Amitriptyline
Amitriptyline belongs to a class of drugs known as tricyclics. Mainly used in the long term treatment of depression, clinical/endogenous depression, and Involutional melancholia (depression of late life) which, is no longer seen as a disease in its own right. Amitriptyline’s properties are known to elevate moods, increase physical activity, improve appetite and restore interest in everyday activities. It has a more sedating effect than similar drugs, and has been around for many years. It is most useful when depression is accompanied by anxiety and insomnia. If a prescribed dosage is taken at night it will encourage the user to sleep, eliminating the need for any additional drugs for sleeping. Amitriptyline may also be used to treat ankylosing spondylitis (a chronic inflammatory arthritis), postherpetic neuralgia and as a preventative against migraine attacks (unlicensed indication),. This medication is also used to treat night time bed wetting in children, and may be prescribed for up to 3 months. If necessary a full physical examination would be necessary before a further course could be given.
Amitriptyline also excels when used to treat nerve pain caused by severe heavy work related wear and tear problems. The down side is when taken as long term pain suppressant it would leave the door open for dependency and possibley major side effect problems, if the medication was stopped suddenly. Common side effects of using amitriptyline are mostly due to its anticholinergic (blocking the passage of impulses through the parasympathetic nerve) activity.
Worsening of your depression or anxiety
If you have had thoughts in the past of harming or killing yourself these could be increased when first starting an antidepressant for depression and/or anxiety disorders, since these medicines all take time to work, usually 2 – 4 weeks for some individuals. You may be more likely to think like this If you have previously had thoughts about killing or harming yourself in the past.
Detailed Information
Quick Guide
- Antidepressant danger of overdose – HIGH.
- Dependency is said to be – LOW.
- Prescription only drug – YES.
- Available as generic – YES (generic drugs, short: generics) is a drug which is produced and distributed without patent protection.
- Alcohol Avoidance – YES.
- Alcohol may increase sedative effect and enhance side effects of this antidepressant.
- Actavis/Amitriptyline tablets contain lactose (a form of sugar). If your doctor has told you that you are intolerant to some sugars, discuss it with him/her before taking this medicine.
- Take Amitriptyline exactly as your doctor has told you.
- Using a glass of water you can take the tablets with, without or after food.
- Try to take your medicine at the same times each day to avoid missing any doses (become habit forming).
Side Effects
You may if prescribed Amitriptyline suffer one or more of these side effects, in the initial stages. However, you may find you do not suffer any at all. It does not automatically follow that being on this medication will cause you unwanted adverse effects.
Common: Dizziness, Blurred Vision, Drowsiness, Constipation, Sweating.
Rare: Difficulty passing water, Palpitations, Sore Throat, Changes in sexual desire and function.
Behavioural changes have been observed in children receiving amitriptyline for the treatment of bedwetting (enuresis). Other side effects in children receiving the treatment for this condition are drowsiness, mild sweating and itching.
Prolonged Use
It is documented that no problem would be expected. However, I am aware of cases where long term use of amitriptyline can cause increased eye pressure in the elderly population. It could also be habit-forming.
As with all high risk drugs stopping amitriptyline suddenly after prolonged use will cause severe withdrawal symptoms. Be guided by your doctors advice if you are looking to withdraw or move to a lower dosage.
Driving, Hazardous Work & Alcohol
Avoid all activities until you know how this medication will affect you. Amitriptyline could be the cause of blurred vision, drowsiness and will reduce your alertness. Alcohol may increase sedative effect and enhance side effects of this antidepressant.
Pregnancy and Breast-Feeding
Manufacture advises: Amitriptyline tablets should not be taken in the first 3 months and last 3 months of pregnancy. You will need to discuss your pregnancy with your doctor as safety in pregnancy is not known. If you are or intend to breast feed Manafactures advise: Do not take Amitriptyline tablets if you intend to breast-feed. You need to discuss this with your doctor, the drug passes into the breast milk and could harm the baby.
Surgery Or Dental Procedure
Discuss with the appropriate people (doctor, dentist, surgeon) if you are to under-go any form of surgery. Amitriptyline may need to be stopped before having a general anaesthetic.
