amitriptyline
Amitriptyline is FDA approved to treat depression. But it isn't as commonly used today as other antidepressants because it can cause a lot of side effects, such as sleepiness and weight gain. In addition, amitriptyline has many interactions with other medications, including other antidepressants, sedatives, and antihistamines. But despite the side effects and interactions, amitriptyline is often used off label for nerve pain due to diabetes and migraine prevention. While its brand name Elavil is no longer available, amitriptyline is available as a generic medication.
What is Amitriptyline?
What is Amitriptyline used for?
- Depression
How Amitriptyline works
Amitriptyline is a tricyclic antidepressant (TCA). It works by raising the levels of important chemicals in your brain that affect your mood, like serotonin and norepinephrine. This can help improve your mood.
Drug facts
Side effects of Amitriptyline
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Sleepiness
- Dizziness
- Weakness
- Fatigue
- Headache
- Dry mouth
- Nausea
- Vomiting
- Constipation
- Weight gain
Less Common Side Effects
- Confusion
- Hallucinations
- Trouble urinating
- Blurred vision
- Skin sensitivity to sunlight
- Hair loss
- Changes in heart rate
- Changes in sex drive
- Erectile dysfunction
Amitriptyline serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Suicidal thoughts or behaviors
- Heart attack: chest pain, cold sweats, left arm pain, difficulty breathing
- Stroke: sudden numbness, weakness, confusion, or difficulty talking
- Serious allergic reaction: difficulty breathing, hives, itching, fast heartbeat, tightness in the throat, dizziness, swelling in the face or tongue
More on Amitriptyline side effects
The following Amitriptyline side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Incidence not known
Abdominal or stomach pain
agitation
black, tarry stools
bleeding gums
blood in urine or stools
blurred vision
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
change in consciousness
changes in patterns and rhythms of speech
chest pain or discomfort
chills
cold sweats
coma
confusion
confusion about identity, place, and time
continuing ringing, buzzing, or other unexplained noise in ears
convulsions
cool, pale skin
cough or hoarseness
dark urine
decrease in frequency of urination
decrease in urine volume
decreased urine output
difficulty in breathing
difficulty in passing urine (dribbling)
difficulty in speaking
disturbance of accommodation
disturbed concentration
dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
double vision
excitement
fainting
false beliefs that cannot be changed by facts
fast, slow, or irregular heartbeat
fear or nervousness
fever with or without chills
flushed, dry skin
fruit-like breath odor
general feeling of tiredness or weakness
headache
hearing loss
high fever
high or low blood pressure
hostility
inability to move arms, legs, or facial muscles
inability to speak
increased hunger
increased need to urinate
increased ocular pressure
increased sweating
increased thirst
increased urination
irritability
lack of coordination
lethargy
light-colored stools
lip smacking or puckering
loss of appetite
loss of balance control
loss of bladder control
loss of consciousness
lower back or side pain
mental depression or anxiety
muscle spasm or jerking of all extremities
muscle tightness
muscle trembling, jerking, or stiffness
muscle twitching
nightmares or unusually vivid dreams
overactive reflexes
painful or difficult urination
passing urine more often
pinpoint red spots on skin
poor coordination
pounding in the ears
puffing of cheeks
rapid or worm-like movements of tongue
rapid weight gain
restlessness
seeing, hearing, or feeling things that are not there
seizures
severe muscle stiffness
shakiness and unsteady walk
shivering
shortness of breath
shuffling walk
slow speech
slurred speech
sores, ulcers, or white spots on lips or in mouth
stiffness of limbs
stupor
sudden loss of consciousness
sweating
swelling of face, ankles, or hands
swelling or puffiness of face
swollen glands
talking or acting with excitement you cannot control
trouble in speaking
trouble sleeping
troubled breathing
twisting movements of body pain or discomfort in arms, jaw, back, or neck
unable to sleep
uncontrolled chewing movements
uncontrolled movements, especially of arms, face, neck, back, and legs
unexplained weight loss
unpleasant breath odor
unsteadiness, trembling, or other problems with muscle control or coordination
unusual bleeding or bruising
unusual tiredness or weakness
unusually pale skin
upper right abdominal pain
vomiting of blood
weakness in arms, hands, legs, or feet
weight gain or loss
yellow eyes and skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of Overdose
Clumsiness
drowsiness
low body temperature
muscle aches
muscle weakness
sleepiness
tiredness
weak or feeble pulse
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Incidence not known
Bigger, dilated, or enlarged pupils (black part of eye)
black tongue
breast enlargement in females
decreased interest in sexual intercourse
hair loss, thinning of hair
hives or welts
inability to have or keep an erection
increased in sexual ability, desire, drive, or performance
increased interest in sexual intercourse
increased sensitivity of eyes to light
loss in sexual ability, desire, drive, or performance
loss of sense of taste
redness or other discoloration of skin
severe sunburn
skin rash
swelling of testicles
swelling of the breasts or breast soreness in males
swelling of the parotid glands
swelling or inflammation of the mouth
unexpected or excess milk flow from breasts
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Amitriptyline
Pros
- Available in many different strengths
- Available as a lower-cost, generic form
- Can take with or without food
Cons
- Has many unpleasant side effects compared to other antidepressants
- Can cause withdrawal symptoms if you suddenly stop taking it after long-term use
- Not the best choice for people with heart problems, glaucoma, or seizures or people age 65 years and older
Pharmacist tips for Amitriptyline
- You can take amitriptyline with or without food. If it upsets your stomach, try taking it with food to help.
