Does Fioricet Work for Migraine Headaches?
Fioricet is a prescription med for migraines containing acetaminophen, caffeine, and butalbital, with limited effectiveness and potential side effects.
amitriptyline
Used for Depression, Migraine
Used for Depression, Migraine
Amitriptyline is also known by the old brand name Elavil. It's a tricyclic antidepressant (TCA) that's approved to treat depression. But it's not used as often today for depression because it can cause a lot of side effects, like sleepiness and weight gain. It also has many drug interactions. Even so, amitriptyline is often used off label for other reasons, like nerve pain from diabetes and to help prevent migraines. Amitriptyline comes as a generic tablet that you take by mouth. The brand name Elavil is no longer available.
What is Amitriptyline?
What is Amitriptyline used for?
How Amitriptyline works
Amitriptyline is a tricyclic antidepressant (TCA). It's not clear how the medication works. But it's thought to treat depression by raising levels of serotonin and norepinephrine in the brain. This can help improve your mood.
When does Amitriptyline start working?Time passed since treatment started:
Drug facts
| Common Brands | Elavil |
|---|---|
| Drug Class | Tricyclic antidepressant |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | Lower-cost generic available |
| Availability | Prescription only |
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
- Blurry vision
- Confusion
- Trouble urinating
- Skin sensitivity to sunlight
- Hair loss
- Low blood pressure when standing up
- Fast heart rate or racing heart
- 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, pain in the left arm, cold sweats, trouble breathing
- Stroke: sudden headache, sudden numbness or weakness on one side of the body, droopy face, confusion, trouble talking, trouble walking
- Serious allergic reaction: trouble breathing, tightness in the throat, hives, itching, fast heartbeat, dizziness, swelling in the face or tongue
When do Amitriptyline possible side effects begin and end?
Time passed since treatment started:
H
D
W
M
Sleepiness
Dizziness
Dry mouth
Risk of worse depression or thoughts of self-harm
Seek immediate medical care if you experience this side effect.
If a line continues to the right, you'll likely keep experiencing this side effect once it starts.
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.
Get your GoodRx coupon
$4.000
GoodRx discount
$4.00
Pros and cons of Amitriptyline
Pros
- Can start to work within 2 to 4 weeks
- Can take with or without food
Cons
- Has many unpleasant side effects, like dry mouth and sleepiness, and drug interactions
- Not the best choice for people with heart problems, trouble urinating, or glaucoma or older adults
Pharmacist tips for Amitriptyline
- You can take amitriptyline with or without food. If it upsets your stomach, try taking it with food next time. This might help calm your stomach.
- You might start to feel better after about 2 to 4 weeks of taking amitriptyline. But it can take 1 to 2 months to feel the full effect. Keep taking amitriptyline as prescribed, even if you don't improve right away. Tell your prescriber if side effects, like sleepiness, dry mouth, or nausea, bother you too much.
- Don't change your dose or stop taking amitriptyline suddenly without talking to your prescriber first. This can cause uncomfortable withdrawal symptoms like nausea, headaches, body aches, or sleep problems. If stopping is the right choice, your prescriber will help lower your dose slowly to prevent withdrawal symptoms.
- Amitriptyline can make you feel tired, sleepy, and dizzy. Don't drive or do anything that needs your full attention until you know how this medication affects you. These side effects might get better as you continue to take the medication for a few weeks.
- Amitriptyline can make your blood pressure drop when you stand up. This can make you feel dizzy or off balance, which can raise your risk of falling. Get up slowly and hold onto something steady after sitting or lying down. If you keep feeling dizzy after a few weeks or if you fall while taking amitriptyline, tell your prescriber.
- Amitriptyline can sometimes make your skin more sensitive to the sun. This can mean that you can get sunburned more easily. When you go outside, be sure to apply sunscreen and wear protective clothing to help prevent sunburn.
- Antidepressants like amitriptyline can raise the risk of suicidal thoughts. Call 911 right away if you or someone close to you notices unusual changes in your behavior or mood while taking this medication.
- If you have diabetes, ask your care team if you need to check your blood sugar more often while taking amitriptyline. This medication can cause blood sugar to go up or down.
- Tell your healthcare team about all the medications you take or plan to take. This helps them make sure your medications are safe to take together. Amitriptyline can interact with many medications and raise the risk of side effects. Taking it with anxiety medications, opioids, or some allergy medications can make you very sleepy. Monoamine oxidase inhibitors (MAOIs) can also raise the risk of a serious problem called serotonin syndrome.
- If you're pregnant or thinking of becoming pregnant, tell your prescriber. They can talk to you about the benefits and risks of taking amitriptyline while pregnant. Note that mental health problems that aren't treated can be harmful for both you and your baby during pregnancy. Your prescriber can help find the safest option for you.
- Let your prescriber know if you want to breastfeed. Amitriptyline can get into breast milk in small amounts. Your prescriber can explain the risks and benefits of taking this medication while breastfeeding. You can also talk to a lactation consultant about other feeding options.
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 or suicidal thoughts and behavior
- Risk factors: Age under 24 years old | History of depression or other mental health conditions
Some people taking amitriptyline for depression might feel worse. This medication can also raise the risk of suidical thoughts or behavior. The risk is highest for people age 24 and younger.
