Amitriptyline dosage depression
Amitriptyline: an antidepressant medicine - NHS
1. About amitriptyline for depression
Amitriptyline is an antidepressant medicine. It's used to treat low mood and depression.
This medicine is only available on prescription. It comes as tablets and as a liquid.
Amitriptyline is also used for some types of pain and to prevent migraines. Find out more about amitriptyline for pain and migraine.
2. Key facts
- Amitriptyline is an antidepressant medicine. It works by increasing levels of a chemical called serotonin in your brain. This can improve your mood.
- You may start to feel better after 1 to 2 weeks but it can take 4 to 6 weeks for amitriptyline to work fully.
- Side effects such as a dry mouth and constipation are common. They're usually mild and go away after a couple of weeks.
- It's best to take amitriptyline in the evening or before you go to bed. This is because it can make you feel sleepy.
- Amitriptyline can cause side effects if you stop taking it suddenly. Talk to your doctor if you want to stop taking it.
3. Who can and cannot take amitriptyline
Most adults can take amitriptyline. It can also be taken by young people aged 16 to 17 years for depression or low mood.
Amitriptyline is not suitable for some people. To make sure it's safe for you, check with your doctor if you:
- have ever had an allergic reaction to amitriptyline or any other medicine
- have a heart problem – amitriptyline can make some heart problems worse
- have a rare blood disorder called porphyria
- have liver problems
- have epilepsy or are having electroconvulsive treatment (ECT) – amitriptyline may increase your risk of having a fit or seizure
- are pregnant, trying to get pregnant or breastfeeding
- have glaucoma – amitriptyline can increase the pressure in your eye
- have thoughts about harming yourself or ending your life
- have problems emptying your bladder
- have type 1 or type 2 diabetes
If you have diabetes, amitriptyline can make it more difficult to keep your blood sugar stable.
Monitor your blood sugar more often for the first few weeks of treatment with amitriptyline and adjust your diabetes treatment if necessary. Speak to your doctor if your blood sugar levels are causing you concern.
4. How and when to take amitriptyline for depression
You'll usually take amitriptyline once a day. It's best to take it before bedtime because it can make you feel sleepy. If you find that you are still feeling drowsy in the morning you could try taking it earlier in the evening.
Dosage and strength
Amitriptyline tablets come in different strengths of 10mg, 25mg or 50mg.
Amitriptyline liquid also comes in 3 different strengths containing 10mg, 25mg or 50mg of amitriptyline in a 5ml spoonful.
The usual dose of amitriptyline for depression in adults is 50mg to 100mg a day. This may go up to 150mg a day if you need a stronger dose, but only under the supervision of a specialist.
Young people aged 16 to 17 years and older people sometimes start on a lower dose of 25mg to 50mg a day to reduce the chance of side effects.
The maximum dose of amitriptyline is 150mg per day.
Sometimes, when you're just starting treatment, you may be told to take a lower dose, 2 or 3 times a day, until you get used to the medicine. This is because taking a smaller dose 2 or 3 times a day for a while can reduce the chance of you having side effects.
How to take it
Amitriptyline does not usually upset your stomach, so you can take it with or without food.
Swallow the tablets whole with a drink of water. If you chew them, they taste bitter.
The liquid comes with a plastic syringe or spoon to help you measure out the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.
What if I forget to take it?
If you take amitriptyline once a day and forget a dose, leave your missed dose and take your next one the next day at the usual time.
If you take amitriptyline 2 or 3 times a day and forget a dose, take it as soon as you remember unless it's close to the time for your next dose.
Never take 2 doses at the same time to make up for a forgotten dose.
If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
What if I take too much?
The amount of amitriptyline that can lead to an overdose varies from person to person.
Taking more than your prescribed dose of amitriptyline can:
- make you feel agitated
- make you sick (vomiting)
- cause shaking
- cause a fast heart rate
- cause fits or seizures (shaking and jerking uncontrollably)
Urgent advice: Contact 111 for advice now if:
- you've taken more than your prescribed dose of amitriptyline
Go to 111.
nhs.uk or call 111
If you need to go to A&E do not drive yourself. Get someone else to drive you or call for an ambulance.
Take the amitriptyline packet, or the leaflet inside it, plus any remaining medicine with you.
5. Side effects
Like all medicines, amitriptyline can cause side effects in some people, but many people have no side effects or only minor ones. Some of the common side effects of amitriptyline will gradually improve as your body gets used to the medicine.
Common side effects
Keep taking the medicine but talk to your doctor or pharmacist if these common side effects bother you or do not go away:
- constipation
- dizziness
- dry mouth
- feeling sleepy, tired or weak
- difficulty peeing
- headaches
Serious side effects
It happens rarely, but some people have a serious side effect after taking amitriptyline.
Call a doctor straight away if:
- your heartbeat becomes fast or irregular
- the whites of your eyes turn yellow, or your skin turns yellow although this may be less obvious on brown or black skin, or you have dark pee – these can be signs of a liver problem
- you have constant headaches, long lasting confusion or weakness, and frequent muscle cramps – together, these can be a sign of low sodium levels in your blood. In severe cases low sodium levels can lead to a fit or seizure
- you have thoughts about harming yourself or ending your life
- you have eye pain, a change in your eyesight, or swelling or redness in or around your eye
- you have constipation that lasts a long time, or problems peeing which are causing stomach ache
Immediate action required: Call 999 and ask for an ambulance if:
- you have weakness on one side of your body
- you have trouble speaking or thinking
- you lose your balance or have blurred eyesight
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to amitriptyline.
Immediate action required: Call 999 or go to A&E now if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of amitriptyline. For a full list see the leaflet inside your medicines packet.
Information:
You can report any suspected side effect using the Yellow Card safety scheme.
Visit Yellow Card for further information.
6. How to cope with side effects of amitriptyline
What to do about:
- constipation – eat more high-fibre foods such as fresh fruit and vegetables and cereals.
