Amitriptyline

Amitriptyline treats depression. Amitriptyline can cause weight gain and drowsiness. Amitriptyline is not recommended in those with certain heart conditions.

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Amitriptyline Overview

Reviewed: May 23, 2013
Updated: 

Amitriptyline is a prescription medication used to treat the symptoms of depression. Amitriptyline belongs to a group of drugs called tricyclic antidepressants (TCAs), which work by adjusting the levels of natural chemicals in the brain.

This medication comes in tablet form and may be taken once or multiple times a day, depending on your doctor’s instructions.

Common side effects of amitriptyline include nausea, vomiting, and weakness.

Amitriptyline can cause drowsiness and dizziness. Do not drive or operate heavy machinery until you know how amitriptyline affects you.  Do not drink alcohol while taking amitriptyline.

Amitriptyline Genetic Information

CYP2D6 is a protein in your body that is involved in the elimination of amitriptyline and other drugs from your body. Some patients have less of this protein in their bodies, affecting how much of the drug gets eliminated. Levels of CYP2D6 can vary greatly between individuals, and those having less of this protein are known as "poor metabolizers." 

CYP2D6 testing is done to determine whether you are a poor metabolizer. If you are a poor metabolizer, the levels of amitriptyline in your blood can become too high. As a result you may be at an increased risk of having more side effects from the drug. 

Your doctor may adjust your dose if you are a poor metabolizer.

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Amitriptyline Cautionary Labels

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Uses of Amitriptyline

Amitriptyline is a prescription medication used to treat symptoms of depression.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Amitriptyline Brand Names

Amitriptyline may be found in some form under the following brand names:

Amitriptyline Drug Class

Amitriptyline is part of the drug class:

Side Effects of Amitriptyline

Serious side effects have been reported with amitriptyline. See “Drug Precautions” section.

Common side effects of amitriptyline include:

  • nausea
  • vomiting
  • weakness
  • drowsiness
  • dizziness
  • dry mouth
  • headache
  • blurred vision
  • change in appetite and weight
  • constipation
  • trouble urinating
  • pain or tingling in the hands or feet
  • changes in sex drive
  • excessive sweating
  • confusion
  • orthostatic hypotension
  • tachycardia (fast heart beat)

This is not a complete list of amitriptyline side effects. Ask your doctor or pharmacist for more information.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Amitriptyline Interactions

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

  • monoamine oxide (MAO) inhibitors such as selegiline (Emsam) and phenelzine (Nardil)
  • cimetidine (Tagamet)
  • disulfiram (Antabuse)
  • quinidine (Quinidex)
  • anti-arrhythmic drugs such as flecainide (Tambocor) and propafenone (Rythmol)
  • barbiturates such as phenobarbital
  • selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa) and fluoxetine (Prozac)
  • epinephrine
  • pseudoephedrine (Sudafed)
  • alcohol

This is not a complete list of amitriptyline drug interactions. Ask your doctor or pharmacist for more information.

Amitriptyline Precautions

Serious side effects have been reported with amitriptyline including:

  • Increased risk of psychosis in schizophrenic patients: Amitriptyline can increase the symptoms of schizophrenia.
  • Worsening of depression or suicide risk: Amitriptyline may worsen depression or cause suicidal thoughts and behavior before medication has its full effect.
    • Watch for signs of changed behavior such as increased agitation, anxiety, insomnia, aggressiveness, impulsivity, hostility, or desire to end one's life.
  • Bipolar disorder: Amitriptyline can worsen symptoms of bipolar disorder.
    • Screening for bipolar disorder should occur in patients diagnosed with depression before starting amitriptyline.
  • Surgery: Amitriptyline should be discontinued several days before any surgery.
  • Electroshock therapy: Amitriptyline together with electroshock therapy may increase the risks of electroshock therapy (e.g. memory loss, confusion)
  • Abnormal glucose levels: Amitriptyline can increase or decrease blood sugar levels.
  • Decreased liver function: Amitriptyline should be used with caution in patients with liver disease.
  • Seizures: Amitriptyline may increase the risk of seizure activity.
  • Urinary retention: Amitriptyline may increase the risk of urinary retention (not able to urinate).
  • Glaucoma or intraocular pressure: Amitriptyline may increase the risk of urinary retention (increased pressure within the eye).
  • Heart disease: Amitriptyline can increase your risk for certain heart problems such as heart attack, arrhythmia (rapid heart rate or rhythm), and stroke.
  • Hypersensitivity reaction: An allergic reaction to amitriptyline can occur. Symptoms of a hypersensitivity reaction include:
    • swelling
    • itchy skin
    • hives
    • rash
    • difficulty breathing or swallowing
    • hoarseness

Amitriptyline can cause drowsiness. Do not drive or operate heavy machinery until you know how amitriptyline affects you.

Do not take amitriptyline if you:

  • are allergic to amitriptyline
  • have taken monoamine oxide (MAO) inhibitors such as selegiline (Emsam) and phenelzine (Nardil) within the past 14 days; use of fluoxetine (Prozac) may require more than 14 days before starting amitriptyline
  • have recently experienced a heart attack
  • are taking cisapride

Amitriptyline Food Interactions

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of amitriptyline, there are no specific foods that you must exclude from your diet when receiving amitriptyline.

 

Inform MD

Before taking amitriptyline, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

  • are allergic to amitriptyline
  • have taken monoamine oxide (MAO) inhibitors such as selegiline (Emsam) and phenelzine (Nardil) within the past 14 days, or have taken fluoxetine within the past 5 weeks
  • take cisapride (Propulsid)
  • have schizophrenia
  • have diabetes
  • have an enlarged prostate
  • have difficulty urinating
  • have a history of glaucoma
  • have a history of seizures
  • have a history of liver disease
  • have a history of heart disease
  • have hyperthyroidism, or an overactive thyroid
  • have undergone or will undergo a surgical procedure
  • are pregnant or breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Amitriptyline and Pregnancy

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Amitriptyline falls into category C. It is not known if amitriptyline will harm your unborn baby. This medication may be given to a pregnant woman if her healthcare provider believes that its benefits to the pregnant woman outweigh any possible risks to her unborn baby.

Amitriptyline and Lactation

Tell your doctor if you are breastfeeding or plan to breastfeed.

You should not take amitriptyline if you are breastfeeding. It can be excreted in your breast milk and may harm your nursing child.

Amitriptyline Usage

Take amitriptyline exactly as prescribed.

This medication comes in tablet form and is taken once or more times per day, with or without food.

Your doctor may suggest taking amitriptyline at bedtime.

If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of amitriptyline at the same time.

Amitriptyline Dosage

Take amitriptyline exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

Your doctor will prescribe the appropriate dose and schedule of amitriptyline depending on your condition, age, and response to the medication. Doses of amitriptyline may range from 10 to 150 mg a day. The maximum daily dose of amitriptyline in the hospital setting is 300 mg a day.

Amitriptyline Overdose

If you take too much amitriptyline call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If amitriptyline is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

Other Requirements

Store amitriptyline at room temperature.

Keep in a tight, light-resistant container.

Keep this and all medicines out of the reach of children.

Amitriptyline FDA Warning

Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-ter studies of major depressive disorder (MDD) and other psyciatric disorders. Anyone considering the use of amitriptyline hydrochloride tablets or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Amitriptyline hydrochloride is not approved for use in pediatric patients.