Watch for signs like worsening depression, anxiety, panic attacks, trouble sleeping, or feeling angry or irritated. This is most important during the first few months of treatment or after a dose change. If you or someone close to you notices unusual mood or behavior changes, talk to your care team. Call 911 right away if you have thoughts of hurting yourself.
Serotonin syndrome
- Risk factors: Taking other medications that raise serotonin levels in the brain
Amitriptyline can sometimes cause a serious and sometimes life-threatening problem called serotonin syndrome. This happens when you have too much serotonin in your brain. Amitriptyline can raise serotonin levels.
The risk is higher if you take amitriptyline with other medications that also raise serotonin levels. These include other antidepressants, cough medications with dextromethorphan, and triptans for migraines. Tell your care team about all the medications you take so they can check your risk.
Watch for a high fever, fast heart rate, heavy sweating, stiff muscles, confusion, or restlessness. These can be signs of serotonin syndrome. Stop taking amitriptyline and get medical help right away if you notice these symptoms.
Not for use alone for bipolar disorder
- Risk factors: Personal history of bipolar disorder | Family history of bipolar disorder, depression, or suicide
Depression can sometimes be the first sign of bipolar disorder. Taking an antidepressant like amitriptyline by itself can cause a manic episode in people with bipolar disorder. A manic episode can look like lots of energy, talking rapidly, racing thoughts, and less need for sleep.
Before starting amitriptyline for depression, tell your prescriber if you or anyone in your family has bipolar disorder. They'll check your risk and make sure you get the right care. Amitriptyline isn't approved to treat bipolar depression. Get medical help right away if you or someone close to you thinks you're having a manic episode.
Risk of heart problems, heart attack, or stroke
- Risk factors: History of heart problems | Taking high doses of amitriptyline
Before starting amitriptyline, talk to your prescriber if you have any heart problems or have had a stroke before. They can help decide if this medication is safe for you. Amitriptyline, especially at higher doses, might affect heart rhythm (arrhythmia). Some people taking tricyclic antidepressants like amitriptyline have had a heart attack or stroke.
Let your prescriber know if your heart feels like it's beating oddly while taking amitriptyline. Get medical help right away if you have chest pain, pain in your left arm, cold sweats, or trouble breathing. These can be signs of a heart attack. Also get emergency help if you have signs of a stroke. This can look like a sudden headache, weakness on one side of the body, a droopy face, confusion, or trouble speaking.
Low sodium levels
- Risk factors: Older adults | Medical condition called syndrome of inappropriate antidiuretic hormone (SIADH) | Taking diuretics (water pills) | Dehydrated or low fluid levels in the body
Amitriptyline can sometimes lower the sodium levels in the body. Low sodium can cause headaches, trouble concentrating, memory problems, confusion, weakness, or balance problems. If you notice any of these symptoms, call your prescriber right away.
Risk of seizure
- Risk factors: History of seizures | Taking high doses of amitriptyline
Amitriptyline might raise your risk of seizures, especially at higher doses. This is one of the reasons why you start at a low dose and why your prescriber will slowly raise the dose over time. If you've had a seizure before, talk to your prescriber to make sure amitriptyline is safe for you. If you have a seizure while taking amitriptyline, get medical help right away.
Angle-closure glaucoma in certain people
- Risk factors: History of angle-closure glaucoma | Have narrow-angle eyes but haven't had laser eye surgery for it yet
Antidepressants like amitriptyline can sometimes cause a sudden eye problem called an angle-closure attack. This is more likely in people with narrow-angle eyes who haven't had laser eye surgery. Tell your prescriber if you've had angle-closure glaucoma before.
Call your eye specialist right away if you have signs of an angle-closure attack. This can include sudden blurry vision, severe eye pain, or see halos around lights. This is a serious eye problem that needs urgent medical care.
Amitriptyline dosage
The average cost for 30 tablets of 25mg of Amitriptyline is $4.00 with a free GoodRx coupon. This is 0.00% off the average retail price of $4.00. 
Tablet
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 | $30.15 | $0.34 |
| 150mg | 30 tablets | $19.67 | $0.66 |
Typical dosage for Amitriptyline
You typically start at a low dose of amitriptyline. Then, your prescriber will adjust your dose depending on how well it's working for you and if you have side effects.
For depression:
- Adults 18 to 64 years old: The typical dose is 50 mg to 100 mg by mouth per day. The dose can be taken in smaller amounts throughout the day or all at once at bedtime. The maximum recommended dose is 150 mg per day.
- Adults 65 years and older: The typical starting dose is 10 mg by mouth three times a day along with 20 mg at bedtime. Your prescriber will adjust the dose based on your needs.
- Children 12 to under 18 years old: The typical starting dose is 10 mg by mouth three times a day along with 20 mg at bedtime. The prescriber will adjust the dose based on your child's needs.
More on Amitriptyline dosage
Interactions between Amitriptyline and other drugs
Amitriptyline may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Amitriptyline. Please note that only the generic name of each medication is listed below.
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?
To access savings, use a GoodRx coupon and pay just a fraction of the retail price.
Amitriptyline (generic)
$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 take or have taken a monoamine oxidase inhibitor (MAOI) within the last 14 days
- Currently recovering from a heart attack
What are alternatives to Amitriptyline?
There are a number of medications that your doctor can prescribe in place of Amitriptyline. Compare a few possible alternatives below.
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Amitriptyline images
