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n.

A tricyclic antidepressant drug, C₂₀H₂₃N.

[Perhaps AMI(NO)– + alteration of TRYPT(OPHAN) + –YL + –INE².]

Definition

Amitriptyline is a medication used to treat various forms of depression, pain associated with the nerves (neuropathic pain), and to prevent migraine headaches. It is sold in the United States under the brand name Elavil.

Purpose

Amitriptyline helps relieve depression and pain. It is often used to manage nerve pain resulting from cancer treatment. Such injury to nerves causes a burning, tingling sensation. This medication, usually given at bedtime, helps patients sleep better.

Description

This medication is one of several tricyclic antidepressants. Amitriptyline acts to block reabsorption of chemicals that transmit nerve messages in the brain.

Recommended Dosage

Amitriptyline's usual adult dose for pain management is 10 mg to 150 mg at bedtime. Patients are generally started on a low dose. The amount of medication may be increased as needed. Side effects, such as a dry mouth and drowsiness, may make it difficult to increase the dose in older adults. Bedtime dosing helps the patient sleep. Doctors generally order 75 mg to 150 mg for depression. It is given at bedtime or in divided doses. It may take 30 days for the patient to feel less depressed. Pain relief is usually noticed sooner than the mood change. Teens and older adults usually receive a lower dose. If the nightly dose is missed, it should not be taken the next morning. Taking amitriptyline during waking hours could result in noticeable side effects. Patients should check with their doctor if the daily dose is missed. Those on more than one dose per day should take a missed dose as soon as it is noted. Patients should not take two doses at the same time. Injectable amitriptyline is available. It should not be used long-term. Patients should switch to tablets as soon as possible.

Precautions

Patients should not suddenly stop taking this medication. The dose should gradually be decreased, then discontinued. If the drug is abruptly stopped, the patient may experience headache, nausea, discomfort throughout the body, and a worsening of original symptoms. Amitriptyline's effects last for three to seven days after the medication has been stopped. Older adults usually are more prone to some side effects. These include drowsiness, dizziness, mental confusion, blurry vision, dry mouth, difficulty urinating, and constipation. Taking a lower dose may help resolve these problems. Patients may need to stop this medication before surgery.

Amitriptyline should not be given to anyone with allergies to the drug or to patients recovering from a heart attack. Patients taking MAO inhibitors, a different type of antidepressant, should not also use amitriptyline. It should be administered with caution to patients with glaucoma, seizures, urinary retention, an overactive thyroid, poor liver or kidney function, alcoholism, asthma, digestive disorders, an enlarged prostate, seizures, or heart disease. This medication should not be given to children under 12. Pregnant women should discuss the risks and benefits of this medication with their doctor. Fetal deformities have been associated with taking this drug during pregnancy. Women should not breastfeed while using amitriptyline.

Side Effects

Common side effects associated with amitriptyline include dry mouth, drowsiness, constipation, and dizziness or lightheadedness when standing. Patients can suck on ice cubes or sugarless hard candy to combat the dry mouth. Increased fiber in the diet and additional fluids may help the constipation. The dizziness is usually caused by a drop in blood pressure when changing position. Patients should slowly rise from a sitting or lying position if dizziness is noticed. Amitriptyline may increase the risk of falls in older adults. Patients should not drive or operate machinery or appliances while under the influence of this drug. Alcohol and other central nervous system depressants can increase drowsiness. Amitriptyline may also produce blurry vision and an irregular or fast heartbeat. Amitriptyline also may raise or lower blood pressure, or cause palpitations. This medication may increase or decrease diabetic patients' blood sugar levels. Amitriptyline may make patients' skin more sensitive to the sun. Patients should avoid direct sunlight, wear protective clothing, and apply sunscreen with a protective factor of 15 or higher.

Amitriptyline may increase appetite, cause weight gain, or produce an unpleasant taste in the mouth. It may also cause diarrhea, vomiting, or heartburn. Taking this medication with food may decrease digestive side effects. Other less likely side effects include muscle tremors, nervousness, impaired sexual function, sweating, rash, itching, hair loss, ringing in the ears, or changes in the make up of the patient's blood. Patients with schizophrenia may develop an increase in psychiatric symptoms.