Try to drink several glasses of water or other non-alcoholic drinks every day. If you can, it may also help to increase your level of exercise. - feeling dizzy – this is probably due to low blood pressure. Drink plenty of water or other non-alcoholic drinks. Do not stand up too quickly after you have been sitting or lying down. Do not drive until you stop feeling dizzy.
- dry mouth – try sugar-free gum or sugar-free sweets.
- feeling sleepy or tired – take amitriptyline in the evening and try to cut down the amount of alcohol you drink. Do not drive, cycle or use tools or machinery if you're feeling sleepy. Talk to your doctor if this does not help.
- difficulty peeing – try to relax when you pee. Do not try to force the flow of urine. If you still cannot go, try again later. Talk to your doctor urgently if you cannot pee at all.
- headaches – make sure you rest and drink plenty of fluids.
Try not to drink too much alcohol. Paracetamol and ibuprofen may help if you need pain relief. Talk to your doctor if the headaches last longer than a week or are severe.
7. Pregnancy and breastfeeding
Amitriptyline and pregnancy
If you are already taking amitriptyline, you may be advised to continue taking it during pregnancy, especially if you take it to treat depression.
If you become pregnant while taking amitriptyline, speak to your doctor. Do not stop taking your medicine unless your doctor tells you to.
Your doctor can explain how taking amitriptyline can help you and how it might affect you. They will also help you choose the best treatment for you and your baby.
Amitriptyline and breastfeeding
If your doctor or health visitor says your baby is healthy, you can take amitriptyline while breastfeeding.
Amitriptyline passes into breast milk in very small amounts, so it's unlikely to cause any harm to your baby.
It's important to keep taking amitriptyline to keep you well. Breastfeeding will also benefit both you and your baby.
If you notice that your baby is not feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, then talk to your midwife, health visitor or doctor as soon as possible.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
- pregnant
- breastfeeding
For more information about how amitriptyline can affect you and your baby during pregnancy, find out more on the Best Use of Medicines in Pregnancy (BUMPS) website.
8. Cautions with other medicines
Many medicines and amitriptyline can affect each other and increase the chances of side effects.
Always check with your doctor or a pharmacist before starting any new medicine while you are taking amitriptyline.
Taking amitriptyline with opioid medicines can increase your risk of becoming very drowsy and having breathing problems. Opioid medicines include:
- codeine
- morphine
- dihydrocodeine
- buprenorphine
- fentanyl
- oxycodone
Tell your doctor if you have ever taken any other medicines for depression. Some antidepressants can affect the way amitriptyline works and cause very high blood pressure. This can happen even after you have stopped taking them.
Mixing amitriptyline with herbal remedies and supplements
Do not take St John's wort, a herbal remedy for depression, while you're taking amitriptyline as this will increase your risk of side effects.
There's very little information about taking amitriptyline with other herbal remedies and supplements. They are not tested in the same way as medicines.
Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions about amitriptyline
How does amitriptyline work in depression?Amitriptyline is from a group of medicines called tricyclic antidepressants. They are thought to work by increasing levels of a chemical called serotonin in your brain. This can improve your mood.
When will I feel better?You may find you are feeling better after a couple of weeks, although it usually takes between 4 and 6 weeks before you feel the full benefit of the medicine.
Do not stop taking amitriptyline after 1 or 2 weeks just because you feel it is not helping your symptoms.
Give the medicine at least 6 weeks to work.
Antidepressants like amitriptyline help to gradually lift your mood so you feel better. You may notice that you sleep better and get on with people more easily because you're less anxious. Hopefully you'll take little things that used to worry you in your stride.
Amitriptyline will not change your personality or make you feel euphorically happy. It will simply help you feel like yourself again.
Do not expect to feel better overnight though. Some people feel worse during the first few weeks of treatment before they begin to feel better.
How long will I take it for?Once you're feeling better it's likely that you will keep taking amitriptyline for several more months. Most doctors recommend that you take antidepressants for 6 months to a year after you've stopped feeling depressed.
Stopping before then can make depression come back.
Talk to your doctor about the risks and benefits of taking amitriptyline for longer than a few months. It will depend on:
- how bad your symptoms are
- whether it's a one-off problem or it keeps coming back
- how well amitriptyline works for you
- any bad side effects you've had
Amitriptyline is safe to take for a long time. There do not seem to be any lasting harmful effects from taking it for many months or years.
Is it addictive?Amitriptyline is not addictive but you can get withdrawal side effects if you stop taking it suddenly.
Do not stop taking it without talking to your doctor first.
What will happen when I stop taking it?If you've been feeling better for 6 months or more, your doctor may suggest coming off amitriptyline.
Your doctor may recommend reducing your dose gradually over several weeks, or longer if you have been taking amitriptyline for a long time.
This is to help prevent any withdrawal side effects you might get as a reaction to coming off the medicine. These include:
- feeling dizzy
- feeling sick
- numbness or tingling in the hands or feet
- trouble sleeping
- feeling agitated or anxious
- headaches
- shaking
Important: Important
Do not stop taking amitriptyline suddenly, or without talking to your doctor first.
Will I gain or lose weight?Amitriptyline can change how hungry you feel. Some people feel more hungry when they're taking it, while others feel less hungry.
So your weight may change when you first start taking it.
If you start to have problems with your weight while taking amitriptyline, talk to your doctor or a pharmacist.
Can I drive or ride a bike?Some people feel sleepy while they're taking amitriptyline. It's best to stop driving and cycling for the first few days of treatment until you know how this medicine makes you feel.
It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.
Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking amitryptyline. GOV.UK has more information on the law on drugs and driving.
Is amitriptyline better than other antidepressants?Amitriptyline does not work any better or worse than other antidepressants.
However, for some people, the side effects are a problem and they may have fewer side effects with another antidepressant. Sometimes people respond better to one antidepressant than to another.
Talk to your doctor if you are not feeling any better after taking amitriptyline for 6 weeks, or sooner if the side effects are still a problem.
