Amitriptyline

💊 What is Amitriptyline used for?

• •Relief of symptoms of depression. The label says endogenous depression is more likely to improve with this medicine than other depressive states.

How it works

How it is usually taken

• •The label says the dose is usually started low and increased slowly, with close attention to how the person responds and any side effects.
• •The label says the dose may be split across the day, and that dose increases are preferably made in the late afternoon or at bedtime.
• •For maintenance treatment, the label says the daily amount may be taken as a single dose, preferably at bedtime.
• •The label says a calming (sedative) effect may appear before the antidepressant effect, and that the full benefit can take as long as 30 days to develop.
• •The label says that once symptoms improve, the dose should be lowered to the least amount that keeps symptoms under control, and that maintenance therapy often continues for 3 months or longer to lower the chance of depression returning.
• •Follow the instructions from your prescriber or pharmacist about how and when to take it.

Comes as

• •Tablets for oral use, available in 10, 25, 50, 75, 100, and 150 mg strengths
• •The label describes 75 mg tablets as purple, round, and marked with "45" on one side. They come in bottles with a child-resistant closure.

⚠️ Amitriptyline side effects

🛑 Who should not take Amitriptyline, and who should be careful

The label says not to take it if

• 🚨You have had a past allergic reaction (hypersensitivity) to amitriptyline. The label says it is contraindicated in this case.
• 🚨You take a monoamine oxidase inhibitor (MAOI). The label says the two should not be given together, and at least 14 days should pass after stopping an MAOI before starting amitriptyline.
• 🚨You take cisapride. The label says it should not be given with amitriptyline because of the risk of heart rhythm problems.
• 🚨You are in the acute recovery phase after a heart attack (myocardial infarction). The label says this drug is not recommended in that situation.

Tell your doctor before taking it if

• •Tell your healthcare provider about all medicines you take, including over-the-counter products. The label says to keep a list to show your provider and not to start new medicines without checking first.
• •Tell your healthcare provider if you have had low sodium levels in your blood during treatment.
• •Do not stop this medicine suddenly without first talking to your healthcare provider. The label says stopping suddenly can cause other symptoms.
• •The label says you may want an eye exam to see whether you are at risk for vision problems, and that preventive treatment is available if you are.
• •The label says it is not recommended for children under 12 years of age.
• •Older adults and adolescents may need lower doses, according to the label.

🔀 Amitriptyline with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •Monoamine oxidase inhibitors (MAOIs): The label says they must not be given together with amitriptyline. Serious reactions, including high fever, severe seizures, and deaths, have occurred when they were combined.
• •Cisapride: The label says it should not be given with amitriptyline because of the risk of increased QT interval and arrhythmia.
• •Topiramate: The label says some patients may have a large increase in amitriptyline levels when taking topiramate. Dose changes should be based on clinical response, not blood levels.
• •Medicines that affect the liver enzyme CYP2D6: The label says some drugs, including quinidine, cimetidine, phenothiazines, propafenone, flecainide, and many other antidepressants, can raise amitriptyline levels and may cause toxicity in someone who was stable before. Examples of SSRIs named include fluoxetine, sertraline, and paroxetine. The label says caution is needed when combining these with amitriptyline or switching between them.
• •Fluoxetine: The label says enough time must pass before starting amitriptyline after fluoxetine is stopped, and that at least 5 weeks may be necessary.
• •The label says that when a CYP2D6-inhibiting drug is stopped, the amitriptyline level may change, so the prescriber may need to adjust treatment.

Alcohol and food

The label does not say.

🤰 Amitriptyline in pregnancy and breastfeeding

Pregnancy

The label does not say.

Breastfeeding

The label does not say.

🗓️ Storage, missed doses and taking too much

Storage

The label does not say.

If a dose is missed

The label does not say.

If too much is taken

The label says deaths can occur from overdose with this class of medicine, and that taking several drugs together, including alcohol, is common in deliberate overdose. Symptoms can appear quickly, so the label says hospital monitoring is needed as soon as possible. Critical effects listed include heart rhythm problems, severe low blood pressure, seizures, and central nervous system depression, including coma. If someone may have taken too much, get emergency medical help right away and contact a poison control center.

🗒️ Questions to ask about Amitriptyline

• What symptoms of depression is this medicine expected to help with, and how long might it take to notice a difference?
• Am I taking any medicines that could interact with amitriptyline, such as an MAOI, cisapride, topiramate, or another antidepressant?
• What warning signs of worsening mood or suicidal thoughts should I watch for, and who should I call?
• Should I have an eye exam, and what vision changes should I report?
• What should I do if I want to stop taking this medicine?
• What signs of low sodium or serotonin syndrome should I know about?

❓ Amitriptyline: frequently asked questions