- Amitriptyline can take 1 to 2 months to work, so you might not feel your depression symptoms improve right away. Your provider might make adjustments to your dose over time to find the dose that works best for you.
- Don't change your dose or suddenly stop taking amitriptyline without talking to your provider first. Doing so can cause bothersome withdrawal symptoms like nausea, headache, irritability, and sleep problems. Follow your provider's instructions to lower your dose slowly over a period of time to prevent withdrawal symptoms.
- Antidepressant medications like amitriptyline can raise the risk of suicidal thoughts. Contact your provider right away if you or your loved ones notice any new or worsening changes in your behavior or mood while you're taking the medication.
- Amitriptyline can make you sleepy and dizzy. Don't drive or do anything requiring concentration until you know how this medication affects you. These side effects might get better after you continue to take the medication for a few weeks.
- Amitriptyline can make your skin more sensitive to the sun, which means you can get sunburned more easily. When you go outside, make sure that you're wearing sunscreen and protective clothing to avoid a serious sunburn.
- If you have diabetes, ask your provider whether you need to check your blood sugar regularly while using amitriptyline. This medication can cause your blood sugar to get too high or too low.
- Make sure to tell your providers about all of the medications you're taking. Don't start any new medications without talking to your provider first. It's important that they make sure all your medications are safe for you because amitriptyline can interact with many medications. Some medications include sedatives, opioid medications, antihistamines, and monoamine oxidase inhibitors (MAOIs). Taking these medications with amitriptyline can raise your risk of side effects.
Common questions about Amitriptyline
Yes, weight gain is one of the more common side effects from amitriptyline. Studies show that people gained 1 to 16 pounds while taking amitriptyline. The amount of weight you might gain can depend on your dose and how long you're taking the medication. To lower your risk for weight gain while taking amitriptyline, make sure to eat a healthy diet and follow a regular exercise routine. Contact your provider if you're uncomfortable with how much weight you've gained during treatment with amitriptyline. They might recommend medications to help you manage your weight or switch you to a different medication.
Yes, you can feel sleepy after you take amitriptyline. In fact, treatment guidelines for insomnia (trouble sleeping) list amitriptyline as an option, particularly for people who have trouble sleeping and depression at the same time. Because this medication can cause sleepiness, make sure you know how it affects you before driving or operating machinery to lower your risk for accidental injuries. If sleepiness from amitriptyline is impacting your daily activities, contact your provider.
No. Amitriptyline isn't known to have a risk of addiction. It also doesn't have a risk of misuse or dependence. For this reason, amitriptyline isn't considered a controlled substance.
You might start to feel improvements in your depression symptoms after about 2 to 4 weeks of starting amitriptyline. But keep in mind that it generally takes about 1 to 2 months of treatment for you to get the full benefits from antidepressants, including amitriptyline. You might feel some side effects, like sleepiness, dry mouth, dizziness, and nausea, before feeling any benefit from the medication. So don't get discouraged and continue taking amitriptyline regularly. If you're not sure whether amitriptyline is working for you, talk to your provider. Don't stop taking amitriptyline without talking to your provider first because you might get bothersome withdrawal symptoms, such as movement, sleeping, or stomach problems.
