Amitriptyline (Elavil)

Amitriptyline is a prescription medicine used to treat symptoms of low mood and depression. It is classified as a tricyclic antidepressant and works by increasing levels of certain natural chemicals in the brain. Always consult your doctor before using amitriptyline, as it can have dangerous effects if used under certain conditions or in conjunction with certain other medications.

Amitriptyline brand names

Some common brand names that amitriptyline is sold under include:

• Elavil
• Vanatrip
• Amitid
• Amitril
• Endep

What is amitriptyline prescribed for?

Amitriptyline is most typically prescribed to treat symptoms of depression in adults, most notably with general depressive disorder.

Amitriptyline can also be used to treat a variety of other conditions, including chronic pain, post-herpetic neuralgia, eating disorders, panic attacks, irritable bowel syndrome, insomnia, post-traumatic stress disorder, and migraines. It is very important that you consult a doctor before using amitriptyline.^[1]

How does amitriptyline work?

Amitriptyline is from a group of medications called tricyclic antidepressants that work to increase certain natural chemicals in the brain, helping to maintain mental stability and balance. It helps to increase the serotonin level in your brain to improve mood and counteract symptoms of depression.

It may take a few weeks to feel the therapeutic benefits of amitriptyline, but it is important to stick to the dose prescribed by your doctor to avoid any serious side effects. Make sure not to stop taking it suddenly without consulting your doctor.

How is amitriptyline usually taken?

Amitriptyline is typically prescribed in tablets taken via oral administration, in doses of either 10mg, 25mg, or 50mg. The tablets should be swallowed whole with water. Amitriptyline also comes in liquid form which comes with a plastic syringe or spoon to measure out the correct dose.

Doses of amitriptyline can have quite a strong sedative effect that could cause you to feel drowsy, so it is often advised to be taken once a day in the evening or before you go to bed.

The usual dose used to treat depression in adults is between 50mg and 100mg a day. The maximum dose of amitriptyline is usually 150mg a day. Your doctor will most likely start by prescribing you a low dose and gradually increase this to help you avoid experiencing severe side effects.

If you miss a dose, you can take the missed dose when you remember. However, if the next dose is coming up soon, skip the missed dose and continue as normal. Do not take a double dose to replace the missed dose.^[2]

How long does amitriptyline stay in your system?

The length of time amitriptyline stays in the system will vary between each person, depending on things like dosage, physical size, genetics, and other medication being taken.

Amitriptyline has a half-life between 10 and 28 hours. This is the amount of time it takes for the concentration of the medication to reduce by a half in your bloodstream. It takes about 5 half-lives for a drug to be completely expelled from your body. Amitriptyline will therefore usually stay in your system for about 2-6 days. ^[3]

Different drug tests can detect amitriptyline for varying lengths of time:

• Urine – As short as several hours or up to a month.
• Blood – Generally shorter for these types of drug tests, ranging from a few hours to a few days
• Hair – Generally longer – can reach up to 90 days
  
  

Side effects of amitriptyline

Taking amitriptyline may cause unexpected changes to your physical and mental health. It can sometimes cause suicidal thoughts, most commonly at the start of treatment or as dosage is being altered. Therefore, it is very important to take amitriptyline exactly as prescribed.

The following list is not exhaustive and those using amitriptyline may experience other side effects.

Common side effects

If any of these side effects start to bother you or don’t go away, consult your doctor:

• Dizziness
• Feeling tired and drowsy
• Feeling weak
• Having trouble urinating
• Constipation
• Headaches

Severe side effects

If you are experiencing any of the following, you should call a doctor straight away:

• Fast or irregular heartbeat
• Eye pain, changes in eyesight or redness, or swelling around your eye
• Chest pain
• Suicidal thoughts (after you have been taking amitriptyline consistently)
• If the whites of your eyes or skin turn yellow. Any yellowing of the skin or eyes can be a sign of liver damage or dysfunction.
• Urine is darker than usual
• Constant headaches, confusion or weakness, and frequent muscle cramps – this combination of symptoms can be due to low sodium levels in your blood. This can lead to seizures.
• Persistent constipation or problems urinating which are causing abdominal pain

Emergency side effects

Call an ambulance immediately if you are suffering from any of the following:

• Weakness on one side of your body
• Difficulty speaking or thinking
• Loss of balance or blurred sight^[1]

