GENERIC NAME: Amitriptyline

COMMON BRANDS: Elavil, Tryptizol, Endep, Vanatrip

Amitriptyline is an oral prescription drug, belongs to a class of drugs known as tricyclic antidepressants that work by the balancing of certain natural chemicals (neurotransmitters like serotonin) in the brain. These drugs primarily used to treat many mental illnesses. It is not available as a brand name drug. It is only available as a generic drug.

What are the uses of Amitriptyline?

This drug is used to treat mental/mood problems like depression associated with anxiety, agitation, or schizophrenia. It may help to enhance the mood and feelings of well-being, ease anxiety and tension, help you to sleep better, and boost your energy level. This medication comes under a class of drugs called as tricyclic antidepressants.

How to use Amitriptyline?

Read the Medication Guide carefully provided by your pharmacist before you initiate taking amitriptyline and every time you get a refill. If you have any issues, Seek advice from your doctor/ physician/pharmacist.

Take this medication orally, usually 1 to 4 times per day or as instructed by your doctor/physician. Use it at bedtime, if you are taking only once a day to reduce daytime sleepiness. The dosage is based on your medical examination and response to treatment.

To minimize the risk of side effects (like drowsiness, dry mouth, dizziness), your doctor/physician may instruct you to begin this medication at a low dose and slowly increase your dose. Obey your doctor’s guidance carefully.

Regularly use this drug to get the maximum benefit from it. To avoid confusion, take the medication at the same time every day. Do not increase your dose or use the drug more often or for a more extended period than prescribed. Your condition will not improve, but your risk of side effects will increase.

It is essential to continue this medicine even if you feel better. Do not discontinue this medication without asking your doctor/physician. Few conditions may get worse when this drug is suddenly discontinued. Furthermore, you may experience symptoms, like mood swings, headache, tiredness, and sleep change. To avoid withdrawal symptoms with this drug, your doctor may decrease your dose gradually. Ask your doctor/physician/pharmacist for further details. Inform any new or worsening symptoms right away.

This medication takes time to work. You may see some benefit in a week. However, it may need up to 4 weeks before you feel the full effect.

Inform your doctor/physician if your condition continues or worsens (like your feelings of sadness get worse, or you have thoughts of suicide).

What are the side effects of Amitriptyline?

See also warning section.

Dizziness, drowsiness, blurred vision, dry mouth, constipation, weight gain, or trouble during urination may happen. If any of these side effects appear or get worst, inform your doctor/physician/ pharmacist immediately.

To decrease the risk of dizziness and lightheadedness, get up slowly when standing from a sitting or lying position. To ease dry mouth, use hard candy(sugarless)or ice chips, chew gum (sugarless), drink water, or use a saliva substitute.

To avoid constipation, maintain an adequate dietary fiber, drink plenty of water, and regularly do exercise. If you develop constipation after using this drug, seek advice from your pharmacist in picking a laxative.

Remember that your doctor/physician has prescribed this medicine because your doctor/physician has found that the benefits are greater than the risk of side effects. Several people using this medication do not have severe side effects.

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

Look for medical assistance as soon as possible if you notice any of these severe side effects like black stools, severe dizziness, vomit that looks like coffee grounds, seizures, fainting, eye pain/swelling/redness, widened pupils or vision changes (seeing rainbows around lights at night).

This drug may rarely cause a severe condition called neuroleptic malignant syndrome (NMS). Get medical assistance immediately if you notice symptoms like fever, muscle stiffness, severe confusion, sweating, fast/irregular heartbeat.

A severe allergic reaction by this drug is infrequent. However, seek prompt medical attention if you notice symptoms of a severe allergic reaction, like a rash, itching/swelling (particularly of the face/tongue/throat), severe dizziness, restlessness.

This record does not contain all possible side effects. If you see other effects not listed above, contact your doctor/physician/pharmacist.

What are the precautions while using Amitriptyline?

See also Warning section.