Are there other treatments that will help?Antidepressants, including amitriptyline, are just one of several approaches to treating depression. Other potential treatments include:
- talking therapy (such as cognitive behavioural therapy (CBT))
- exercise programmes
- help to get a good night's sleep
Choosing a treatment that's most suitable for you depends on:
- how long you've had depression
- your symptoms
- whether you've had depression before
- whether previous treatment has worked
- how likely you are to stick with your treatment
- the potential side effects
- your preferences and priorities
You can drink alcohol while taking amitriptyline but it may make you feel sleepy.
It might be best to stop drinking alcohol until you see how the medicine makes you feel.
You can eat and drink normally while taking amitriptyline. However, it might be best to stop drinking alcohol until you see how the medicine makes you feel.
Will it affect my contraception?Amitriptyline does not affect any type of contraception, including the combined pill and emergency contraception.
Will it affect my sex life?The good effects of amitriptyline may, after a while, improve your sex life as your mood lifts and you become interested in life and relationships again.
Some of the possible negative effects include:
- having problems with getting an erection and problems ejaculating
- having some vaginal bleeding
Sexual side effects are not common and should pass after the first couple of weeks.
If they do not, and this is a problem for you, go back to your doctor to see if there's another antidepressant you can try.
If you get vaginal bleeding after the menopause make an appointment to see your doctor as soon as possible.
Will it affect my fertility?There's no evidence that amitriptyline affects either male or female fertility.
Will recreational drugs affect it?Cannabis with amitriptyline can give you a fast heartbeat. Cannabis can also make drowsiness worse, especially if you've just started taking amitriptyline.
Methadone and other opiates (for example, heroin) can increase the risk of severe drowsiness if you're taking amitriptyline.
It can be dangerous to take amitriptyline with:
- stimulants like MDMA (ecstasy) or cocaine
- hallucinogens like LSD
- novel psychoactive substances (previously called legal highs), like mephedrone
Find out more the side effects of some recreational drugs on the Frank website.
Important: Important
Amitriptyline has not been properly tested with recreational drugs. Talk to your doctor if you think you might use recreational drugs while taking amitriptyline.
Amitriptyline: a medicine used to treat pain and prevent migraine
1. About amitriptyline for pain and migraine
Amitriptyline is a medicine used for treating pain. You can take it:
- to treat nerve pain (neuralgia) and back pain
- to help prevent migraine attacks
Amitriptyline is available on prescription. It comes as tablets and as a liquid that you drink.
Amitriptyline is also used to treat depression.
Read about amitriptyline for depression.
2. Key facts
- It's best to take your amitriptyline in the evening or before you go to bed.
This is because it can make you feel sleepy. - You may start to feel better after 1 or 2 weeks, but it can take 6 weeks for amitriptyline to work as a painkiller.
- Amitriptyline can cause extra side effects if you stop taking it suddenly. Talk to your doctor if you want to stop taking it.
- Amitriptyline is also used to treat depression, but at lower doses it's very good for treating pain.
3. Who can and cannot take amitriptyline
Most adults (aged 18 and over) can take amitriptyline. Children aged 2 years and older can take it for some types of nerve pain.
Amitriptyline is not suitable for some people. Check with your doctor before starting to take amitriptyline if you:
- have ever had an allergic reaction to amitriptyline or any other medicine
- have a heart problem – amitriptyline can make some heart problems worse
- have a rare blood disorder called porphyria
- have liver or kidney problems
- have epilepsy – amitriptyline can increase seizures or fits
- have ever taken any medicines for depression – some antidepressants used rarely can affect the way amitriptyline works
- are pregnant, trying to become pregnant, or breastfeeding
- have an eye problem called glaucoma – amitriptyline can increase the pressure in your eye
- have thoughts about harming yourself or ending your life
- have type 1 or type 2 diabetes
If you have diabetes, amitriptyline may change your blood sugar level.
If you usually test your blood sugar levels, you may have to do this more often for the first few weeks of treatment. Talk to your diabetes doctor if the reading goes too high or low.
4. How and when to take amitriptyline
It's usual to take amitriptyline once a day. It's best to take it before bedtime because it can make you feel sleepy. If you find that you are still feeling drowsy in the morning you could try taking it earlier in the evening.
This medicine does not usually upset your stomach. You can take it with or without food.
Swallow the tablets whole, with a drink of water. If you chew them, they taste bitter.
The liquid comes with a plastic syringe or spoon to help you measure out the right dose. If you don't have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give the right amount.
Dosage
Amitriptyline tablets come in 3 different strengths – 10mg, 25mg or 50mg.
The liquid also comes in 3 different strengths – containing 10mg, 25mg or 50mg of amitriptyline in a 5ml spoonful.
The usual starting dose for adults and older children (aged 12 to 17 years) is 10mg a day. This dose can be increased by your doctor if you need better pain relief.
The starting dose for younger children depends on their weight and symptoms. The doctor will tell you how much to give them.
The maximum dose of amitriptyline for treating pain is 75mg a day. Your doctor may give you a higher dose if you're taking it to prevent migraine.
What if I forget to take it?
If you forget to take your amitriptyline, take it as soon as you remember, unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next one as normal.
If amitriptyline usually makes you sleepy and you need to drive, cycle or use tools or machinery, skip the missed dose and then take the next dose as normal.
Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.
If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
What if I take too much?
Urgent advice: Contact 111 for advice now if:
- you take more than your usual dose of amitriptyline
Go to 111.nhs.uk or call 111
Taking too much amitriptyline can cause serious side effects such as a change in your heartbeat, seizures or fits.
5. Side effects
Like all medicines, amitriptyline can cause side effects in some people, but many people have no side effects or only minor ones.
Some of the common side effects of amitriptyline gradually improve as your body gets used to the medicine.
Common side effects
Doses of amitriptyline for pain are lower than the doses for depression. This means the common side effects tend to be milder and go away within a few days.
Keep taking the medicine but talk to your doctor or pharmacist if these side effects bother you or do not go away:
- constipation
- dizziness
- dry mouth
- feeling sleepy
- difficulty peeing
- headache
Serious side effects
It happens rarely, but some people have a serious side effect after taking amitriptyline.