Amitriptyline precautions

Before taking amitriptyline, it is important to share the following information about your medical history with your doctor to ensure it is safe for them to prescribe the medication:

• Any allergies, including amitriptyline or other tricyclic antidepressants.
• Any other prescription and non-prescription medications, vitamins or supplements you are taking.
• Bleeding problems, breathing problems, liver, kidney, or heart disease
• Pregnancy or plans to become pregnant
• Whether you are currently breastfeeding
• Recent heart attack, heart failure, slow heartbeat, or family history of heart conditions
• Personal or family history of mental health conditions including bipolar disorder, psychosis, schizophrenia or a history of suicide
• Drinking large quantities of alcohol
• Family history of seizures, diabetes, or glaucoma
• Enlarged prostate or overactive thyroid gland

Your doctor may warn you to take the following precautions while taking amitriptyline:

• If you are having surgery, including dental surgery, tell the doctor or dentist that you are taking amitriptyline.
• This medication passes into breast milk and the effect on a nursing infant is unknown. Consult your doctor before breastfeeding.
• This medication may make you more sensitive to the sun, so you should limit sun exposure. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.
• Amitriptyline may make you dizzy or drowsy or cause blurred vision. Avoid driving or using machinery until you can do so safely.
• Alcohol or cannabis can add to the drowsiness caused, so avoid alcoholic beverages and talk to your doctor if you are using cannabis.^[1]

Amitriptyline drug interactions

Many medicines and amitriptyline can affect each other and increase the chances of side effects. Always inform your doctor of any medication you are taking and check with your doctor or a pharmacist before starting any new medicine while you are taking amitriptyline.

Medications that have the most severe side effects when taken with amitriptyline include

• Monoamine oxidase inhibitor (MAOIs)
• Adrenaline/epinephrine
• Bupropion
• Cinacalcet
• Clozapinem
• Dronedarone
• Ephedrine
• Fluoxetine
• Fluvoxamine
• Isocarboxazid
• Lithium
• Moclobemide
• Ozanimod
• Paroxetine
• Phenelzine
• Phenylephrine
• Terbinafinem
• Tranylcypromine

Some other examples of specific interactions with amitriptyline:

• Amitriptyline v opioid medicines – can increase extreme drowsiness and breathing problems. Opioid medicines include codeine, morphine, fentanyl, and dihydrocodeine.
• Amitriptyline v other antidepressants – can also affect the way amitriptyline works and cause very high blood pressure.
• Amitriptyline vMAO inhibitors – can have serious, and possibly fatal, effects. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication.
• Amitriptyline v Aspirin – can increase the risk of bleeding.

• Amitriptyline v other medication causing drowsiness – can increase drowsiness e.g. sleeping pills, muscle relaxants, seizure medication, or even cold and flu medicine.

Examples of other drugs that may affect how amitriptyline works:

• Drugs to treat irregular heart rate (e.g.quinidine/propafenone/flecainide)
• Drugs classified as “blood thinners” (e.g.warfarin) and certain drugs for high blood pressure.
• Drugs that affect the heart rhythm (e.g.amiodarone, dofetilide and pimozide).^[4]

Amitriptyline storage

Amitriptyline should be stored at room temperature and kept away from any moisture and heat. It is important to keep the container tightly closed when not in use to avoid moisture getting to the medication.

What to do if you overdose on amitriptyline

Taking more than your prescribed dose of amitriptyline can cause serious effects. Symptoms of an overdose may include:

• Extreme drowsiness
• Hallucinations
• Shaking
• Rigid muscles
• Vomiting
• Fever or cold body temperature
• Confusion and problems concentrating
• Slow or shallow breathing
• Fast or irregular heartbeat
• Shaking, fits or seizures

Frequently asked questions about amitriptyline

Is amitriptyline addictive?

Amitriptyline is not known to be addictive. However, you can get withdrawal effects if you decide to stop taking it suddenly. It is important to avoid this, or changing your prescribed dose at all, without consulting your doctor.

Does amitriptyline cause weight gain?

Yes, weight gain has been reported as a side effect for patients taking amitriptyline. Amitriptyline is a tricyclic antidepressant, and these are known to block histamine receptors. This can be a cause for an increase in appetite and subsequent weight gain.

Are there any alternative treatments to amitriptyline?

Antidepressants like amitriptyline are only one of the methods to treat depression and low mood. Other options to explore include talking therapy (e.g., cognitive behavioral therapy), exercise programs, and support groups.^[2]