Amitriptyline : Uses, Side Effects, Interactions & More

A small number of children, adolescents, and young adults (up to 24 years of age) who took antidepressants (‘mood elevators’) such as amitriptyline during clinical studies became suicidal (thinking about harming or killing themselves or planning or try to do it). Children, adolescents, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, adolescents, and young adults who do not take antidepressants to treat these conditions. However, experts are not sure how great this risk is and how much should be taken into account when deciding whether a child or adolescent should take an antidepressant. Children under the age of 18 should not normally take amitriptyline, but in some cases, a doctor may decide that amitriptyline is the best medicine for treating a child’s condition.

You should know that your mental health can change in unexpected ways when you take amitriptyline or other antidepressants, even if you are an adult over the age of 24. You may be suicidal, especially at the beginning of your treatment and any time the dose is increased or decreased. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: new or worsening depression; thinking about, or planning or attempting to, hurt or commit suicide; extreme worry; agitation; panic attacks; Difficulty falling asleep or staying asleep; aggressive behavior; irritability; act without thinking; severe restlessness; and a frenzy of abnormal excitement. Make sure your family or caregiver knows what symptoms can be serious so they can call the doctor when you cannot seek treatment on your own.

Your healthcare provider will want to see you often while you are taking amitriptyline, especially at the beginning of your treatment. Make sure to keep all appointments for office visits with your doctor.

Your doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you start treatment with amitriptyline. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also get the Medication Guide from the FDA website: http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm.

Regardless of your age, before taking an antidepressant, you, your parents, or your caregiver should discuss the risks and benefits of treating your condition with an antidepressant or other treatments with your doctor. You should also talk about the risks and benefits of not treating your condition. You should know that having depression or another mental illness greatly increases your risk of becoming suicidal. This risk is higher if you or someone in your family has or has ever had bipolar disorder (mood that changes from depressed to abnormally excited) or mania (frantic, abnormally excited mood) or has thought or tried to commit suicide. Talk to your doctor about your condition, symptoms, and personal and family medical history. You and your doctor will decide what type of treatment is right for you.

Amitriptyline is used to treat symptoms of depression. Amitriptyline is in a class of medications called tricyclic antidepressants. It works by increasing the amounts of certain natural substances in the brain that are needed to maintain mental balance.

Amitriptyline comes as a tablet to take by mouth. It is usually taken one to four times a day. Take amitriptyline at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any parts you don’t understand. Take amitriptyline exactly as directed. Do not take more or less, or take it more often than prescribed by your doctor.

Your doctor will likely prescribe a low dose of amitriptyline for you and gradually increase it.

It may take a few weeks or more before you feel the full benefit of amitriptyline. Keep taking amitriptyline even if you feel fine. Do not stop taking amitriptyline without consulting your doctor. If you stop taking amitriptyline suddenly, you may experience withdrawal symptoms such as nausea, headache, and lack of energy. Your doctor will likely reduce your dose gradually.

Amitriptyline is also used to treat eating disorders, post-herpetic neuralgia (burning, shooting pains, or pains that can last for months or years after a shingles infection), and to prevent migraines. Talk to your doctor about the possible risks of using this drug for your condition.

This medicine may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking amitriptyline,