Amitriptyline is often used off label to help with nerve pain. You might feel nerve pain relief within a few weeks of starting amitriptyline. Keep in mind that you might feel side effects, like sleepiness, dry mouth, and dizziness, first before pain relief, but they should get better as you continue taking the medication. Don't get discouraged, and continue taking amitriptyline regularly. Let your provider know if you feel amitriptyline isn't working to relieve your pain.
It takes about 2 to 6 days for most of amitriptyline to leave your body after a single dose. Keep in mind that this time frame is an estimate based on the half-life of amitriptyline, a measurement of how long it takes for your body to clear half of the medication from your system. The time it takes to clear amitriptyline out of your system can differ from person to person depending on certain factors, such as your age or your genetics. If you're having side effects from amitriptyline, they might last up until the time it takes for the medication to clear out of your system.
No, amitriptyline isn't an SSRI, or a selective serotonin reuptake inhibitor. Instead, amitriptyline is a tricyclic antidepressant (TCA). Both SSRIs and TCAs are antidepressants that are used to help with depression. But they differ slightly in how they work in the brain and what side effects they cause.
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Risks and warnings for Amitriptyline
Amitriptyline can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Worsening depression, suicidal thoughts, and unusual behavior
- Risk factors: Age under 24 years old | History of depression or other mental health conditions
Taking amitriptyline can make your depression worse and cause you to have thoughts of suicide or harming yourself. The risk is highest if you're 24 years of age or younger, during the first few weeks of taking the medication, and when your dose changes. If you or anyone around you notices that you have suicidal thoughts or unusual behavior (e.g., anxiety, panic attacks, difficulty sleeping, feeling angry or irritated, restlessness) while taking amitriptyline, get medical help right away.
Not for use alone in bipolar disorder
Depression can be the first sign of bipolar disorder. If you're at risk for bipolar disorder, taking antidepressants, like amitriptyline, by themselves can trigger a bipolar manic episode. Before starting amitriptyline, your provider will check to see whether you have or are at risk for bipolar disorder. Amitriptyline isn't used to treat bipolar depression. Talk to your provider right away if you or your loved ones notice unusual changes in your behavior, such as racing thoughts, restlessness, getting easily distracted, or unusual talkativeness.
Risk of heart problems, heart attack, or stroke
- Risk factors: History of heart problems | Taking high doses of amitriptyline
It's possible for amitriptyline to affect your heart rhythm and cause a fast or irregular heart beat (e.g., arrhythmia). In addition, some people taking medications like amitriptyline have had a heart attack or stroke during treatment. If you have any heart problems or had a stroke before, talk to your provider before starting amitriptyline to see whether this medication is right for you.
Seizures
- Risk factors: History of seizures | Taking high doses of amitriptyline
Amitriptyline might raise your risk of seizures, especially when used at higher doses. If you've had a seizure before, discuss with your provider to see whether amitriptyline is right for you.
Glaucoma
- Risk factors: History of angle-closure glaucoma
Amitriptyline can lead to or worsen angle-closure glaucoma. You might need to see your optometrist regularly and get eye exams to check your eyes and make sure your vision isn't worsening. Contact your provider if you notice changes in your vision after starting amitriptyline.
Higher risk of falls
- Risk factors: Age 65 years or older | Low blood pressure | Taking medications that lower blood pressure | History of medical conditions that can lower blood pressure
Amitriptyline can make you feel tired. It can also lower your blood pressure, which can make you feel dizzy or lose your balance. These can all lead to accidental falls and injuries. When standing from a sitting or lying position, make sure to get up slowly and hold onto something. If you still feel dizzy after a couple weeks or experience a fall while taking amitriptyline, contact your provider. They might recommend that you switch to a different medication.
Amitriptyline dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 10mg | 30 tablets | $4.00 | $0.13 |
| 25mg | 30 tablets | $4.00 | $0.13 |
| 50mg | 90 tablets | $10.00 | $0.11 |
| 75mg | 30 tablets | $4.00 | $0.13 |
| 100mg | 90 tablets | $26.12 | $0.29 |
| 150mg | 30 tablets | $18.11 | $0.60 |
Typical dosage for Amitriptyline
- Adults 18 to 64 years old: The typical dose is 50 mg to 100 mg by mouth per day. The dose is either split into several smaller doses throughout the day or taken as a single dose before bedtime. The maximum recommended dose is 150 mg per day.