Call a doctor straight away if you have:
- a fast or irregular heartbeat
- yellow skin, or the whites of your eyes go yellow – these can be signs of a liver problem
- a headache, feel confused or weak, or get muscle cramps – these can be signs of a low sodium level in your blood
- thoughts about harming yourself or ending your life
- eye pain, a change in your eyesight, swelling or redness in or around your eye
Immediate action required: Call 999 or go to A&E if:
- you have weakness on one side of your body, trouble speaking or thinking, loss of balance or blurred eyesight – these can be signs of a stroke
- you have had a seizure or fit
- you get severe chest pain – this can be a sign of a heart attack
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to amitriptyline.
Immediate action required: Call 999 or go to A&E now if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of amitriptyline. For a full list see the leaflet inside your medicine packet.
Information:
You can report any suspected side effect using the Yellow Card safety scheme.
Visit Yellow Card for further information.
6. How to cope with side effects of amitriptyline
What to do about:
- constipation – eat more high-fibre foods such as fresh fruit and vegetables and cereals.
Try to drink several glasses of water or other non-alcoholic drinks every day. If you can, it may also help to do some exercise. - dizziness – this is probably due to low blood pressure. Drink plenty of water or other non-alcoholic drinks. Do not stand up too quickly after you have been sitting or lying down.
- dry mouth – try sugar-free gum or sugar-free sweets.
- feeling sleepy or tired – take amitriptyline in the evening and cut down on the amount of alcohol you drink. Do not drive, cycle or use tools or machinery if you're feeling this way.
- difficulty peeing – relax when you try to pee. Do not try to force the flow of urine. If you still cannot go, try again later. Talk to your doctor urgently if you cannot pee at all.
- headaches – make sure you rest and drink plenty of fluids. Do not drink too much alcohol.
Try taking paracetamol or ibuprofen if you need pain relief. Talk to your doctor if the headaches last longer than a week or are severe.
7. Pregnancy and breastfeeding
Amitriptyline and pregnancy
Amitriptyline is generally not recommended in pregnancy. This is because it has been linked to a small risk of problems for your baby if you take it in early or late pregnancy.
Talk to your doctor as there may be other painkillers you can take instead of amitriptyline. Paracetamol is usually the first choice of painkiller if you're pregnant or breastfeeding.
Your doctor will only prescribe amitriptyline for your pain while you're pregnant if the benefits of taking the medicine outweigh the risks.
Amitriptyline and breastfeeding
Amitriptyline is not usually recommended if you're breastfeeding.
Amitriptyline gets into breast milk. It's been linked with side effects like sleepiness in breastfed babies.
Talk to your doctor if you want to breastfeed. There may be other medicines that you can take instead of amitriptyline.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
- pregnant
- breastfeeding
For more information about how this medicine can affect you and your baby during pregnancy, read this leaflet about amitriptyline on the Best Use of Medicines in Pregnancy (BUMPs) website.
You can also read more about paracetamol in pregnancy on the NHS website.
8. Cautions with other medicines
Many medicines and amitriptyline can affect each other and increase the chances of side effects.
Always check with your doctor or a pharmacist before starting any new medicine while you are taking amitriptyline.
Taking opioid-based medicines, like codeine, morphine or oxycodone, together with amitriptyline can increase your risk of becoming very drowsy and having breathing problems.
Tell your doctor if you have ever taken any medicines for depression. Some antidepressants can affect the way amitriptyline works to cause very high blood pressure. This can happen even after you have stopped taking them.
Mixing amitriptyline with herbal remedies and supplements
Do not take St John's wort, a herbal remedy often taken for depression, while you are being treated with amitriptyline. It will increase your risk of side effects.
There’s very little information about taking amitriptyline with other herbal remedies and supplements. They are not tested in the same way as medicines.
Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions about amitriptyline
How does amitriptyline work?Amitriptyline is from a group of medicines called tricyclic antidepressants.
They are thought to work by increasing a chemical called serotonin in your brain. This can improve your mood.
This can also change the way that your nerves receive pain signals so pain goes away. This helps your symptoms if you are taking amitriptyline for pain relief or migraine.
When will I feel better?You may find you are sleeping better straight away. But it usually takes 1 or 2 weeks for pain to begin to wear off.
It can take between 4 and 6 weeks before you feel the full benefits of amitriptyline as a painkiller.
Do not stop taking amitriptyline after 1 to 2 weeks just because you feel it's not helping your symptoms.
Give it at least 6 weeks to work.
Many people sleep better while they're taking amitriptyline.
Although amitriptyline is an antidepressant, the doses are lower to help pain. Taking amitriptyline as a painkiller will not change your personality or make you feel any different.
How long will I take amitriptyline for?Once you're feeling better you'll probably continue to take amitriptyline for as long as it's working for you as a painkiller or to help prevent migraines.
Some people take it for many months and even for years.
Is it safe to take amitriptyline for a long time?Amitriptyline is safe to take for a long time. There do not seem to be any lasting harmful effects from taking it for many months or years.
Is amitriptyline addictive?Amitriptyline is not addictive but you can get extra side effects if you stop taking it suddenly.
You may have flu-like symptoms like feeling sick, muscle pain and feeling tired or restless.
To help prevent this happening, your doctor will probably recommend reducing your dose gradually over several weeks – or longer, if you have been taking amitriptyline for a long time.
What will happen when I stop taking amitriptyline?You may get extra side effects when you stop taking amitriptyline, especially if you stop taking it suddenly.
These side effects are a physical reaction as the medicine leaves your system. You may get flu-like symptoms like feeling sick, muscle pain and feeling tired or restless.
To help prevent them, your doctor will probably recommend reducing your dose gradually over several weeks – or longer, if you have been taking amitriptyline for a long time.
Important: Important
Do not stop taking amitriptyline suddenly, or without talking to your doctor.
Amitriptyline can change how hungry you feel. Some people feel more hungry when they're taking it – others feel less hungry. So your weight may change when you first start taking it.