• Tell your doctor and pharmacist if you are allergic to amitriptyline or any other medications.
• Tell your doctor if you are taking cisapride (Propulsid) (not available in the US) or monoamine oxidase (MAO) inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate), or if you have taken an MAO inhibitor within the past 14 days. Your doctor will probably tell you not to take amitriptyline.
• Tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: antihistamines; cimetidine (Tagamet); diet pills; disulfiram (Antabuse); guanethidine (Ismelin); Ipratropium (Atrovent); quinidine (Quinidex); medicines for irregular heartbeats, such as flecainide (Tambocor) and propafenone (Rythmol); medications for anxiety, asthma, colds, irritable bowel disease, mental illness, nausea, Parkinson’s disease, seizures, ulcers, or urinary problems; other antidepressants; phenobarbital (Bellatal, Solfoton); selective serotonin reuptake inhibitor (SSRI) sedatives such as citalopram (Celexa), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft); sleeping pills; thyroid medications; and tranquilizers. Tell your doctor or pharmacist if you stopped taking fluoxetine (Prozac, Sarafem) in the past 5 weeks. Your doctor may need to change the doses of your medications or monitor you closely for side effects.
• Tell your doctor if you have recently had a heart attack. Your doctor will probably tell you not to take amitriptyline.
• Tell your doctor if you drink large amounts of alcohol and if you have or have ever had glaucoma (an eye condition); an enlarged prostate (a male reproductive gland); difficulty urinating seizures an overactive thyroid gland (hyperthyroidism); diabetes; schizophrenia (a mental illness that causes disturbed or unusual thoughts, loss of interest in life, and strong or inappropriate emotions); or liver, kidney, or heart disease.
• Tell your doctor if you are pregnant or plan to become pregnant. If you become pregnant while taking amitriptyline, call your doctor. Do not breastfeed while you are taking amitriptyline.
• Talk to your doctor about the risks and benefits of taking this medicine if you are 65 years of age or older. Older adults should generally not take amitriptyline because it is not as safe or effective as other medications that can be used to treat the same condition.
• If you are having surgery, including dental surgery, tell the doctor or dentist that you are taking amitriptyline.
• You should know that amitriptyline can make you drowsy. Do not drive a car or operate machinery until you know how this medicine affects you.
• Remember that alcohol can increase the drowsiness caused by this drug.

Unless your doctor tells you otherwise, continue your normal diet.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Amitriptyline may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• vomiting
• drowsiness
• weakness or tiredness
• nightmares
• headaches
• dry mouth
• constipation
• difficulty urinating
• blurred vision
• pain, burning, or tingling in the hands or feet
• changes in sex drive or ability
• excessive sweating
• changes in appetite or weight
• confusion
• unsteadiness

Some side effects can be serious. If you experience any of the following symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately:

• slow or difficult speech
• dizziness or faintness
• weakness or numbness of an arm or a leg
• crushing chest pain
• rapid, pounding, or irregular heartbeat
• severe skin rash or hives
• swelling of the face and tongue
• yellowing of the skin or eyes
• jaw, neck, and back muscle spasms
• uncontrollable shaking of a part of the body
• fainting
• unusual bleeding or bruising
• seizures
• hallucinating (seeing things or hearing voices that do not exist)

Amitriptyline can cause other side effects. Call your doctor if you have any unusual problems while taking this medicine.

If you experience a serious side effect, you or your doctor can submit a report online to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medicine in the container it came in, tightly closed, and out of the reach of children. Store at room temperature and away from excess heat and moisture (not in the bathroom).

Unnecessary medications must be disposed of in special ways to ensure that pets, children, and others cannot consume them. However, you should not flush this medicine down the toilet. Instead, the best way to dispose of your medications is through a drug take-back program. Talk to your pharmacist or contact your local garbage / recycling department to find out about take-back programs in your community. See the FDA Safe Drug Disposal website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medicines out of the sight and reach of children, since many containers (such as those containing weekly pills and those for eye drops, creams, patches and inhalers) are not resistant to children and small children can easily open them. To protect young children from poisoning, always close the safety caps and immediately place the medicine in a safe place, one that is upright and out of their sight and reach. http://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim collapsed, had a seizure, has trouble breathing, or cannot wake up, immediately call 911 for emergency services.

Symptoms of overdose may include:

• irregular heartbeat
• seizures
• coma (loss of consciousness for a period of time)
• confusion
• problems concentrating
• hallucinating (seeing things or hearing voices that do not exist)
• agitation
• drowsiness
• rigid muscles
• vomiting
• fever
• cold body temperature

Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body’s response to amitriptyline.

Do not let anyone else take your medicine. Ask your pharmacist any questions you have about refilling your prescription.

It is important that you keep a written list of all prescription and over-the-counter (over-the-counter) medications you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should take this list with you each time you visit a doctor or if you go into hospital. It is also important information to take with you in case of emergencies.