Before using amitriptyline, inform your doctor/physician/ pharmacist if you are allergic to it, or to other tricyclic antidepressants (nortriptyline), or if you have any other allergies. This medication may contain inactive ingredients, which can cause allergic reactions or other problems. Speak to your pharmacist for further details.

Before taking this drug, inform your doctor/physician/ pharmacist about your medical history, mainly like bleeding problems, liver problems, breathing problems, recent heart attack, difficulty in urinating (due to enlarged prostate), hyperthyroidism, personal or family history of mood/mental conditions (bipolar disorder, psychosis), personal or family history of glaucoma (angle-closure type), family history of suicide, seizures, conditions that may enhance your risk of seizures (brain disease, alcohol withdrawal).

Amitriptyline may induce a condition that affects the heart rhythm (QT prolongation). QT prolongation can infrequently cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (like severe dizziness, fainting) that need medical attention immediately.

The chances of QT prolongation may increases if you have certain medical issues or you are on other drugs that may cause QT prolongation. Before taking amitriptyline, inform your doctor/physician/pharmacist about all the medications you are using and if you have the following issues such as certain heart problems (slow heartbeat, heart failure, QT prolongation in the EKG), family history of some heart problems (QT prolongation in the EKG, sudden cardiac death).

Low potassium or magnesium in the blood may enhance your risk of QT prolongation. This risk may rise if you use certain drugs like diuretics/”water pills” or if you have certain medical issues like severe sweating, diarrhea, or vomiting. Inform your doctor/physician about taking amitriptyline safely.

This medicine may cause dizziness or drowsiness or blur your vision. Alcohol or marijuana can cause more dizziness or drowsiness. Avoid driving, or using machinery, or doing anything that requires alertness or clear vision till you can do it safely. Avoid alcoholic beverages. Inform your doctor if you are taking marijuana.

Before surgery, inform your doctor/dentist about all the products you are using like prescription drugs, nonprescription drugs, and herbal products.

This medicine may increase your skin sensitive to the sun. Avoid sun exposure and tanning booths and sunlamps. Apply sunscreen and wear protective clothing when going outdoors. Inform your doctor/physician immediately if you get sunburns or have skin blisters/redness.

In diabetic patients, this drug may make it difficult to control blood sugar levels. Monitor your blood sugar levels frequently and inform your doctor/physician about the results. Your doctor/physician may require to adjust your diabetes dosage, exercise program, or diet.

Older adults are more prone to the side effects of this drug, mainly dizziness, drowsiness, confusion, dry mouth, constipation, difficulty urinating, and QT prolongation (see above). Dizziness, drowsiness, and confusion can enhance the risk of falling.

Avoid this medication during pregnancy, used only when needed. Seek advice regarding the risks and benefits of the drug from your doctor/physician.

As untreated mental/mood problems (depression, anxiety, panic disorder) can be a severe condition, do not stop taking this drug unless directed by your doctor/physician. If you are planning a pregnancy, become pregnant, or think you may be pregnant, right away discuss with your doctor/physician about the benefits and risks of using this medication at the time of pregnancy.

Amitriptyline passes into breast milk, and the effect on a nursing infant is unknown. Seek advice from your doctor/physician before breastfeeding.

What are the drug interactions of Amitriptyline?

Drug interactions may alter how your drug works or may enhance your risk for serious side effects. This list does not consist of all possible drug interactions. Keep a record of all the products you are using including prescription/nonprescription drugs and herbal products and inform your doctor/ pharmacist. Don’t start, stop, or alter the dosage of any medicines without your doctor/physician’s consent.

Few products that may interact with this drug like disulfiram, arbutamine, thyroid supplements, other drugs that can induce bleeding/bruising (antiplatelet drugs like clopidogrel, NSAIDs like ibuprofen, “blood thinners” like warfarin), anticholinergic drugs (like benztropine, belladonna alkaloids), certain drugs for high blood pressure (drugs that work in the brain like clonidine, guanabenz).