Tell Your Doctor or Pharmacist
You should tell your doctor if you have a current health problem. For example: heart disease, kidney problems, if you are pregnant or you intend to become pregnant or if you think you may be at risk from drug treatment for any other reason. Some types of medication can cause serious adverse effects when taken side by side so it is important to tell your doctor of any other medication you are already taking. This should also include any over-the-counter medication. For example: Painkillers, cold remedies, herbal and complimentary / alternative medication.
See full list of things you should tell your doctor about.»Over 60′s & Children
A reduced dose may be necessary for the over 60′s. An example of this could be a dosage of 10-25mg. three times daily. The dosage could be slowly increased if there be a need. This drug is not recommended for children under 16 years of age for the treatment of depression. However, amitriptyline can be used to treat bed wetting (nocturnal enuresis) in children, but is not recommended for those children under the ages of 6 yrs of age.
Overdose
If you have taken a lot of tablets at the same time or you beleive a child may have swallowed some inform your doctor immediately.
Failing this go to your nearest accident and emergency department of your local hospital. Take the container with you. This will help the hospital staff identify what has been taken and work towards given the right kind of help without delay.
Symptoms of an overdose include fast regular heart beat, dilated pupils, drowsiness, coma, difficulty breathing, jerky movements, hot dry skin, dry mouth and tongue, difficulty passing water, intestinal blockage, uncontrolled eye movement.
Other Medication Reactions
All drugs that have a sedative effect on the nervous system will more likely than not increase the sedative properties of this drug. Amitriptyline may block the blood pressure-lowering action of the following: guanethiidine, debrisoquine, bethanidinea and possibly clonidine. Amitriptyline may cause an increase in blood pressure if used together with the following: Adrenaline, noradrenaline, ephedrine, isoprenaline, phenylephrine, phenylpropanolamine and should be avoided. Bad interactions such as: an increase in body temperature and convulsions could occur if monoamine oxidase inhibitors (MAOIs) are taken along side amitriptyline. A minimum of 14 days should elapse between discontinuing an MAOI’s and starting amitriptyline (tricyclic antidepressant).The effects of anti epileptic drugs are also reduced by amitriptyline.
Barbiturates and carbamazepine may cause a decrease in the antidepressant action of amitriptyline. Methylphenidate may increase the antidepressant action of amitriptyline. Anti-cholinergic drugs such as atropine may cause paralysis of the small intestine, urine retention, or glaucoma when combined with amitriptyline, especially in the elderly.
Cimetidine can reduce the breakdown of amitriptyline, which is necessary for this drug to be removed from the body (excreted). You may require Medical advice if you are taking ritonavir this is because it may interact with amitriptyline causing clinical problems.
Missed Dose
If for what ever reason you forget to take your medication you should take it as soon as you remember. Depending on the time your medication is usually due, if within 3 hours take a single dose and skip the next. Do not double up on the dosage. Ideally you would have already checked with your doctor. Failing this ring the surgery or check next time you see your doctor for guide lines on missing a dosage.
Reducing or Stopping Medication
An abrupt stop in taking this medication can result in unpleasant side effects. See your doctor who will advise you and if need be a slow withdrawal from the drug.
Withdrawal side-effects may also include: feeling sick, malaise and headache, dream and sleep disturbances, irritability and restlessness. Mania or hypomania (exaggerated mood and/or elation) may occur 2-7 days after stopping the tablets.
Effect Of Medication (from one dose)
Sedation can appear within several hours. However, to receive the full benefit of this medication it could take between 2 – 4 weeks
Safety and Storage
- Never take more than the original dosage prescribed by your doctor.
- If your due to have treatment like an operation or dental work tell the person carrying out the treatment which medicines you are taking.
- When you buy any medicines over-the-counter check with the pharmacist that they are safe to take with your other medicines.
- Never take Amitriptyline if it has past the expiry date shown on the box or container.
- Do not store medication above a temperature of 25°C or above a working area where high condensation may exist.
- Keep Amitriptyline in its original container, in a cool dry place, away from the reach and eye sight of children.
- Always read the printed information leaflet that comes with your medicine if possible, before beginning treatment.
- Keep your patient information Leaflet (PIL) with your medicine you may need to refer to it at a later date.
- Do not discard old or unwanted drugs into your trash, sink or toilet.
- Return all unused or old medicines/drugs to your pharmacist. who will dispose of them safely. without causing unwanted effects on our environment.