- Children 12 to 17 years old and adults 65 years and older: The typical starting dose is 10 mg by mouth three times per day along with 20 mg at bedtime.
Your provider will adjust your dose depending on how well you respond to the medication and whether you're having side effects.
More on Amitriptyline dosage
Interactions between Amitriptyline and other drugs
More on Amitriptyline interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Bepridil
- Bromopride
- Cisapride
- Clorgyline
- Dronedarone
- Furazolidone
- Grepafloxacin
- Iproniazid
- Isocarboxazid
- Levomethadyl
- Linezolid
- Mesoridazine
- Methylene Blue
- Metoclopramide
- Moclobemide
- Nialamide
- Pargyline
- Phenelzine
- Pimozide
- Piperaquine
- Procarbazine
- Ranolazine
- Safinamide
- Saquinavir
- Selegiline
- Sparfloxacin
- Terfenadine
- Thioridazine
- Toloxatone
- Tranylcypromine
- Ziprasidone
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acecainide
- Aceclofenac
- Acemetacin
- Albuterol
- Alfentanil
- Alfuzosin
- Almotriptan
- Amiodarone
- Amisulpride
- Amoxapine
- Amphetamine
- Amtolmetin Guacil
- Anagrelide
- Apomorphine
- Aprindine
- Aripiprazole
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Artemether
- Asenapine
- Aspirin
- Astemizole
- Atazanavir
- Azimilide
- Azithromycin
- Benzhydrocodone
- Benzphetamine
- Bretylium
- Bromfenac
- Brompheniramine
- Bufexamac
- Buprenorphine
- Bupropion
- Buserelin
- Buspirone
- Butorphanol
- Celecoxib
- Ceritinib
- Chloral Hydrate
- Chloroquine
- Chlorpheniramine
- Chlorpromazine
- Choline Salicylate
- Ciprofloxacin
- Citalopram
- Clarithromycin
- Clofazimine
- Clomipramine
- Clonidine
- Clonixin
- Clozapine
- Cocaine
- Codeine
- Crizotinib
- Cyclobenzaprine
- Dabrafenib
- Darunavir
- Dasatinib
- Degarelix
- Delamanid
- Desipramine
- Deslorelin
- Desmopressin
- Desvenlafaxine
- Deutetrabenazine
- Dexibuprofen
- Dexketoprofen
- Dextroamphetamine
- Dextromethorphan
- Diclofenac
- Diflunisal
- Dihydrocodeine
- Dipyrone
- Disopyramide
- Dofetilide
- Dolasetron
- Domperidone
- Donepezil
- Doxepin
- Doxorubicin
- Doxorubicin Hydrochloride Liposome
- Droperidol
- Droxicam
- Efavirenz
- Eletriptan
- Encorafenib
- Enflurane
- Entrectinib
- Epinephrine
- Erythromycin
- Escitalopram
- Eslicarbazepine Acetate
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenfluramine
- Fenoprofen
- Fentanyl
- Fepradinol
- Feprazone
- Fingolimod
- Flecainide
- Floctafenine
- Fluconazole
- Flufenamic Acid
- Fluoxetine
- Flurbiprofen
- Foscarnet
- Fostemsavir
- Frovatriptan
- Gatifloxacin
- Gemifloxacin
- Glasdegib
- Glucagon
- Glycopyrrolate
- Glycopyrronium Tosylate
- Gonadorelin
- Goserelin
- Granisetron
- Halofantrine
- Haloperidol
- Halothane
- Histrelin
- Hydrocodone
- Hydromorphone
- Hydroxychloroquine
- Hydroxytryptophan
- Hydroxyzine
- Ibuprofen
- Ibutilide
- Iloperidone
- Imipramine
- Indomethacin
- Inotuzumab Ozogamicin
- Iobenguane I 123
- Iobenguane I 131
- Isoflurane
- Isradipine
- Ivabradine
- Ivosidenib
- Ketoconazole
- Ketoprofen
- Ketorolac
- Lacosamide
- Lapatinib
- Lasmiditan
- Lefamulin
- Lenvatinib
- Levalbuterol
- Levofloxacin
