Amitriptyline | Side Effects, Dosage, Uses & More
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Amitriptyline

Highlights

  1. Amitriptyline is used to help relieve symptoms of depression.
  2. This drug comes as a tablet you take by mouth.
  3. Amitriptyline is available as a generic drug. It’s not available as a brand-name drug.

IMPORTANT INFORMATION

FDA warning

This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.

Suicidal thoughts and behavior. Amitriptyline can increase the risk of suicidal thoughts and behavior in children, adolescents, and young adults. Your doctor and family members should watch you closely for signs of changes in your behavior or worsening depression when you start taking this drug.

Other warnings

Worsening of depression
You might experience an initial worsening of your depression, thoughts of suicide, and behavioral changes when you first start taking amitriptyline. This risk may last until the drug starts working for you.

Withdrawal symptoms
If you’ve been taking this medication for a long time you shouldn’t stop taking it suddenly. Stopping it suddenly may cause side effects such as nausea, headache, and tiredness. Your doctor will tell you how to slowly lower your dose over time if you’re told to stop taking the drug.


Drug features

Amitriptyline is a prescription drug. It comes as a tablet you take by mouth. This medication is not available as a brand-name drug. It’s only available as a generic drug. Generic drugs typically cost less than brand-name drugs.

Why it's used

Amitriptyline is used to help relieve symptoms of depression.

How it works

Amitriptyline belongs to a class of drugs called tricyclic antidepressants. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Amitriptyline works on your central nervous system to increase the level of certain chemicals in your brain and improve your depression.

Amitriptyline side effects

More common side effects

The more common side effects of amitriptyline can include:

  • confusion
  • numbness and tingling in your arms and legs
  • headache
  • constipation or diarrhea
  • blurred vision
  • skin rash
  • swelling of your face and tongue
  • nausea
  • unexpected weight gain or loss

Serious side effects

Call your doctor right away if you have serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Heart attack. Symptoms can include:
    • chest pain
    • shortness of breath
    • pain or pressure in your chest or upper body
  • Stroke. Symptoms can include:
    • weakness in one part or side of your body
    • slurred speech
Pharmacist's Advice

Alan Carter,PharmD

Healthline Pharmacist
Editorial Team

Do not stop taking amitriptyline without first talking to your healthcare provider. Amitriptyline can cause dizziness and drowsiness during the first few hours after you take it. If you notice drowsiness while you take this drug, your doctor may have you take your dose at bedtime.

Amitriptyline may interact with other medications

Amitriptyline can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Alcohol interaction

The use of drinks that contain alcohol can increase your risk of serious side effects including sedation.

Drugs you should not take

Taking certain drugs with amitriptyline may cause serious side effects. You should not take these drugs and amitriptyline at the same time. Examples of these drugs include:

  • Monoamine oxidase inhibitors (MAOIs). Examples of these drugs include:
    • phenelzine
    • tranylcypromine
    • selegiline

Using an MAOI with amitriptyline can lead to seizures or even death. Do not take an MAOI within 2 weeks of stopping amitriptyline, unless told by your doctor. Do not start taking amitriptyline if you stopped taking a MAOI in the last 2 weeks, unless told by your doctor. Ask your doctor or pharmacist  whether any of the drugs you take is an MAOI if you aren’t sure.

  • Cisapride. Taking this drug with amitriptyline could increase your risk of irregular heart rhythm.
  • Quinidine. Taking this drug with amitriptyline could increase the amount of amitriptyline in your body. This could lead to dangerous side effects.

Drugs that cause more adverse effects

Taking amitriptyline with certain drugs may increase your risk of a dangerously high fever. Examples of these drugs include:

  • Sertraline, fluoxetine, and paroxetine. These drugs can increase the toxic side effects of amitriptyline.
  • Cimetidine. Taking this drug with amitriptyline could increase the amount of amitriptyline in your body. This could increase your risk of side effects.
  • Anticholinergic drugs. Examples include diphenhydramine, loratadine, oxybutynin, solifenacin, and olanzapine. Taking these drugs with amitriptyline can increase your risk of side effects.
  • Neuroleptic drugs. Examples include clozapine, risperidone, and haloperidol. Taking these drugs with amitriptyline can increase your risk of side effects.