Do not leave your doctors surgery until you have a clear understanding of what the drug your doctor has prescribed for you does, and why you have been prescribed it. It is common for people who do not understand the reason behind there treatment to take their medication correctly.
Reference:
- Manufacturer’s Actavis UK Ltd. Patient Information Leaflet (PIL) last updated on electronic Medicines Compendium eMC: 18/03/2011. Amitriptyline Tablets 10mg, 25mg, 50mg.
- British National Formulary – 61st Edition (March 2011) British Medical Association and Royal Pharmaceutical Society of Great Britain, London.
- If you are pregnant, breast feeding or trying for a child.
- If you have had epileptic fits.
- If you have long-term kidney or liver problems.
- If you have glaucoma.
- If you have urinary problems (difficulty passing water).
- If you have prostate troubles (especially an enlarged prostate).
- If you have had mania or a psychotic illness.
- If you are due to have surgery or dental work, that involves an anaesthetic, in the near future.
- If you suffer from porphyria. (a disease affecting the skin, or nervous system, or both).
- If you have thyroid problems.
- If you are receiving electroconvulsive Therapy (ECT).
- If you have heart problems or recovering from a heart attack.
- If you are taking an MAOI drug.
- If you suffer from narrow angle glaucoma or increased pressure in the eye/s.
- If you have previously had thoughts about killing or harming yourself.
- If you are taking other medicines, including those available to buy without a prescription (over the counter), vitamins, herbal or complementary medicines.
Amitriptyline hydrochloride contains:
- Each tablet contains 10mg, 25mg or 50mg of the active ingredient amitriptyline hydrochloride.
- The other ingredients are:
- lactose monohydrate, microcrystalline cellulose (E460), maize starch,
- colloidal anhydrous silica, magnesium stearate, hypromellose (E464), titanium dioxide (E171), macrogol.
- The 10mg tablet also contains: indigo carmine (E132).
- The 25mg tablet also contains: talc (E553b), quinoline yellow (E104), iron oxide (E172), sunset yellow (E110), indigo carmine (E132). It is possible for some individuals to suffer and allergic reaction to the ingredient sunset yellow (E110).
- The 50mg tablet also contains: talc (E553b), quinoline yellow (E104), iron oxide (E172).
Stop taking Amitriptyline tablets and contact your doctor immediately. Symptoms of an allergic reaction include: A skin rash, which may be itchy, sensitivity to the sun or sun lamps, puffy, swollen face or tongue, which may be severe causing shortness of breath, swelling, shock and collapse.
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About the Author: The Medibolism Team
It must be stressed that we are not doctors. We only have an interest in the medication, healthy living, etc. The information on this site has been derived from personal experiences, medical leaflets, books, doctor advice, and other professional means. The medicine database is referenced to British National Formulary - 61st Edition (March 2011).
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iam using amitriplyne senc 5weakes for sever epression.i improved but i sitill have proplem . my proplem is the picture from my past live and most all the people i know befor or now.that one makmy anxity and i feel iam not normal.my quastion if i contenue my reat ment that proplem it will go ? THANK U
Hi Mahassen,
I am having a little problem understanding everything you have wrote. You do not say how much or how often you take your medication, but I will cover as much as I can. First be aware I can not interfere with your doctors diagnosis. You would have been given amitriptyline by your doctor based on what you told him or her.
The medication you are taking belongs to a particular drug group called Tricyclic Antidepressants, and it may take several weeks before you feel the full benefits of this drug. It is an excellent drug for long term depression, and if you are having trouble sleeping it can also help. If after several weeks you still feel there has been no further change to how you feel, you will need to see your doctor again. Explain how you feel, and that there have been no changes to your symptoms, your doctor may suggest an increase in your dosage. This would not be unusual as you may well need an increased dosage. It is quite possible your doctor has given you amitriptyline to see if this particular type of drug will be of benefit to you.
There are other drugs that may be of more help than amitriptyline, please check with your doctor. Have you thought about taking a form of talk therapy? A counsellor, or some other qualified professional who will be able to offer you a none judgemental environment and help you work through this problem. You will still be able to take your medication alongside talk therapy. You say you feel you are ‘not normal’. I can only say that normal is only relevant to the individual, we are all unique and what may be normal to me may not be normal to someone else.