Interactions

Patients should always tell all doctors and dentists that they are taking this medication. Amitriptyline may decrease the effectiveness of some drugs used to treat high blood pressure. Amitriptyline should not be taken with other antidepressants, epinephrine and other adrena-line-type drugs, or methylphenidate. Patients should not take over-the-counter medications without checking with their doctor. For instance, amitriptyline should not be taken with Tagamet (cimetidine) or Neo-Synephrine. Patients taking this drug should avoid the dietary supplements St. John's wort, belladonna, henbane and scopolia. Black tea may decrease the absorption of this drug. Patients should ingest the drug and tea at least two hours apart.

—Debra Wood, R.N.

Brand names: Elavil®, Tryptanol™, Vanatrip®

Chemical formula:

Drug Forms:
• Amitriptyline tablets (below)
• Amitriptyline injection

Español:
• Tabletas de amitriptilina
• Inyección de amitriptilina

Amitriptyline tablets

What are amitriptyline tablets?

AMITRIPTYLINE (Elavil®, Endep®) is an antidepressant. Amitriptyline can lift your spirits by treating your depression, especially if it is associated with sleep disturbance. Improvement of sleep patterns can be the first benefit of treatment. Your prescriber or health care professional may prescribe amitriptyline for other conditions, such as relief from nerve pain. Generic amitriptyline tablets are available.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:
• an alcohol problem
• asthma, difficulty breathing
• bipolar disorder or a family history of bipolar disorder
• blood disorders or disease
• diabetes
• difficulty passing urine, prostate trouble
• glaucoma
• having intramuscular injections
• heart disease or previous heart attack
• liver disease
• over active thyroid
• Parkinson's disease
• schizophrenia
• seizures (convulsions)
• stomach disease
• thoughts or plans of suicide; a previous suicide attempt or family history of suicide attempt
• an unusual or allergic reaction to amitriptyline, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I take this medicine?

Take amitriptyline tablets by mouth. Follow the directions on the prescription label. Swallow the tablets with a drink of water. You can take the tablets with or without food. Take your doses at regular intervals. Do not take your medicine more often than directed. Do not stop taking except on your prescriber's advice.

Do not use this medication in children unless you have been specifically instructed to do so by your health care provider. Contact your pediatrician or health care professional regarding the use of this medicine in children. Special care may be needed.

Adolescents, 12 to 18 years old, and elderly patients over 65 years old may have a stronger reaction to this medicine and need smaller doses.

What drug(s) may interact with amitriptyline?

Amitriptyline can interact with many other medicines. Some interactions can be very important. Make sure your prescriber or health care professional knows about all other medicines you are taking. Many important interactions are listed below:

Do not take amitriptyline with any of the following medications:
• astemizole (Hismanal®)
• cisapride (Propulsid®)
• probucol
• terfenadine (Seldane®)
• thioridazine (Mellaril®)
• medicines called MAO inhibitors-phenelzine (Nardil®), tranylcypromine (Parnate®), isocarboxazid (Marplan®), selegiline (Eldepryl®)
• other medicines for mental depression (may be duplicate therapies or cause additive side effects)

Amitriptyline may also interact with any of the following medications:
• alcohol
• antacids
• atropine and related drugs like hyoscyamine, scopolamine, tolterodine and others
• barbiturate medicines for inducing sleep or treating seizures (convulsions), such as phenobarbital
• blood thinners, such as warfarin
• bromocriptine
• bupropion
• cimetidine
• clonidine
• cocaine
• delavirdine
• diphenoxylate
• disulfiram
• donepezil
• drugs for treating HIV infection
• female hormones, including contraceptive or birth control pills and estrogen
• galantamine
• herbs and dietary supplements like ephedra (Ma huang), kava kava, SAM-e, St. John's wort, valerian, or others
• imatinib, STI-571
• kaolin; pectin
• labetalol
• levodopa and other medicines for movement problems like Parkinson's disease
• lithium
• medicines for anxiety or sleeping problems
• medicines for colds, flu and breathing difficulties, like pseudoephedrine
• medicines for hay fever or allergies (antihistamines)
• medicines for weight loss or appetite control
• medicines used to regulate abnormal heartbeat or to treat other heart conditions (examples: amiodarone, bepridil, disopyramide, dofetilide, encainide, flecainide, ibutilide, mibefradil, procainamide, propafenone, quinidine, and others)
• metoclopramide
• muscle relaxants, like cyclobenzaprine
• other medicines for mental or mood problems and psychotic disturbances
• prescription pain medications like morphine, codeine, tramadol and others
• procarbazine
• seizure (convulsion) or epilepsy medicine such as carbamazepine or phenytoin
• stimulants like dexmethylphenidate or methylphenidate
• some antibiotics (examples: erythromycin, gatifloxacin, levofloxacin, linezolid, moxifloxacin, sotalol, sparfloxacin)
• tacrine
• thyroid hormones such as levothyroxine