AMITRIPTYLINE WARNINGS

People with heart disorders:
Taking this drug could cause heart problems, such as irregular heart rhythm, heart attack, and stroke. Do not take this drug if you’re recovering from a recent heart attack.

People with bipolar disorder:
Before starting you on treatment with antidepressants, such as amitriptyline, it’s important for your doctor to check your risk of bipolar disorder. Your doctor should do this because a major depressive episode is usually the first symptom noticed in people with bipolar disorder. This drug should not be used in people with bipolar disorder.

People with a history of seizures:
Taking this drug may increase your risk of seizures. If you have a history of seizures, your doctor will monitor you closely while you’re taking this drug. If you have a seizure while taking this drug, stop taking it and call your doctor right away.

People with a history of glaucoma or increased eye pressure:
Taking this drug could increase the pressure in your eyes. If you have a history of glaucoma or increased eye pressure, your doctor will monitor you closely while you’re taking this drug.

Pregnant women:
Amitriptyline is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should only be used if the potential benefit justifies the potential risk to the fetus.

Women who are breast-feeding:
Amitriptyline passes into breast milk and may cause side effects in a child who is breast-fed.

Talk to your doctor if you breast-feed your child. You may need to decide whether to stop breast-feeding or stop taking this medication.

For seniors:
The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects. These side effects include fast heart rate, difficulty urinating, constipation, dry mouth, and blurred vision.

For children:
This drug shouldn’t be used in people younger than 12 years.

When to call the doctor:
Call your doctor if you notice worsening depression or suicidal thoughts. Also call your doctor right away if you become pregnant while taking this drug.

Allergies:
Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).


Amitriptyline and withdrawal

You Asked, We Answered

  • Can I have withdrawal symptoms if I stop taking amitriptyline?
  • If you suddenly stop taking amitriptyline, you can experience withdrawal symptoms such as nausea, headache, and fatigue. Taking too much amitriptyline can lower your blood pressure and cause an irregular heart rate, confusion, hallucinations, and even convulsions. This is why it is very important to follow your doctor’s instructions for not just taking this drug but also for stopping this drug.

    - Healthline Pharmacist Review Team

How to take amitriptyline

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Depression

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

Adult Dosage (ages 18-64 years)

  • The typical starting dose is 75 mg per day. This dose is usually divided into two or three smaller doses and taken throughout the day.
  • Your doctor will slowly increase your dose if needed.
  • The maximum dose is 150 mg per day.

Child Dosage (ages 12-17 years)

  • The typical starting dose is 75 mg per day. This dose is usually divided into two or three smaller doses and taken throughout the day.
  • Your doctor will slowly increase your dose if needed.
  • Adolescents generally need lower doses than adults.

Child Dosage (ages 0-11 years)
It hasn’t been confirmed that amitriptyline is safe and effective for use in people younger than 12 years.

Senior dosage (ages 65 years and older)
The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.
Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body

Pharmacist's Advice

Alan Carter,PharmD

Healthline Pharmacist
Editorial Team

Amitriptyline comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all
If you don’t take your amitriptyline, your depression may worsen. If you stop taking this medication suddenly you may experience withdrawal side effects, such as nausea, headache, and tiredness.

If you miss doses or don’t take the drug on schedule
Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much
You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include: irregular heart rhythm, severely low heart rate, convulsions, hallucinations, confusion, and muscle rigidity

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room right away.

What to do if you miss a dose
Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working
Over time you should notice an improvement in your symptoms of depression. This can take more than a month.

Amitriptyline is used for long-term treatment.

Important considerations for taking this drug

You can take amitriptyline with or without food.

You can cut or crush the tablet

Store this drug carefully

  • Store amitriptyline at room temperature between 68°F and 77°F (20°C and 25°C). It can be kept for brief periods between 59°F and 86°F (15°C and 30°C). Keep it away from light.
  • Don’t store this drug in moist or damp areas, such as bathrooms.
    • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
    • Don’t worry about airport x-ray machines. They can’t hurt your medication.
    • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
    • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

A prescription for this medication is refillable
You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

When traveling with your medication

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Your doctor will check your mental health
You should make sure to tell your doctor about any unusual changes in your behavior and mood.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.


Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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