11 Amitriptyline (Elavil) Side Effects You Should Know About

Amitriptyline belongs to a class of medications called tricyclic antidepressants (TCAs). It’s only FDA-approved to treat depression, but it may be prescribed off-label for other medical conditions. This includes anxiety, chronic nerve pain, and insomnia, among others.

Amitriptyline isn’t usually a first-choice treatment for depression. This is because it tends to have more side effects than other antidepressants.

Amitriptyline side effects at a glance

Below is a list of mild, rare, and serious amitriptyline side effects reported in clinical studies. Keep in mind that this isn’t a complete list. Reach out to your healthcare team if you have questions about other possible amitriptyline side effects.

Promotion disclosure

Amitriptyline

Avg retail price

$4.00(Save Free%)

GoodRx discount

$4.00

Compare all prices

Mild amitriptyline side effects include:

• Weight gain

• Nausea

• Constipation

• Dry mouth

• Trouble peeing

• Headache

• Dizziness

• Drowsiness

• Fatigue

• Changes to sex drive

• Heart palpitations

• Orthostatic hypotension (low blood pressure after changing body positions)

• Sweating

• Nightmares

• Ringing in the ears (tinnitus)

• Hair loss

Rare and serious amitriptyline side effects include:

• Enlarged breasts (in both men and women)

• Numbness or tingling of hands and feet

• Increased risk of fractures

• Vision problems

• Agitation

• Changes in behavior

• Hallucinations

• Irregular heartbeat

This medication also has a boxed warning for an increased risk of suicidal thoughts and behavior. This is the FDA’s strictest warning for medications.

Let’s take a closer look at 10 possible amitriptyline side effects and what you can do about them.

EXPERT PICKS: WHAT TO READ NEXT

• Is your antidepressant working? Seven signs can help you assess your treatment.

• Considering a new depression treatment? Learn the best way to switch from one antidepressant to another.

• Amitriptyline and alcohol? A risky combination it’s best to avoid. Here’s why.

1. Weight gain

Some people taking amitriptyline may report changes in their body weight, including weight gain. People also report an increased appetite while taking amitriptyline.

It’s unclear if this happens because of amitriptyline itself, or if appetite improves once depression symptoms lessen. One study found that people taking amitriptyline gained between 1 lb and 16 lbs. But keep in mind that each person may respond differently.

You may be able to manage these weight changes by maintaining a healthy diet, being mindful of snacking, and having a regular exercise plan. If the weight gain is significant or bothering you, it may be a good idea to speak with your prescriber about this effect. They may connect you with a nutrition expert or make changes to your medication.

2. Constipation

Constipation may also be an amitriptyline side effect you experience. TCAs are anticholinergic medications. These types of medications slow down how fast food moves through your intestines, which can lead to constipation.

You may be able to manage constipation by eating plenty of high-fiber foods and drinking more fluids. If that’s not enough, talk to your pharmacist about an over-the-counter (OTC) laxative option.

But if you find you’re dealing with constipation more often than not, it’s likely time to talk to your prescriber. They can suggest other options for relief or a different antidepressant medication.

3. Dry mouth

Dry mouth can also occur when taking anticholinergic medications like amitriptyline. This happens because they lower the amount of saliva produced in your mouth.

You may be able to improve dry mouth by sipping on water or sucking on ice chips throughout the day. Chewing sugar-free gum or using a saliva substitute spray or mouthwash, such as Biotene, may also help. If these tips don’t help, or you’re developing dental issues from the lack of saliva, it may be a good idea to loop in your prescriber.

4. Trouble peeing

Along with constipation, you might also have trouble peeing when you’re taking amitriptyline. Anticholinergic medications can block the signals in charge of contracting your bladder. This can make it harder for you to empty it normally.

This symptom may improve as your body adjusts to amitriptyline. But if you notice you’re barely urinating or not urinating at all, this may be a sign of urinary retention. If left untreated, this can lead to infections or kidney damage, which can be dangerous. Let your prescriber know right away if you spot these symptoms, or if you have pain when peeing or see blood in your urine.