If you start to have problems with your weight while taking amitriptyline, talk to your doctor or a pharmacist
Can I drive or ride a bike?Some people feel sleepy while they're taking amitriptyline. It is best to stop driving and cycling for the first few days of treatment until you know how this medicine makes you feel.
Are there other treatments for nerve pain or migraines?Antidepressants like amitriptyline are just one of several ways to treat nerve pain or prevent migraine. Other treatments include:
- painkillers such as paracetamol
- medicines that are usually used for epilepsy such as pregabalin
- medicines that are usually used to treat high blood pressure such as propranolol
- physiotherapy
Choosing a treatment that's most suitable for you depends on:
- how long you've had the pain
- your symptoms
- what medicines have worked or not worked for you in the past
You can drink alcohol while taking amitriptyline but it may make you feel sleepy.
It's usually best to stop drinking alcohol until you see how the medicine makes you feel.
Apart from avoiding drinking too much alcohol, you can eat and drink normally while taking amitriptyline.
Will it affect my contraception?Amitriptyline does not affect any type of contraception including the combined pill and emergency contraception.
Will amitriptyline affect my sex life?Some people have sex-related problems while taking amitriptyline. These can include:
- men having problems with getting an erection and problems with ejaculating
- women having some vaginal bleeding
- both men and women having breast swelling
Sexual side effects are not common and should pass after the first couple of weeks.
If they do not, and this is a problem for you, go back to your doctor to see if there's another medicine you can try.
If you're a woman and you get vaginal bleeding after the menopause, make an appointment to see your doctor as soon as possible.
Will amitriptyline affect my fertility?There is no clear evidence that amitriptyline affects either male or female fertility.
Will recreational drugs affect amitriptyline?Cannabis with amitriptyline can make you feel very sleepy, especially if you've just started taking amitriptyline. Cannabis with amitriptyline can also give you a fast heartbeat.
It is potentially dangerous to take amitriptyline with:
- methadone
- stimulants like MDMA (ecstasy) or cocaine
- hallucinogens like LSD
- novel psychoactive substances (previously called "legal highs") like mephedrone
Amitriptyline has not been properly tested with recreational drugs.
Talk to your doctor if you think you might use recreational drugs while taking amitriptyline.
Arpimed
Reception of Amitriptyline is possible not earlier than 14 days after discontinuation of MAO inhibitors.
Warnings and precautions
Talk to your doctor or pharmacist before using Amitriptyline.
Arrhythmias and hypotension may occur with high doses of amitriptyline. This can also occur at regular doses if you suffer from heart disease.
QT prolongation
Cardiac abnormalities called “QT prolongation” (as seen on an electrocardiogram, ECG) and arrhythmia (rapid or irregular heartbeat) have been observed with Amitriptyline. Tell your doctor if:
- you have a slow heartbeat,
- you have or have had problems where your heart is not able to supply the body with the blood it needs (a condition called heart failure),
- are taking other medicines that can cause heart problems, or
- have a disorder that results in low levels of potassium or magnesium or high levels of potassium in the blood
- if you are preparing for surgery, as it may be necessary to stop taking amitriptyline before administering anesthetics.
In case of emergency surgery, the anesthesiologist should be informed about the treatment with amitriptyline. - have an overactive thyroid or are taking thyroid medication.
Suicidal thoughts and worsening of your depressive disorder
If you are depressed, you may sometimes have suicidal thoughts and desire to hurt yourself. These may be increased the first time antidepressants are used, as these drugs take time to develop an effect, about 2 weeks or more.
This is especially observed in the following categories of patients:
- if you have had suicidal thoughts and desire to hurt yourself in the past,
- if you are young. Data from clinical studies have shown that an increased risk of suicidal tendencies occurs in people under the age of 25 with psychiatric disorders treated with antidepressants.
If you have suicidal thoughts and want to hurt yourself, call your doctor or go to the hospital right away.
It may be helpful to tell a relative or close friend that you are depressed and ask them to read this leaflet. You can ask them to tell you if they think your depression or anxiety is getting worse, or if they are worried about changes in your behavior.
Manic episode
Some patients with manic-depressive illness may enter a manic phase. It is characterized by exuberant and rapidly changing ideas, hyperthymia (persistent high spirits), and excessive physical activity.
Tell your doctor if you have or have recently had health problems, especially if you have
- narrow angle glaucoma (loss of vision due to an abnormal increase in intraocular pressure)
- epilepsy, history of convulsions or seizures
- difficulty urinating
- prostate enlargement
- diseases of the thyroid gland
- bipolar disorder
- schizophrenia
- acute liver diseases
- severe heart disease
- pyloric stenosis (narrowing of the opening at the outlet of the stomach) and paralytic ileus (intestinal obstruction)
- diabetes, because you may need to adjust the dose of your diabetes medicine.
If you are using antidepressants such as selective serotonin reuptake inhibitors (SSRIs), your doctor may consider changing the dose of your medicine (see section Other drugs and Amitriptyline and section How to take Amitriptyline).
Older people are more likely to experience certain side effects, such as dizziness with orthostatic hypotension (see section Possible side effects).
Children and adolescents
Depression, neuropathic pain, chronic tension headache and migraine prophylaxis
Amitriptyline should not be used in children and adolescents under 18 years of age as safety and efficacy have not been established in this age group.
Bedwetting
- ECG should be performed before initiation of amitriptyline therapy to rule out long QT syndrome
- Medicines in this group should not be taken concomitantly with anticholinergics (see also section Other medicines and Amitriptyline)
- Suicidal thoughts and behavior may also develop during early antidepressant treatment for disorders other than depression; in the treatment of patients with bedwetting, the same precautions should be observed as in the treatment of patients with depression.
Other medicines and Amitriptyline
Some medicines can affect the way other medicines work and this can sometimes cause serious side effects.