Please, do not stop taking your medication without first speaking to your doctor.
I hope that helps.
iam taking amitriplyne sence 10 weakes for treat sever depression .i went to doctor and she gave me to take amitriplyne .she start with low does 50 g after she increase to 100 g regularly. i improve alot almost i improve 80 persent my gustion that is amitriplyne will work more antil will recover my depression.
Hi Mahassen,
We are so pleased to hear you are feeling a lot better, since your doctor increased your medication dosage. Try to remember that you are not alone, many people at some stage in there lives suffer from depression.
The purpose of your medication is to help you cope with the problems you have encountered. It does this by lifting your mood allowing you to see the more positive side of your life, restoring your appetite and helping you to sleep better. We all need to sleep well otherwise our body over time would not be able to cope with our everyday lifestyle and eventually lead to health problems both physical and mental.
Your medication has sedative properties that will help you back to a regular sleep pattern. Getting regular sleep will also help to lift your mood. If your appetite has been poor this would also add to making you feel unwell in yourself. Amitriptyline will also improve your appetite. If you have been unable to cope with people and life around you your medicine will help to restore your interest in the things you used to like doing.
I think you have done exceptionally well to be feeling an 80% increase in your health. Keep your doctor informed on how you progress with the medication and do not stop taking your tablets without speaking to your doctor first.
Now might be a good time to talk on a one-to-one bases with a Counsellor or a close friend who knows you well and you feel you can trust. There are also self help groups where individuals can discuss their feelings within the self help group. You do need to focus on the fact that you have improved tremendously since you last posting keep with the positive out-look… onward and upward…
Other than offering you an understanding ear, I can not interfere in your doctors treatment or diagnosis of your personal mental health.
Hi there I am currently taking amitriptyline and propanolol 4 panic disorder. Is there any herbs or essential oils that I should avoid? Thanks
Hi
Using Aromatherapy for personal home use is what I consider to be a safe valuable healing tool If applied carefully and competently, but you should view essential oils in the same vein as conventional medication. There are situations in which certain oils are not safe and should not be used.
If you enjoy a massage from time to time listed below are some conditions that you would need to seek professional medical advice before you enjoy your massage:
Hyper or hypotension (high or low blood pressure), heart disease, pregnancy, circulatory problems, taking anti-coagulants, varicose veins, pacemaker, haemophilia, thyroid problems, cancer, recent operations or injuries, severe skin complaints, epilepsy, asthma, allergies, diabetes.
Most essential oils do not cause drug interactions – but as new drugs become available, it is always a good idea to ask your doctor before using essential oils or herbal supplements.
One known drug I am aware of that essential oils may interact with is know as Coumarin, an oral anticoagulant medication used to thin blood. Grapefruit essential oil should be avoided by those using this drug, this would also apply to grapefruit drinks. However, in general essential oils are safe to use while taking medication.
As for Herbs there is one I am aware of. That would be St John’s-Wort because it may decrease the medication you may be taking making it less effective. The following medicines may cause an interaction and St Johns Wort should be avoided:
anticonvulsants (e.g. carbamazepine, phenobarbital, phenytoin)
Antidepressants (e.g. amitriptyline, citalopram, fluoxetine)
aprepitant
ciclosporin
digoxin, dronedarone
eplerenone, etravirine, everolimus
gefitinib
imatinib, irinotecan, ivabradine, lapatinib
non-nucleoside reverse transcriptase inhibitors for HIV infection (e.g. efavirenz, nevirapine)
oestrogens and progestogens, (e.g. in oral contraceptive pills.), protease inhibitors for HIV infection (e.g. amprenavir, atazanavir, darunavir, indinavir, nelfinavir, ritonavir, saquinavir, tipranavir)
warfarin.
This list is not complete there are others and your doctor should be consulted.
Speaking from a personal point of view I used amitriptyline as a pain suppressant for many years after suffering damage to my spine and I never had any problems using essential oils or herbs. I feel you would be more likely to suffer an allergic reaction to the oils more than an interaction with conventional medication.
You have been given this information in response to a question left on our website. It should not be taken as a diagnosis. If you are in any doubt check it out with your doctor or pharmacist.
Mediteam.
