Amitriptyline is a prescription drug that’s used to treat depression. It’s sometimes known by its former brand name, Elavil, but its manufacturer, AstraZeneca, stopped making it. Amitriptyline is only available as a generic drug in the United States.
Besides depression, amitriptyline can be used “off-label” to treat post-herpetic neuralgia (a condition that occurs after having shingles), attention deficit hyperactivity disorder (ADHD), and certain eating disorders. It may also be used to prevent symptoms of migraines.
Amitriptyline is in an older class of drugs called tricyclic antidepressants (TCAs), which include some of the earliest medications designed to treat depression. Other drugs in this class are desipramine (Norpramin), nortriptyline (Pamelor, Aventyl), and imipramine (Tofranil).
These antidepressants work by stopping the brain’s nerve cells from absorbing the neurotransmitters epinephrine and serotonin. Tricyclic antidepressants are more likely to cause serious side effects than today’s newer antidepressants, such as Prozac and other selective serotonin reuptake inhibitors (SSRIs), so doctors don’t prescribe amitriptyline as often as they once did.
Amitriptyline was originally approved by the Food and Drug Administration (FDA) in 1983.
• Amitriptyline oral tablet is available as a generic drug. It’s not available as a brand-name drug.
• Amitriptyline comes only as a tablet you take by mouth.
• Amitriptyline oral tablet is used to help relieve symptoms of depression
This drug in indicted for the following conditions. Major depressive disorder in adults Management of neuropathic pain in adults Prophylactic treatment of chronic tension type headache (CTTH) in adults Prophylactic treatment of migraine in adults Treatment of nocturnal enuresis in children aged 6 years and above when organic pathology, including spina bifida and related disorders, have been excluded and no response has been achieved to all other non-drug and drug treatments, including antispasmodics and vasopressin-related products. This product should only be prescribed by a healthcare professional with expertise in the management of persistent enuresis.
Off-label uses: irritable bowel syndrome, sleep disorders, diabetic neuropathy, agitation,fibromyalgia, and insomnia
The mechanism of Action
The mechanism of action of this drug is not fully elucidated. It is suggested that amitriptyline inhibits the membrane pump mechanism responsible for the re-uptake of transmitter amines, such as norepinephrine and serotonin, thereby increasing their concentration at the synaptic clefts of the brain. These amines are important in regulating mood. The monoamine hypothesis in depression, one of the oldest hypotheses, postulates that deficiencies of serotonin (5-HT) and/or norepinephrine (NE) neurotransmission in the brain lead to depressive effects. This drug counteracts these mechanisms, and this may be the mechanism of amitriptyline in improving depressive symptoms.
The FDA requires amitriptyline to carry a black-box warning because of the risk of suicide. In short-term studies, a small number of children, teen-agers and young adults (up to 24 years old) who took antidepressants such as amitriptyline became suicidal shortly after starting treatment.
You may have suicidal thoughts while taking an antidepressant, especially if you are younger than 24 years old. Your family members or other caregivers should watch for changes in your mood or other symptoms. Whether its analgesic effects are related to its mood-altering activities or attributable to a different, less obvious pharmacological action (or a combination of both) is unknown
You, a family member, or caregiver should tell your doctor right away if you experience any of the following symptoms while taking amitriptyline (especially during the first weeks of treatment or any time you change your dose):
• Thoughts of harming or killing yourself
• Worsening depression
• Extreme worry or other new feelings of anxiousness
• Panic attacks
• Difficulty falling asleep or staying asleep
• Aggressive behavior
• Unusual restlessness
• Unusual mood or behavior changes
• Unusual excitement or hyperactivity
• Agitation, hostility, or aggressiveness
• Unusually impulsive behavior
Children under age 18 should not take amitriptyline, but in rare cases, a doctor may decide the benefits outweigh the risks.
Before having any type of surgery, you should tell your surgeon that you are taking amitriptyline.
You may also need to make a plan with the doctor who prescribed the drug to carefully taper off before surgery.
You should not stop taking amitriptyline suddenly, as you could experience withdrawal symptoms.
It may take a few weeks before you feel the full effects of this medication.
Use this drug as directed, stay in touch with your doctor during your treatment for depression, and tell your doctor if amitriptyline isn’t helping after four weeks.
Before taking amitriptyline, you should tell your doctor if you have any of the following conditions:
• Heart disease
• A history of heart attack, stroke, or seizures
• A history of drinking large amounts of alcohol
• Bipolar disorder (manic depression), schizophrenia, or any other mental illness
• Overactive thyroid
• An enlarged prostate
• Urination problems
Pregnancy and Amitriptyline
Amitriptyline might harm an unborn baby. Tell your doctor if you’re pregnant or might become pregnant while using this medicine. You should not breastfeed while using this drug. Amitriptyline can also pass into breast milk and may harm a breastfeeding baby.
Amitriptyline side effects
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.
More common side effects
The more common side effects of amitriptyline can include:
• Numbness and tingling in your arms and legs
• Constipation or diarrhea
• blurred vision
• Skin rash
• swelling of your face and tongue
• Unexpected weight gain or loss
If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.
Adult dosage (ages 18–64 years)
• Typical starting dosage: 75 mg per day, usually in divided doses.
• Dosage increases: Your doctor will slowly increase your dosage if needed.
• Maximum dosage: 150 mg per day.
• Alternative dosage regimen: Start with 50 to 100 mg at bedtime. This may be increased by 25 or 50 mg as needed in the bedtime dose, for a total of 150 mg per day.
Child dosage (ages 0–17 years)
It hasn’t been confirmed that amitriptyline is safe and effective for use in children younger than 17 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.