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Updated 11 February 2013

Amitriptyline

Amitriptyline is used for the treatment of depressive illness, and depression associated with anxiety.

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Amitriptyline is the active ingredient of Tryptanol and Trepiline.

Amitriptyline is also one of multiple active ingredients found in Limbetrol (amitriptyline and chlordiazepoxide).

General information

Amitriptyline is used for the treatment of depressive illness, and depression associated with anxiety. It is also used as adjunctive therapy for bed-wetting in children older than 6 years of age. Amitriptyline is furthermore used with great success in the treatment of chronic pain syndromes (neck and back pain, amongst others) and migraine. It has also been used to treat nerve pain such as that accompanied by shingles.

Amitriptyline elevates mood, increase physical activity, improves appetite and restores interest in everyday activities.

Because of its effect on appetite, many taking amitriptyline may experience unwelcome weight gain.

The drug has significant sedative effects and may be useful in the treatment of insomnia.

How does it work?

Amitriptyline has an effect on serotonin, noradrenaline and acethylcholine. These brain chemicals play an important role in mood, emotion, mental state and anxiety, and by elevating these brain chemicals, the conditions for which amitriptyline is indicated, is greatly improved.

Fast facts

Drug schedule: Schedule 5

Available as : Tablets

What does it do? Amitriptyline is an antidepressant, sedative and anti-anxiety agent

Overdose risk: High

Dependence risk: Low

Available as a generic? Yes

Available on prescription only? Yes

User information

Onset of effect: Antidepressant effect is only evident after 3-6 weeks; to induce sedation the drug is effective within a couple of hours.

Duration of action: As an antidepressant, the effects may for as long as 6 weeks after discontinuing drug.

Dietary advice: Take amitriptyline with food to reduce gastrointestinal side effects.

Stopping this medicine: Stopping this medication too soon may cause a recurrence of the original symptoms. Always consult your doctor.

Prolonged use: No problems foreseen; tolerance to many side effects may occur over time.

Special precautions

Consult your doctor before using this drug if:

  • you have epilepsy,
  • you have abnormal heart rhythms,
  • you have impaired liver function,
  • you had a recent heart attack,
  • you have a thyroid condition,
  • you have an enlarged prostate,
  • you have glaucoma, or
  • you are taking other medication.

Pregnancy: Avoid. Potential risk to the foetus has been reported. Consult your doctor before use, or if you are planning to fall pregnant.

Breastfeeding: Avoid. It is unknown how this medication may affect your baby. Consult your doctor before use.

Porphyria: Avoid. This medication may cause serious adverse effects. Consult your doctor before use.

Infants and children: Safety and efficacy of this medication has not been established for children under the age of 6 for bed wetting, and children under the age of 16 for depression.

Elderly: Caution is advised in the elderly as side effects may be more severe.

Driving and hazardous work: Caution is advised as use of this medication may lead to dizziness, light-headedness and/or sedation. Avoid such activities until you know how it affects you.

Alcohol: Avoid concomitant use of alcohol with this medication as alcohol may potentiate sedative effects.

Possible side effects

Side effect

Frequency

Consult your doctor

Common

Rare

Only if severe

In all cases

Confusion

x

x

Dry mouth

x

x

Headache

x

x

Nausea/ vomiting

x

x

Weight gain/ increased appetite

x

x

Heartburn

x

x

Constipation

x

x

Difficulty urinating

x

x

Hallucinations

x

x

Fatigue

x

x

Blurred vision

x

x

Impaired concentration

x

x

Dilated pupils/ eye pain

x

x

Difficulty breathing

x

x

Seizures

x

x

Palpitations

x

x

Fever/ sore throat

x

x

Interactions

Drug interactions

Warfarin

Blood clotting time may be affected

Antihistamines

Increased risk of heart rhythm disturbance

Barbiturates

Reduced amitriptyline efficacy

Benzodiazepines

Possible increase in sedative effects

Cimetidine

Possible amitriptyline toxicity

Fluoxetine

Increased risk of serotonin toxicity

Fluvoxamine

Increased risk of amitriptyline toxicity

Monoamine oxidase-inhibitors

Serious interactions may occur. Wait at least after stopping MAOI before starting amitriptyline

Nitrates

Possible reduced effect on sublingual (under tongue) nitrates

Oral contraceptives

Increased risk of amitriptyline toxicity

Rifampicin

Reduced amitriptyline effect

Sertraline

Increased risk of serotonin toxicity

Tobacco

Possible reduced effect of amitriptyline

Disease interactions

Consult your doctor before using this drug if you have epilepsy, glaucoma, abnormal heart rhythms, impaired liver function, had a recent heart attack, have a thyroid condition or if you have an enlarged prostate.

Overdose action

A small overdose is no cause for concern. In case of intentional large overdose, seek emergency medical attention.

Recommended dosage

Adults: 25mg 2-4 times daily (maximum 300mg daily)

Teenagers: 10mg three times a day with 20mg at bedtime.

Bedwetting

Children 6-12: 10-25mg at bedtime

Children over 12: 25-50mg at bedtime

This material is not intended to substitute medical advice, but is for informational purposes only. Please consult a physician for specific treatment and recommendations.

 
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