5. Dizziness

Amitriptyline may make you feel dizzy, especially when you first start taking it. Dizziness may be more likely when you go from sitting to standing quickly. This is due to a drop in blood pressure (called orthostatic hypotension). 

Holding on to something and taking it slow when changing positions may be helpful. It’s also a good idea to use caution when driving or performing other tasks that require coordination until you know how amitriptyline affects you. And let you prescriber know if dizziness doesn’t go away or worsens.

6. Drowsiness, confusion, or hallucinations

Amitriptyline can cause drowsiness, and is sometimes even prescribed off-label for insomnia. Taking amitriptyline at night may help lessen daytime sleepiness. But let your prescriber know if you’re feeling too drowsy during the day and it doesn’t improve.

In rare cases, more serious brain-related side effects can develop. These include confusion, hallucinations, or feeling disoriented. If this happens, let your prescriber know right away.

7. Headache

Headache is another common amitriptyline side effect. Anticholinergic medications can be dehydrating, which can make headaches more likely. So staying hydrated may help prevent them. You can also try OTC headache medications, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Just make sure these medications are OK with your prescriber first.

If your headaches don’t go away or worsen, let your healthcare team know. They’ll help find what’s causing them and the best course of treatment for you.

8. Changes to sex drive

Amitriptyline may also cause side effects related to your sex drive.

Less desire for sex and/or erectile dysfunction may happen when taking amitriptyline. This seems to be more likely in males and often improves over time.

But you may also see a rise in your sex drive while taking amitriptyline. Depression can lower your sex drive. So, as your depression symptoms improve, your sex drive may also go up.

If you notice sexual changes when taking amitriptyline, it might help to wait a few weeks to see if they go away on their own. If they’re still bothersome after that, contact your prescriber. Other antidepressants are less likely to cause this side effect, so they may be a better choice for you.

9. Greater risk of bone fractures

TCAs such as amitriptyline may also increase your risk of bone fractures. This isn’t a common side effect, and there isn’t a clear reason why it may happen. Some experts believe falls are the actual cause of these bone fractures. Dizziness and drowsiness are common amitriptyline side effects that can make falls more likely, so this makes sense.

As mentioned, you can help prevent falls by taking amitriptyline at night and moving slowly when standing up. Talk to your prescriber if bone health is a concern for you. They may want to keep an eye on your bone density while you’re taking amitriptyline.

10. Suicidal thoughts

Amitriptyline has a boxed warning (the most serious type of medication warning the FDA can give) for increased suicidal thoughts. This side effect seems to be more common in people ages 24 and younger. All antidepressants include this warning. No matter your age, it’s an important side effect to know about.

You’re more likely to see this side effect soon after starting amitriptyline or after a change in your dose. If you notice negative changes in your mood or behavior while taking amitriptyline, let your prescriber know right away.

If you or someone you know is having thoughts of suicide, you’re not alone, and help is available. Call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.

11. Changes in heart rate

Your heart rate may change when taking amitriptyline. This can include a fast, pounding, or fluttering heart rate. In rare cases, it can also cause a change to your heart rate called QT prolongation. This is more common if you take amitriptyline with other medications that can also cause this side effect.

This side effect is more likely if you take too much amitriptyline. It can also happen if you stop taking amitriptyline suddenly. You shouldn’t stop taking amitriptyline without your prescriber’s OK. They’ll be able to give you directions to safely stop the medication over time.

If you experience changes to your heart rate while taking amitriptyline, contact your prescriber right away. If you also feel faint, have shortness of breath, or experience chest pain get emergency medical attention. These can be signs of a more serious heart problem.

Why trust our experts?

Written by:

Jill Barat, PharmD

Jill Barat, PharmD has nearly 10 years of experience as a pharmacist, including serving as the pharmacist in charge at an independent sterile and non-sterile compounding pharmacy. She also worked as the head of medical content for a telemedicine company.

Reviewed by:

Lauren Freels, PharmD Candidate

During her schooling, Lauren has gained experience in a multitude of fields within pharmacy, such as community, hospital, and nontraditional pathways. All of her experiences have driven her passion for public health and being able to have a positive impact in the healthcare field.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Our editorial standards

Meet our experts