Chronic lack of sleep is more than just frustrating. It can impact all areas of your life including physical and mental health. The Centers for Disease Control and Prevention (CDC) report that more than 35 percent of American adults aren’t getting enough sleep.

If you’re not getting the sleep you need, there are several different treatments, including medications that can help.

Medicines for sleep work in different ways to help you either fall asleep or stay asleep. Your doctor may discuss prescribing amitriptyline (Elavil, Vanatrip) to help you sleep.

If you’re trying to decide if amitriptyline is right for you, here are some things to consider.

Amitriptyline is a prescription drug available as a tablet in several strengths. It’s approved for use to treat depression but is also often prescribed for several other conditions like pain, migraines, and insomnia.

Although it has been around for many years, it is still a popular, low-cost generic medication.

Amitriptyline is approved by the Food and Drug Administration (FDA) to treat depression, but doctors also prescribe the drug to help with sleep. When a doctor prescribes a medication for a use other than one that has been approved by the FDA, it’s known as off-label use.

Doctors prescribe off-label for several reasons including:

  • Age. A doctor may prescribe a drug to someone younger or older than approved by the FDA drug label.
  • Indication or use. A medication may be prescribed for a condition other than what FDA approved.
  • Dose. A doctor may prescribe a lower or higher dose than listed on the label or FDA recommended.

FDA does not make recommendations to doctors on how to treat patients. It’s up to your doctor to decide the best treatment for you based on their expertise and your preference.

Amitriptyline has a “black box warning” from the FDA. This means the drug has some important side effects that you and your doctor should consider before you take this medicine.

Amitriptyline FDA warning
  • Amitriptyline has increased the risk of suicidal thoughts and behavior in some individuals, particularly children and young adults. It is important to monitor for worsening symptoms of mood, thoughts, or behavior and call 911 immediately if you notice changes.
  • You can also call the National Suicide Prevention Lifeline at 800-273-8255 if you or someone you know is having suicidal thoughts.
  • Amitriptyline is not approved by the FDA for use in children younger than 12.

Amitriptyline is a type of medicine called a tricyclic antidepressant (TCA). These medications work by increasing certain brain chemicals called neurotransmitters like serotonin and norepinephrine to help improve mood, sleep, pain, and anxiety.

It’s not clear exactly how amitriptyline works for sleep, but one of its effects is to block histamine, which may result in drowsiness. This is one reason doctors prescribe amitriptyline as a sleep aid.

Amitriptyline for sleep is prescribed at different doses. The dose will depend on many factors like your age, other medicines you may be taking, your medical condition, and drug cost.

For adults, the dose is typically between 50 and 100 milligrams at bedtime. Adolescents and older adults may take lower dosages.

If you have certain known gene variations such as changes to the CYP2D6 and CYP2C19 genes, you might need dose adjustments to lower the chance of side effects with amitriptyline.

Consider asking your doctor or pharmacist about gene testing called pharmacogenomics. This has become very popular to help personalize your medicines so they work best for you.

Starting at a low dose helps the doctor see how you are reacting to the medicine before making changes.

Amitriptyline can have some serious side effects. Before taking the medicine, be sure to let your doctor know if you have ever had an allergic reaction to amitriptyline or other drugs, or if you have ever had suicidal thoughts or behavior.

Let your doctor know if you have:

  • heart disease, liver, or kidney problems
  • glaucoma, as amitriptyline can increase the pressure in your eye
  • diabetes, as amitriptyline can affect your sugar levels, so you may need to check your sugar more often when you start taking amitriptyline
  • epilepsy, as amitriptyline can increase the risk of seizures
  • bipolar disorder, mania, or schizophrenia

Talk to your doctor if you are pregnant or breastfeeding. Research has not made clear for certain whether amitriptyline is safe to use during pregnancy or if you are breastfeeding.

Common side effects

When you first start taking amitriptyline, you might experience some side effects. They usually go away after a few days. Talk to your pharmacist or doctor if they are bothersome and continue.

  • dry mouth
  • headache
  • weight gain
  • constipation
  • trouble urinating
  • a sudden drop in blood pressure particularly when standing up from sitting
  • drowsiness or dizziness
  • blurry vision
  • shaky hands (tremor)

Serious side effects

Although it is rare, amitriptyline can cause some severe side effects. Call 911 right away if you experience a life-threatening medical emergency.

when to seek emergency care

Call 911 right away if you experience any of these symptoms while taking amitriptyline, as they may indicate a life-threatening medical emergency:

  • rapid or irregular heart rate
  • chest pain and shortness of breath, which could signal a heart attack
  • weakness on one side of body or slurred speech, which could signal a stroke

You may experience other symptoms not listed here. Always talk to your doctor about what you may be experiencing to learn if your medicine is responsible.

Amitriptyline can interact with several medications. It is essential to let your doctor and pharmacist know all the prescription medications, over-the-counter medications, and dietary supplements you are taking to avoid a potentially serious reaction.

The most common medications that interact with amitriptyline include:

  • monoamine oxidase inhibitors (MAOIs) like selegiline (Eldepryl): can cause seizures or death
  • quinidine: can cause heart problems
  • opioid medicines like codeine: can increase drowsiness and raise the risk for serotonin syndrome, which can cause increased blood pressure and elevated heart rate
  • epinephrine and norepinephrine: can increase blood pressure, headaches, and chest pain
  • topiramate: can cause high levels of amitriptyline in your body, increasing your risk of side effects

This is not a complete list. There are several other drugs that may interact with amitriptyline. Check with your doctor if you have specific concerns.

Until your body gets used to the medicine, be careful with any activities that require you to be alert like driving or operating machinery.

You should not drink alcohol or take other medicines that can make you drowsy with amitriptyline because it can increase the effect of the drug.

You should not suddenly stop taking amitriptyline. Talk to your doctor about the best way to gradually stop this medicine.

A few advantages of amitriptyline include:

  • Less expensive. Amitriptyline is an older medicine available as a generic, so it’s inexpensive compared to some newer sleep aids.
  • Not habit forming. Amitriptyline is not addictive or habit forming like other medicines used for insomnia like diazepam (Valium)

Amitriptyline can be helpful if insomnia is results from another condition you may have, such as pain, depression or anxiety. You should discuss all your symptoms with your doctor to find the best treatment option for you.

Amitriptyline has been around for many years and is an inexpensive option as a sleep aid. Amitriptyline and antidepressants like it are commonly used off-label to treat insomnia, especially in people who also have symptoms of depression.

Amitriptyline can cause significant side effects and can interact with other medications. If you’re considering amitriptyline to help you get more restful sleep, be sure to talk to your doctor about any other medications and supplements you’re already taking.