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines such as: (used to treat Parkinson's disease). They should not be taken during a course of treatment with amitriptyline (see section Do not take amitriptyline)
John's wort - herbal remedy for depression
Also tell your doctor if you are taking, have recently taken or may be taking medicines that can affect your heart rate, including:
- medicines for the treatment of palpitations (including quinidine and sotalol)
- astemizole and terfenadine (used to treat allergic reactions and hay fever)
- medicines used to treat certain mental illnesses (including pimozide and sertindole)
- cisapride (used to treat certain types of indigestion)
- halofantrine (used to treat malaria)
- methadone (used for pain management and drug detox)
- diuretics (including furosemide).
If you are having surgery with general or local anesthetics, you must tell your doctor that you are taking this drug.
You must also tell your dentist that you are taking this drug before you use a local anesthetic.
Amitriptyline with alcohol
It is not recommended to drink alcohol during treatment with this medicine, as this may increase the sedative effect.
Pregnancy and lactation
If you are pregnant or breastfeeding, think you may be pregnant or are planning to become pregnant, please consult your healthcare professional.
Amitriptyline is not recommended during pregnancy unless you and your doctor have discussed the risks and benefits of using the drug.
If you are taking this drug during the last trimester of pregnancy, you should know that your newborn baby may have the following side effects such as irritability, increased muscle tension, tremors, irregular breathing, reluctance to drink fluids, loud crying, urinary retention and constipation.
Your doctor will tell you to start/continue/stop breastfeeding or stop using this drug based on the benefits of breastfeeding for your baby and the benefits of therapy for you.
Influence on the ability to drive and use mechanisms
The drug may cause drowsiness, dizziness, especially at the beginning of treatment. It is unacceptable to drive or work with mechanisms if it negatively affects you.
Important information about the ingredients of Amitriptyline tablets
Amitriptyline tablets contain lactose medicine.
How to take Amitriptyline
Amitriptyline should be taken exactly as directed by your doctor. If you have any doubts, you should consult your doctor or pharmacist.
Not all dosage regimens are possible with different dosage forms and doses of the drug.
The appropriate dosage form and dosage must be selected for starting 3 and subsequent increasing doses.
Depression
Adults :
The recommended starting dose is 25 mg twice a day. Depending on the clinical effect, the dose may be increased up to 150 mg/day divided into two doses.
Elderly patients (over 65 years of age) and patients with cardiovascular disease
The recommended starting dose is 10-25 mg per day. Depending on the clinical effect, the dose may be increased to 100 mg / day, divided into two doses. If you are taking 100mg to 150mg of the drug, you may need to see your doctor more often.
Use in children and adolescents
Amitriptyline is not recommended for children and adolescents to treat depression. See section 2 for more information.
Neuropathic pain, chronic headaches tension-type headaches and migraine prophylaxis
Your doctor will adjust the dose to your treatment according to your symptoms and your response to your symptoms.
Adults :
The recommended starting dose is 10-25 mg in the evening.
The recommended daily dose is 25-75 mg.
Depending on the clinical effect, the dose may be gradually increased. If you are taking more than 100mg/day, you may need to see your doctor more often. Take the drug once a day or divide the dose into two doses, your doctor will tell you.
Elderly patients (over 65 years of age) and patients with cardiovascular disease
The recommended starting dose is 10-25 mg in the evening.
Depending on the clinical effect of the drug, the dose may be gradually increased.
If you are taking more than 75 mg/day, you may need to see your doctor more often.
Use in children and adolescents
Amitriptyline is not recommended for use in children and adolescents for the treatment of neuropathic pain, chronic tension headache and migraine prophylaxis.
For more information, see What you need to know before you use Amitriptyline.
Bedwetting
Use in children and adolescents
0022
The dose should be increased gradually.
Should be taken 1 to 1.5 hours before bedtime.
Before starting treatment, your healthcare provider should perform an ECG to check for signs of a palpitations.
Your doctor will re-evaluate your condition after 3 months of treatment and, if necessary, perform a repeat ECG.
Do not stop taking this medicine without your doctor's advice.
Special patient populations
Patients with liver disease or known to be "slow metabolizers" are usually given lower doses.
Your doctor may take blood samples to check your amitriptyline level (see What you need to know before you use amitriptyline).
How and when to take Amitriptyline
The drug should be taken during or after a meal.
Tablets should be swallowed whole with water. Tablets should not be chewed.
Treatment period
Do not change the dose of the drug or stop taking the drug without consulting a doctor.
Depression
As with other drugs used to treat depression, this too can take several weeks before you feel any improvement in your condition.
In the treatment of depression, the duration of treatment is individual and is usually at least 6 months. The duration of treatment is determined by your doctor.
Continue taking Amitriptyline for as long as your doctor tells you to. The disease may persist for a long time. If you stop treatment too soon, the symptoms of the disease may recur.
Neuropathic pain, chronic headaches tension type and migraine prevention
It may take a few weeks for your condition to improve.
Talk to your doctor about the duration of treatment and continue taking the drug until the doctor stops it.
Bedwetting
Your doctor will determine if you need to continue treatment after 3 months of taking the drug.
If you have taken more Amitriptyline than recommended
If you have taken more Amitriptyline than prescribed by your doctor, contact your doctor or the nearest hospital emergency department immediately, even if you do not experience any discomfort or symptoms of poisoning . Take the medicine package with you if you go to the doctor or hospital.
Overdose symptoms include:
- dilated pupils
- rapid or irregular heartbeat
- difficulty urinating
- Dry mouth or tongue
- intestinal obstruction
- seizures
- fever
- anxiety
- confusion
- hallucinations
- involuntary movements
- low blood pressure, weak pulse, pallor
- shortness of breath
- cyanosis of the skin
- Decreased heart rate
- drowsiness
- loss of consciousness
- coma
- various heart diseases such as cardiac conduction block, heart failure, hypotension, cardiogenic shock, metabolic acidosis, hypokalemia.
If you forget to take Amitriptyline
Take your next dose at the usual time. Do not take a double dose to make up for a missed one.
If you stop taking Amitriptyline
Your healthcare provider will decide when and how to stop treatment in order to avoid unwanted symptoms that may occur when stopping the drug suddenly (for example, headache, feeling unwell, insomnia and irritability).