Using MAO inhibitors with this drug may induce a severe (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, phenelzine, procarbazine, methylene blue, moclobemide, rasagiline, safinamide, selegiline, tranylcypromine) during therapy with this medicine. Avoid most MAO inhibitors for two weeks before and after treatment with this drug. Seek advice from your doctor/physician when to start or stop taking this medication.

Other medications can affect the elimination of amitriptyline from your body, thereby affecting how amitriptyline works. Drugs like cimetidine, terbinafine, drugs to treat irregular heart rate (for example quinidine/propafenone/flecainide), antidepressants (for example SSRIs including paroxetine/fluoxetine/fluvoxamine). This is not a full record of all possible side effect.

Several drugs besides amitriptyline may affect the heart rhythm (QT prolongation in the EKG), like amiodarone, pimozide, cisapride, dofetilide, procainamide, quinidine, sotalol, macrolide antibiotics (erythromycin), among others. Therefore, before taking amitriptyline, inform your doctor/physician about all the medications you are currently using.

Inform your doctor/physician/pharmacist if you are using other products that cause drowsiness, including marijuana, alcohol, antihistamines (cetirizine, diphenhydramine), drugs for sleep or anxiety (alprazolam, diazepam, zolpidem), muscle relaxants, and narcotic pain relievers (codeine).

Check the labels on all your medicines (like an allergy or cough-and-cold products) as they may contain decongestants or ingredients that cause drowsiness. Seek advice from your pharmacist about using those products safely.

Aspirin can raise the risk of bleeding when used with this drug. However, if your doctor/physician has instructed you to take low-dose of aspirin for heart attack or stroke prevention (generally at dosages of 81-325 milligrams per day), regularly take this drug unless your doctor advises you otherwise. Inform your doctor/physician/pharmacist for further details.

Amitriptyline is very similar to nortriptyline. Avoid using medications containing nortriptyline while taking amitriptyline.

WARNINGS:

Antidepressant drugs are used to treat a variety of conditions, for example, depression and mental/mood disorders. These medications help to prevent suicidal attempts/ thoughts and provide other significant benefits. However, a small number of people (particularly people below 25 years ) who use antidepressants for any condition may observe worsening depression, other mental/ mood symptoms, or suicidal thoughts/attempts. However, it is necessary to seek advice from your doctor/physician about the risks and benefits of the antidepressant medication.

Inform your doctor/physician immediately if you notice worsening of depression / other psychiatric conditions, unexpected behavior changes (possible like suicidal thoughts/attempts), or other mental/mood changes (new/worsening anxiety, panic attacks, trouble sleeping, irritability, severe restlessness, hostile/angry feelings, impulsive actions, very rapid speech). Carefully observe these symptoms when a new antidepressant drug is started or when the dose is altered.

What are the forms and strengths of Amitriptyline?

Generic: Amitriptyline
Form: Oral tablet
Strengths: 10mg, 25mg, 50mg, 75mg, 100mg, and 150mg.

What is the dosage of Amitriptyline?

For Depression:

Adult (18–64 years)

Starting dosage: 75mg per day, generally in divided doses and your doctor will slowly increase your dosage if needed.
Maximum dosage: 150mg per day.
Alternative dosage regimen: Start with 50 to 100mg at bedtime. This may be increased by 25 or 50mg as needed in the bedtime dose, for a total of 150mg per day.

Pediatric:

Children ( 0–17 years)

It is not confirmed that amitriptyline is safe and effective for the use in children younger than 17 years.

Geriatric:

Older adults (above 65 years)

The kidneys of older people may not work efficiently, and this can cause your body to metabolize drugs slowly. As a result, more of a drug remains in your body. This increases the chances for side effects.

Your doctor/physician may prescribe you a lower dosage initially or a different schedule. This can help maintain normal levels of this drug in your body.

Disclaimer

TheMedPharma has made every effort to make sure that all the information is factually correct, comprehensive, and up-to-date. However, this website should not be considered as a substitute for the advice, knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or licensed health care professional before taking any medication. The drug information contained herein is subjected to changes if required. The lack of warnings or other information for a given drug does not mean that the drug or its combination is safe, effective or appropriate for use in all patients.