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What should I watch for while taking amitriptyline?

Visit your prescriber or health care professional for regular checks on your progress. It can take several days before you feel the full effect of amitriptyline. A Medication Guide About Using Antidepressants in Children and Teenagers is available from your health care professional and should be read by the patients and their family or caregivers. Discuss this Medication Guide with the health care provider if this drug is being used in a child or adolescent.

If you have been taking amitriptyline regularly for some time, do not suddenly stop taking it. You must gradually reduce the dose or you may get severe side effects. Ask your prescriber or health care professional for advice. Even after you stop taking amitriptyline it can still affect your body for several days.

If you notice any unusual effects, such as restlessness, worsening of depression, agitation, difficulty sleeping, irritability, anger, acting on dangerous impulses, or suicide thoughts or attempts, you should call your health care provider immediately.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how amitriptyline affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol may increase dizziness and drowsiness. Avoid alcoholic drinks.

Do not treat yourself for coughs, colds, or allergies without asking your prescriber or health care professional for advice. Some ingredients can increase possible side effects.

Your mouth may get dry. Chewing sugarless gum or sucking hard candy, and drinking plenty of water will help.

Amitriptyline may cause dry eyes and blurred vision. If you wear contact lenses you may feel some discomfort. Lubricating drops may help. See your ophthalmologist if the problem does not go away or is severe.

Amitriptyline may make your skin more sensitive to the sun. Keep out of the sun, or wear protective clothing outdoors and use a sunscreen. Do not use sun lamps or sun tanning beds or booths.

If you are diabetic, check your blood sugar more often than usual, especially during the first few weeks of treatment with amitriptyline. Amitriptyline can affect blood glucose (sugar) levels. Call your prescriber or health care professional for advice if you notice a change in the results of blood or urine glucose tests.

If you are going to have surgery or will need an x-ray procedure that uses contrast agents, tell your prescriber or health care professional that you are taking this medicine.

What side effects may I notice from taking amitriptyline?

Side effects that you should report to your prescriber or health care professional as soon as possible:
• abnormal production of milk in females
• anxiety, agitation, panic attacks, inability to sleep, irritability, hostility or extreme anger, aggressiveness, engaging in unusual or dangerous activities, restlessness or inability to sit still, extreme elation or feeling of happiness that may switch back and forth with a depressed or sad mood
• blurred vision or eye pain
• breast enlargement in both males and females
• confusion, hallucinations (seeing or hearing things that are not really there)
• difficulty breathing
• fainting spells
• fever with increased sweating
• irregular or fast, pounding heartbeat, palpitations
• muscle stiffness, or spasms
• pain or difficulty passing urine, loss of bladder control
• seizures (convulsions)
• sexual difficulties (decreased sexual ability or desire, difficulty ejaculating)
• stomach pain
• swelling of the testicles
• tingling, pain, or numbness in the feet or hands
• unusual weakness or tiredness
• yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
• anxiety
• constipation, or diarrhea
• drowsiness or dizziness
• dry mouth
• increased sensitivity of the skin to sun or ultraviolet light
• loss of appetite
• nausea, vomiting
• skin rash or itching
• weight gain or loss

Where can I keep my medicine?

Keep out of the reach of children in a container that small children cannot open.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

Last updated: 7/1/2002

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

A tricyclic antidepressant in humans; used in dogs and cats to treat psychodermatosis and as an antipruritic.

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