If you have any further questions on the use of this medicine, ask your doctor or pharmacist.
| 💊 Ingredients of the drug Amitriptyline ✅ Use of the drug Amitriptyline Save Search for analogues Interaction Description of the active ingredients of the preparation Amitriptyline (Amitriptyline) The scientific information provided is general and cannot be used to make decisions. Update date: 2021.12.06 Marketing authorization holder:DALHIMFARM JSC (Russia) ATX code: N06AA09 (Amitriptyline) Active substance: amitriptyline (amitriptyline) Rec.INN WHO registered Dosage form
Release form, packaging and composition drug Amitriptyline Tablets white with a grayish to white with a yellowish tint, flat cylindrical shape with a bevel.
Excipients : lactose monohydrate (milk sugar) - 51.1 mg, potato starch - 14.47 mg, microcrystalline cellulose - 4 mg, colloidal silicon dioxide (aerosil) - 0.08 mg, gelatin - 1.05 mg, calcium stearate - 1 mg. 10 pcs. - cellular contour packings (5) - packs of cardboard. Clinical and pharmacological group: Antidepressant Pharmacotherapeutic group: Antidepressant Pharmacological actionAntidepressant from the group of tricyclic compounds, dibenzocycloheptadine derivative. The mechanism of antidepressant action is associated with an increase in the concentration of noradrenaline in synapses and / or serotonin in the central nervous system due to inhibition of neuronal reuptake of these mediators. It also has some analgesic effect, which is thought to be related to changes in CNS concentrations of monoamines, especially serotonin, and effects on endogenous opioid systems. It has a pronounced peripheral and central anticholinergic effect due to its high affinity for m-cholinergic receptors; a strong sedative effect associated with affinity for histamine H 1 receptors, and alpha-adrenergic blocking action. The mechanism of therapeutic action in bulimia nervosa has not been established (possibly similar to that in depression). Amitriptyline has been shown to be clearly effective in bulimic patients both without depression and in its presence, while a decrease in bulimia can be observed without a concomitant weakening of the depression itself. Efficacy in bedwetting appears to be due to anticholinergic activity resulting in increased bladder distensibility, direct β-adrenergic stimulation, α-adrenergic agonist activity associated with increased sphincter tone and central blockade of serotonin uptake. It has an antiulcer effect, the mechanism of which is due to the ability to block histamine H 2 receptors in the parietal cells of the stomach, as well as to have a sedative and m-anticholinergic effect (in case of gastric ulcer and duodenal ulcer, it reduces pain, accelerates the healing of the ulcer). Reduces blood pressure and body temperature during general anesthesia. Does not inhibit MAO. Antidepressant effect develops within 2-3 weeks after the start of use. PharmacokineticsThe bioavailability of amitriptyline is 30-60%. Plasma protein binding 82-96%. V d - 5-10 l/kg. Metabolized to form the active metabolite nortriptyline. T 1/2 - 31-46 hours Excreted mainly by the kidneys. Indications of the active substances of the drug AmitriptylineDepression (especially with anxiety, agitation and sleep disorders, including in childhood, endogenous, involutional, reactive, neurotic, drug-induced, with organic brain damage, alcohol withdrawal), schizophrenic psychoses, mixed emotional disorders, behavioral disorders (activity and attention), bulimia nervosa, tension headache, migraine, neuropathic pain, chronic pain in cancer patients, rheumatic pain, nocturnal enuresis (except for patients with bladder hypotension), peptic ulcer of the stomach and duodenum. Open list of ICD-10 codes
Dosage regimenThe route of administration and dosing regimen of a particular drug depends on its form of release and other factors. The optimal dosage regimen is determined by the doctor. Compliance of the dosage form of a particular drug with indications for use and dosing regimen should be strictly observed. For oral administration, the initial dose is 25-50 mg at night. For nocturnal enuresis in children aged 6-10 years - 10-20 mg / day at night, aged 11-16 years - 25-50 mg / day. V / m - the initial dose is 50-100 mg / day in 2-4 injections. If necessary, the dose can be gradually increased to 300 mg / day, in exceptional cases - up to 400 mg / day. Side effects From the side of the nervous system: drowsiness, asthenia, fainting, anxiety, disorientation, agitation, hallucinations (especially in elderly patients and in patients with Parkinson's disease), anxiety, restlessness, manic state, hypomanic condition, aggressiveness, memory impairment, depersonalization, increased depression, decreased ability to concentrate, insomnia, nightmares, yawning, activation of psychotic symptoms, headache, myoclonus, dysarthria, tremor (especially of the hands, head, tongue), peripheral neuropathy (paresthesia ), myasthenia gravis, myoclonus, ataxia, extrapyramidal syndrome, increased frequency and intensification of epileptic seizures, changes in the EEG. From the side of the cardiovascular system: orthostatic hypotension, tachycardia, conduction disturbances, dizziness, nonspecific ECG changes (ST interval or T wave), arrhythmia, blood pressure lability, intraventricular conduction disturbance (expansion of the QRS complex, changes in the PQ interval, bundle branch block). From the digestive system: nausea, heartburn, vomiting, gastralgia, increase or decrease in appetite (weight gain or decrease), stomatitis, change in taste, diarrhea, darkening of the tongue; rarely - liver dysfunction, cholestatic jaundice, hepatitis. On the part of the endocrine system: testicular edema, gynecomastia, mammary gland enlargement, galactorrhea, changes in libido, decreased potency, hypo- or hyperglycemia, hyponatremia (decreased production of vasopressin), syndrome of inappropriate ADH secretion. From the side of the hematopoietic system: agranulocytosis, leukopenia, thrombocytopenia, purpura, eosinophilia. Allergic reactions: skin rash, pruritus, urticaria, photosensitivity, swelling of the face and tongue. Effects due to anticholinergic activity: dry mouth, tachycardia, disturbances of accommodation, blurred vision, mydriasis, increased intraocular pressure (only in persons with a narrow anterior chamber angle of the eye), constipation, paralytic ileus, urinary retention, decreased sweating, confusion, delirium, or hallucinations. Other: hair loss, tinnitus, edema, hyperpyrexia, swollen lymph nodes, pollakiuria, hypoproteinemia. Contraindications for use Acute period and early recovery period after myocardial infarction, acute alcohol intoxication, acute intoxication with hypnotics, analgesics and psychotropic drugs, angle-closure glaucoma, severe