- Levomilnacipran
- Levorphanol
- Lidoflazine
- Lisdexamfetamine
- Lithium
- Lofexidine
- Lopinavir
- Lorcainide
- Lorcaserin
- Lornoxicam
- Loxapine
- Loxoprofen
- Lumefantrine
- Lumiracoxib
- Macimorelin
- Meclofenamate
- Mefenamic Acid
- Mefloquine
- Meloxicam
- Meperidine
- Metaxalone
- Methacholine
- Methadone
- Methamphetamine
- Metronidazole
- Milnacipran
- Mirtazapine
- Moricizine
- Morniflumate
- Morphine
- Morphine Sulfate Liposome
- Moxifloxacin
- Nabumetone
- Nafarelin
- Nalbuphine
- Naproxen
- Naratriptan
- Nefazodone
- Nefopam
- Nepafenac
- Niflumic Acid
- Nilotinib
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Norepinephrine
- Norfloxacin
- Nortriptyline
- Octreotide
- Ofloxacin
- Ondansetron
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Oxaprozin
- Oxycodone
- Oxymetazoline
- Oxymorphone
- Oxyphenbutazone
- Ozanimod
- Paliperidone
- Palonosetron
- Panobinostat
- Parecoxib
- Paroxetine
- Pasireotide
- Pazopanib
- Peginterferon Alfa-2b
- Pentamidine
- Pentazocine
- Phenylbutazone
- Piketoprofen
- Pimavanserin
- Piroxicam
- Pitolisant
- Pixantrone
- Ponesimod
- Posaconazole
- Pranoprofen
- Procainamide
- Prochlorperazine
- Proglumetacin
- Promethazine
- Propafenone
- Propoxyphene
- Propyphenazone
- Proquazone
- Protriptyline
- Quetiapine
- Quinidine
- Quinine
- Rasagiline
- Remifentanil
- Revefenacin
- Ribociclib
- Risperidone
- Rizatriptan
- Rofecoxib
- Salicylic Acid
- Salsalate
- Scopolamine
- Secretin Human
- Selpercatinib
- Sematilide
- Sertindole
- Sertraline
- Sevoflurane
- Sibutramine
- Siponimod
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- Sodium Salicylate
- Solifenacin
- Sorafenib
- Sotalol
- Spiramycin
- Sufentanil
- Sulfamethoxazole
- Sulindac
- Sulpiride
- Sultopride
- Sumatriptan
- Sunitinib
- Tacrolimus
- Tapentadol
- Tedisamil
- Telavancin
- Telithromycin
- Tenoxicam
- Tetrabenazine
- Tiaprofenic Acid
- Tiotropium
- Tolfenamic Acid
- Tolmetin
- Toremifene
- Tramadol
- Trazodone
- Triclabendazole
- Trifluoperazine
- Trimethoprim
- Trimipramine
- Triptorelin
- Tryptophan
- Valdecoxib
- Vandetanib
- Vardenafil
- Vemurafenib
- Venlafaxine
- Vilanterol
- Vilazodone
- Vinflunine
- Voclosporin
- Voriconazole
- Vortioxetine
- Zolmitriptan
- Zotepine
- Zuclopenthixol
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acenocoumarol
- Arbutamine
- Atomoxetine
- Bethanidine
- Carbamazepine
- Cimetidine
- Desogestrel
- Diazepam
- Dicumarol
- Dienogest
- Drospirenone
- Ethinyl Estradiol
- Ethynodiol
- Fluvoxamine
- Fosphenytoin
- Galantamine
- Gestodene
- Guanethidine
- Levonorgestrel
- Mestranol
- Nomegestrol
- Norethindrone
- Norgestimate
- Norgestrel
- Phenprocoumon
- Phenytoin
- Rifapentine
- Ritonavir
- S-Adenosylmethionine
- St John's Wort
- Warfarin
How much does Amitriptyline cost?
$4.00
Amitriptyline contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Amitriptyline will not be safe for you to take.
- Currently taking or have taken an MAOI within the last 14 days
- Recent heart attack
What are alternatives to Amitriptyline?
News about Amitriptyline
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