Generic Name: Amitriptyline Brand Name(s): Generics only. No brands available.

Know the basics

What is amitriptyline used for?

Amitriptyline is used to treat mental/mood problems such as depression. It may help improve mood and feelings of well-being, relieve anxiety and tension, help you sleep better, and increase your energy level. Amitriptyline belongs to a class of medications called tricyclic antidepressants. It works by affecting the balance of certain natural chemicals (neurotransmitters such as serotonin) in the brain.

Other uses: this section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by yourhealth care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

This medication may also be used to treat nerve pain (such as peripheral neuropathy, postherpetic neuralgia), eating disorder (bulimia), other mental/mood problems (such as anxiety, panic disorder), or to prevent migraine headaches.

How should I take amitriptyline?

Take this medication by mouth, usually 1 to 4 times daily or as directed by your doctor. If you take it only once a day, take it at bedtime to help reduce daytime sleepiness. The dosage is based on your medical condition and response to treatment.

To reduce your risk of side effects (such as drowsiness, dry mouth, dizziness), your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor’s instructions carefully.

Take this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time(s) each day. Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase.

It is important to continue taking this medication even if you feel well. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Also, you may experience symptoms such as mood swings, headache, tiredness, and sleep change. To prevent these symptoms while you are stopping treatment with this drug, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details. Report any new or worsening symptoms immediately.

This medication may not work right away. You may see some benefit within a week. However, it may take up to 4 weeks before you feel the full effect.

Tell your doctor if your condition persists or worsens (such as your feelings of sadness get worse, or you have thoughts of suicide).

How do I store amitriptyline?

Amitriptyline is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store amitriptyline in the bathroom or the freezer. There may be different brands of amitriptyline that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush amitriptyline down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Know the precautions & warnings

What should I know before using amitriptyline?

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.

Is it safe to take amitriptyline during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this medication during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking this medication. This medication is pregnancy risk category C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Know the side effects

What are the side effects of amitriptyline?

Some common side effects include: Drowsiness, dizziness, dry mouth, blurred vision, constipation, weight gain, or trouble urinating may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or use a saliva substitute.

To prevent constipation, maintain a diet adequate in fiber, drink plenty of water, and exercise. If you become constipated while using this drug, consult your pharmacist for help in selecting a laxative.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor immediately if any of these rare but serious side effects occur: easy bruising/bleeding, persistent heartburn, shaking, mask-like facial expressions, muscle spasms, severe stomach/abdominal pain, decreased sexual ability/desire, enlarged/painful breasts.

Seek immediate medical attention if any of these rare but very serious side effects occur: black stools, vomit that looks like coffee grounds, severe dizziness, fainting, seizures.

This medication may rarely cause a very serious condition called neuroleptic malignant syndrome (NMS). Get medical help right away if you have any of the following symptoms: fever, muscle stiffness, severe confusion, sweating, fast/irregular heartbeat.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Know the interactions

What drugs may interact with amitriptyline?

Amitriptyline may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures or anxiety can add to sleepiness caused by amitriptyline. Tell your doctor if you regularly use any of these medicines, or any other antidepressants.

Before taking amitriptyline, tell your doctor if you have used an “SSRI” antidepressant in the past 5 weeks, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft).

Tell your doctor about all other medicines you use, especially:

  • Cimetidine (Tagamet);
  • Isoniazid (for treating tuberculosis);
  • Methimazole (Tapazole);
  • Nicardipine (Cardene);
  • Ropinirole (Requip);
  • John’s wort;
  • Ticlopidine (Ticlid);
  • An antibiotic such as terbinafine (Lamisil);
  • Anti-malaria medication such as chloroquine (Arelan) or pyrimethamine (Daraprim), or quinine (Qualaquin);
  • HIV or AIDS medicine such as delavirdine (Rescriptor) or ritonavir (Norvir, Kaletra);
  • Medicine to treat psychiatric disorders, such as aripiprazole (Abilify), chlorpromazine (Thorazine), clozapine (Clozaril, fazaclo), fluphenazine (Permitil, Prolixin), haloperidol (Haldol), perphenazine (Trilafon), or thioridazine (Mellaril);
  • A heart rhythm medication such as amiodarone (Cordarone, Pacerone), dofetilide (Tikosyn), ibutilide (Corvert), or sotalol (Betapace); or
  • A heart rhythm medication such as disopyramide (Norpace), dronedarone (Multaq), flecainide (Tambocor), mexiletine (Mexitil), procainamide (Pronestyl), propafenone (Rythmol), or quinidine (Quin-G).

Does food or alcohol interact with amitriptyline?

Amitriptyline may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

  • Tobacco;
  • Ethanol.

What health conditions may interact with amitriptyline?

Amitriptyline may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

  • Bipolar disorder (mood disorder with alternating episodes of mania and depression), or risk of;
  • Heart attack, recent—Should not be used in patients with these conditions.
  • Diabetes;
  • Glaucoma;
  • Heart disease;
  • Overactive thyroid;
  • Schizophrenia;
  • Seizures, history of;
  • Urinary retention (trouble urinating), history of—Use with caution. May make these conditions worse.
  • Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Understand the dosage

The information provided is not a substitute for medical advice. Always consult your doctor or pharmacist before using this medication.