disorders of AV and intraventricular conduction II degree), lactation period, children under 6 years of age (for oral administration), children under 12 years of age (for intramuscular and intravenous administration), simultaneous treatment with MAO inhibitors and the period 2 weeks before their use, increased sensitivity to amitriptyline. Use during pregnancy and lactationAmitriptyline should not be used during pregnancy, especially in the first and third trimesters, except in cases of emergency. Adequate and strictly controlled clinical studies of the safety of the use of amitriptyline during pregnancy have not been conducted. Amitriptyline should be phased out at least 7 weeks before expected delivery to avoid neonatal withdrawal. In experimental studies amitriptyline was teratogenic. Contraindicated during lactation. It is excreted in breast milk and may cause drowsiness in infants. Use in hepatic impairmentUse with caution in hepatic impairment. Use in impaired renal functionUse with caution in impaired renal function. Pediatric useContraindication: children under 6 years of age (for oral administration), children under 12 years of age (for intramuscular and intravenous administration). Use in elderly patients In elderly patients, it can provoke the development of drug-induced psychoses, mainly at night (after discontinuation of the drug they pass within a few days), and also cause paralytic ileus. Special instructionsUse with caution in ischemic heart disease, arrhythmia, heart block, heart failure, myocardial infarction, arterial hypertension, stroke, chronic alcoholism, thyrotoxicosis, against the background of therapy with thyroid drugs, with impaired liver and / or kidney function. During therapy with amitriptyline, care must be taken when abruptly moving to an upright position from a lying or sitting position. Abrupt discontinuation may lead to withdrawal syndrome. Amitriptyline at doses greater than 150 mg/day lowers the seizure threshold; the risk of developing epileptic seizures in predisposed patients should be taken into account, as well as in the presence of other factors that increase the risk of developing a convulsive syndrome (including with brain damage of any etiology, simultaneous use of antipsychotic drugs, during the period of refusal of ethanol or withdrawal of drugs, with anticonvulsant activity). Consideration should be given to the possibility of suicide attempts in patients with depression. Should only be used in combination with electroconvulsive therapy under close medical supervision. In predisposed patients and elderly patients, it can provoke the development of drug-induced psychoses, mainly at night (after discontinuation of the drug they disappear within a few days). May cause paralytic ileus, predominantly in patients with chronic constipation, the elderly, or in patients requiring bed rest. Before general or local anesthesia, the anesthesiologist should be warned that the patient is taking amitriptyline. With prolonged use, an increase in the incidence of caries is observed. May increase the need for riboflavin. Amitriptyline can be used no earlier than 14 days after discontinuation of MAO inhibitors. Do not use simultaneously with adreno- and sympathomimetics, incl. with epinephrine, ephedrine, isoprenaline, norepinephrine, phenylephrine, phenylpropanolamine. Use with caution concomitantly with other anticholinergic drugs. Do not drink alcohol while taking amitriptyline. Influence on the ability to drive vehicles and mechanisms During the period of treatment, one should refrain from potentially hazardous activities that require increased attention and rapid psychomotor reactions. Drug interactionsWhen used simultaneously with drugs that have a depressant effect on the central nervous system, a significant increase in the inhibitory effect on the central nervous system, hypotensive effect, respiratory depression is possible. When used simultaneously with drugs with anticholinergic activity, it is possible to increase anticholinergic effects. With simultaneous use, it is possible to increase the effect of sympathomimetic agents on the cardiovascular system and increase the risk of developing cardiac arrhythmias, tachycardia, and severe arterial hypertension. When used simultaneously with antipsychotics (neuroleptics), metabolism is mutually inhibited, while the threshold for convulsive readiness decreases. When used simultaneously with antihypertensive agents (with the exception of clonidine, guanethidine and their derivatives), it is possible to increase the antihypertensive effect and the risk of developing orthostatic hypotension. With simultaneous use with MAO inhibitors, the development of a hypertensive crisis is possible; with clonidine, guanethidine - it is possible to reduce the hypotensive effect of clonidine or guanethidine; with barbiturates, carbamazepine - it is possible to reduce the effect of amitriptyline due to an increase in its metabolism. A case of the development of serotonin syndrome with simultaneous use with sertraline is described. With simultaneous use with sucralfate, the absorption of amitriptyline is reduced; with fluvoxamine - increases the concentration of amitriptyline in the blood plasma and the risk of developing a toxic effect; with fluoxetine - the concentration of amitriptyline in the blood plasma increases and toxic reactions develop due to inhibition of the CYP2D6 isoenzyme under the influence of fluoxetine; with quinidine - it is possible to slow down the metabolism of amitriptyline; with cimetidine - it is possible to slow down the metabolism of amitriptyline, increase its concentration in blood plasma and develop toxic effects.    Copyright © · The Wright Initiative · Articles · Site Map 
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decisions about the use of a particular drug. 
With prolonged use, it reduces the functional activity of β-adrenergic receptors and serotonin receptors in the brain, normalizes adrenergic and serotonergic transmission, restores the balance of these systems, disturbed during depressive states. In anxiety-depressive conditions, it reduces anxiety, agitation and depressive manifestations. 
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1 
Then, within 5-6 days, the dose is individually increased to 150-200 mg / day (most of the dose is taken at night). If there is no improvement within the second week, the daily dose is increased to 300 mg. With the disappearance of signs of depression, the dose is reduced to 50-100 mg / day and therapy is continued for at least 3 months. In elderly patients with mild disorders, the dose is 30-100 mg / day, usually 1 time / day at night, after achieving a therapeutic effect, they switch to the minimum effective dose - 25-50 mg / day. 
