropathy.
Centers for Disease Control and Prevention.Shingles symptoms and complications.
MedlinePlus.Migraine.
MedlinePlus.Fibromyalgia.
Harvard Medical School, Harvard Health Publishing.Are antidepressants also pain relievers?
Ferreira GE, McLachlan AJ, Lin CC, et al.Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: Systematic review and meta-analysis.BMJ. 2021;372:m4825. doi:10.1136/bmj.m4825
Strauss LD, Weizenbaum E, Loder EW, Rizzoli PB.Amitriptyline dose and treatment outcomes in specialty headache practice: A retrospective cohort study.Headache. 2016 Nov;56(10):1626-34. doi:10.1111/head.12987
Sandoz Pharmaceutical.Package insert - amitriptyline.
Coupland C, Hill T, Morriss R, Arthur A, Moore M, Hippisley-Cox J.Antidepressant use and risk of suicide and attempted suicide or self harm in people aged 20 to 64: Cohort study using a primary care database.BMJ. 2015;350:h517. doi:10.1136/bmj.h517
MedlinePlus.Amitriptyline.
Güloglu C, Orak M, Ustündag M, Altunci YA.Analysis of amitriptyline overdose in emergency medicine.Emerg Med J. 2011;28(4):296-9. doi:10.1136/emj.2009.076596
Maarrawi J, Abdel Hay J, Kobaiter-Maarrawi S, Tabet P, Peyron R, Garcia-Larrea L.Randomized double-blind controlled study of bedtime low-dose amitriptyline in chronic neck pain.Eur J Pain. 2018;22(6):1180-7. doi:10.1002/ejp.1206
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