Thanks 4 advice! Had read on net that lavander oil helps amitriptyline 2 work better. Also read taking it with tea reduces uptake of it (bad news 4 us brits!). Also takin ginseng with it could be a big no no as ginseng contains a compound similar 2 MAO antidepressants. As on net might not be accurate but thought interesting all the same. Cheers Stu
Your welcome. Many thanks for your info. I try to keep Medibolism as up to date as one man alone possibly can. Any offered info is much appreciated.
Ben.
My brother was taking amitriptoline at 25 mlg he started with mild shaking of the left hand he was taking for migraines it was working til he got a bad migrain after a fall. he’s 52. he had an epidural shortly before this fall. the amitrip was increase stedally to 100 mlg we noticed an increase in the shaking of left hand and some stuttering. We thought it might be epidural that caused it. he was then sent to neroligist and was given phino-barbital for what they called essential tremors. approx two weeks he sort of stayed the same, maybe shaking hand increased. apparently the doctor increase the amitrip to 50mlg 3 pills a day. he went on a family trip and during this time his voice was shaking he was having truble urinating and his handshaking more and he was crying. Oh and he was born with one kidney that he found out at age 32. My question is would it only be the amitrip or could the phino-barbital or epidural contribute to these symptoms and could he have any long term damage from this? We thought he might be having a stroke and he was taken to doctor and was taken off phino but put on carvadoba/levadopa by the nero doctor. that was last friday and his regular doctor, on monday, is taking him off amitrip when we voiced our concerns that it might be that medication. I’m worried that he might have permanent damage. how long will this get out of his system?
Hi Mary
Tricyclic Antidepressants (TCA) of which amitriptyline is one takes about 10 days to leave the body. However, there are factors to be taken into consideration first.
Factors which affect metabolism:
the body’s rate of metabolism. (How long the body takes to breakdown the drug and dispose of it) also the body mass of the individual (example large frame, small frame, overweight and underweight).
the age of the individual taking the drug concerned. For example: people over the age of sixty may be more sensitive to amitriptyline than those people who are younger.
the overall health of the person taking the drug.
the amount of the drug taken and frequency of use, how the drug is taken (example: swallowed, inhaled, injected), even the individuals tolerance to drugs or alcohol.
The above are all factors that will make a big difference as to how quickly the drug leaves the system.
I am not in a position to comment on how the professionals have handled your brothers treatment. If you as a family feel the doctor could do more for your brother or you are unhappy with his treatment methods your are entitled to a second opinion.
You have been given this information in response to a question left on our website. It should not be taken as a diagnosis and has been given for information purposes only.
If you are in any doubt check it out with your doctor or pharmacist.
Many thanks for your visit.
Hi,
I am taking 50mg of amitriptyline at night time (for possible fibromyalgia). I am due to have a general anaesthetic on October 12th. My pre-op assessment isn’t until the day before so it may be too late to put the question to the pre-op doctor. My question is should I stop taking this medication prior to having the general, and if so, how many hours beforehand should I stop taking it?
Best wishes,
DP
Hi dpeake,
The person that would normally answer questions is on a well earned autumn break so we are unable to answer your question. However, if you are taking amitriptyline at night we would assume your family doctor would have prescribed them for you. You say it may be to late in the day to ask the pre-op doctor. We would suggest you ring your family doctors surgery and make them aware of your concerns and to check with the doctor handling your medication as to whether or not to stop your treatment prior to your general anaesthetic.
The reason for sometimes stopping amitriptyline and other sedative drugs is because it has its self a sedative effect on the central nervous system. When receiving a general anaesthetic this may enhance the effects of your medication.
You may find that you may not need to stop your nightly tablet as the pre-op and general anaesthetic may only need to be altered to accommodate for your regular medication.
Please be aware, when you do get the answer to your question from your doctor make sure you also mention you are taking amitriptyline, on a regular basis, to the pre-op doctor, regardless.
We here at medibolism wish you well.
Note: You have received this information because of the question you left on our website. Please be aware we are not doctors here at medibolism. Our main goal is to give the individual an informed choice about the medication they may be taken or about to take. The information should not be used as a guarantee or diagnosis. We would advise any information received from us should be first checked-out with your doctor, pharmacist or a qualified medical practitioner.