What is the dose of Amitriptyline for an adult?

Usual Adult Dose for Depression

Initial dose: 25 to 100 mg orally per day in 3 to 4 divided doses or 50 to 100 mg at bedtime.
Maintenance dose: 25 to 150 mg per day in single or 3 to 4 divided doses. 25 mg per day at bedtime has been used for premenstrual depression. Dose increases should be made gradually. A small number of hospitalized patients may need as much as 300 mg per day. ECG, blood pressure, and heart rate monitoring is recommended for patients receiving high doses.
20 to 30 mg intramusclar up to 4 times a day. Patients should be switched to oral therapy as soon as possible.

Usual Adult Dose for Migraine Prophylaxis

10 mg orally once a day at bedtime.

Usual Adult Dose for Dysthymia

Initial dose: 75 mg orally per day orally in single or divided doses.
Maintenance dose: 150 to 300 mg per day orally in single or divided doses. Dose increases should be made gradually. ECG, blood pressure, and heart rate monitoring is recommended for patients receiving high doses.
20 to 30 mg intramusclar up to 4 times a day. Patients should be switched to oral therapy as soon as possible.

Usual Adult Dose for Pain

Initial dose: 75 mg orally per day orally in single or divided doses.
Maintenance dose: 150 to 300 mg per day orally in single or divided doses. Dose increases should be made gradually. ECG, blood pressure, and heart rate monitoring is recommended for patients receiving high doses.
20 to 30 mg intramusclar up to 4 times a day. Patients should be switched to oral therapy as soon as possible.

Usual Adult Dose for Post Traumatic Stress Disorder

Initial dose: 75 mg orally per day orally in single or divided doses.
Maintenance dose: 150 to 300 mg per day orally in single or divided doses. Dose increases should be made gradually. ECG, blood pressure, and heart rate monitoring is recommended for patients receiving high doses.
20 to 30 mg intramusclar up to 4 times a day. Patients should be switched to oral therapy as soon as possible.

Usual Adult Dose for Somatoform Pain Disorder

Initial dose: 75 mg orally per day orally in single or divided doses.
Maintenance dose: 150 to 300 mg per day orally in single or divided doses. Dose increases should be made gradually. ECG, blood pressure, and heart rate monitoring is recommended for patients receiving high doses.
20 to 30 mg intramusclar up to 4 times a day. Patients should be switched to oral therapy as soon as possible.

What is the dose of Amitriptyline for a child?

Usual Pediatric Dose for Depression

9 to 12 years:
Initial dose: 1 mg/kg/day orally in 3 divided doses
Maintenance dose: 1 to 5 mg/kg/day in 3 divided doses. Dose increases should be made gradually. ECG, heart rate, and blood pressure monitoring is recommended when doses exceed 3 mg/kg/day.
12 to 18 years:
Initial dose: 25 to 50 mg orally per day orally in single or 3 to 4 divided doses.
Maintenance dose: 20 to 200 mg per day in divided doses. Dose increases should be made gradually. 10 mg orally 3 times a day and 20 mg at bedtime may be satisfactory in patients who do not tolerate higher dosages.
20 to 30 mg intramusclar up to 4 times a day. Patients should be switched to oral therapy as soon as possible.

Usual Pediatric Dose for Pain

1 to 12 years:
Initial dose: 0.1 mg/kg orally at bedtime (investigational).
Maintenance dose: May increase as tolerated over 2 to 3 weeks to 0.5 to 2 mg/kg at bedtime.
12 to 18 years:
Initial dose: 25 mg twice daily.
Maintenance dose: 50 to 200 mg per day in divided doses. Dose increases should be made gradually.

Usual Pediatric Dose for Migraine Prophylaxis

6 to 12 years: 0.25 to 1.5 mg/kg/day once daily at bedtime (investigational). Dose increases should be made gradually.
12 to 18 years:
Initial dose: 25 mg twice daily.
Maintenance dose: 50 to 200 mg per day in divided doses. Dose increases should be made gradually.

Usual Pediatric Dose for Urinary Incontinence

2 to 6 years: 10 mg orally at bedtime has been tried for nocturnal enuresis (investigational).

How is amitriptyline available?

Amitriptyline is available in the following dosage forms and strengths:

Tablet, Oral: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

Symptoms of overdose may include:

  • Irregular heartbeat;
  • Seizures;
  • Coma (loss of consciousness for a period of time);
  • Confusion;
  • Problems concentrating;
  • Hallucinating (seeing things or hearing voices that do not exist);
  • Agitation;
  • Drowsiness;
  • Rigid muscles;
  • Vomiting;
  • Fever;
  • Cold body temperature.

What should I do if I miss a dose?

If you miss a dose of amitriptyline , take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: January 4, 2017 | Last Modified: January 4, 2017