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Why it's used

Amitriptyline is used to treat depression that is causing sadness, low mood, and loss of interest in patients. It is a prescription medicine. This medicine works by enhancing the amount of certain organic substances in the brain thereby helping maintain a balance. Amitriptyline is also used to treat severe headaches caused by migraine. It is also used to treat pain caused by nerve injuries, or pain in the head, neck, or behind the eyes. Amitriptyline is also used to treat uncontrolled urination while sleeping at night when other treatments have failed.
Tricyclic Antidepressants
Amitriptyline belongs to a class of medicines called Tricyclic Antidepressants. Tricyclic Antidepressants are used to treat depression, anxiety, and certain kinds of pain.

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How to use

Read the directions on the product label, patient guide, or medicine guide provided by the medicine company or your pharmacist before starting to use Amitriptyline. If you have any questions related to this medicine, ask your doctor or pharmacist. Consume this medicine as recommended by your doctor.
Amitriptyline is consumed with or without food. Amitriptyline is consumed 1-1.5 hours before sleeping for the treatment of night-time bed-wetting.

Typical Dosage

The typical dose of Amitriptyline is 25 mg - 50 mg daily (not more than 150 mg in one day). The maximum adult dose of Amitriptyline is 150 mg per day in a day. This medicine is typically used for a period of 6 months for depression, and 3 months for involuntary urination while sleeping. Amitriptyline is commonly used at the same time every day. It takes 2-4 weeks for neuropathic pain and antidepressant effect for this medicine to start to work. This medicine is not known to be habit-forming.
This medicine is to be used for longer periods of time. Amitriptyline may be prescribed for long-term use to prevent the recurrence of low mood, loss of interest in things, and feeling of sadness caused by the major depressive disorder. You should continue to use this medicine as directed by the doctor even if you feel well.

Talk to Your Doctor

Talk to your doctor if your condition persists or worsens or if you develop new symptoms. Tell your doctor if suicidal thoughts, anxiety, feeling restlessness, insomnia, irritability, changes in behavior or mood pattern, eye pain, changes in vision, and swelling in eyes. If you have issues with the health of your liver, a low dose will usually be prescribed to elderly patients. You should consult with your doctor before stopping the use of Amitriptyline.
Your doctor may recommend a lower initial dose of this medicine to see the impact of this medicine on the body. Please follow your doctor's directions. Older patients may see an increase in the incidence of side-effects with this medicine. As a result, a lower dose may be recommended for older patients.
When stopping this medicine, you may experience withdrawal symptoms such as nausea, headache, feeling of discomfort, irritability, restlessness, and disturbed sleep.

Use in Children

The safety and effectiveness of using Amitriptyline in children has not been established. This medicine is not recommended to use in children less than 18 years. However, for the treatment of involuntary urination at night Amitriptyline can be given to children 6 years or older for a period of three months.

Avoid Alcohol

Avoid the consumption of alcohol with Amitriptyline.

Lab Tests

Your doctor may request that specific lab tests be performed before you start using Amitriptyline. You may need to have Electrocardiogram test. This test may be needed before the start of use of this medicine to prevent an irregular heartbeat, also called heart rhythm disorder.

Storage

You should store Amitriptyline at 20º-25ºC (68º-77ºF), away from moisture, and away from light. Store the medicine away from the reach of children and pets.
Medicines may be prescribed for uses other than those listed in the medicine guide. Do not use Amitriptyline for conditions for which it was not prescribed. Do not give Amitriptyline to other people who might have the same conditions or symptoms that you have. Self-medication may harm them.

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How to take Amitriptyline

The dose and frequency of using Amitriptyline will depend on the following factors:
  • age of the patient
  • patient's health
  • the health of the patient's kidneys
  • medicines recommended by the doctor
  • any other medicines being used
  • herbal supplements being used
  • response to the medicine

Amitriptyline Dosage

Dosage for depressed mood or loss of interest in activities

Adult
  • Recommended: 25 mg 2 times daily. If necessary, increase by 25 mg every other day up to 150 mg daily taken as two doses.
  • Initial: 25 mg 2 times daily
  • Maximum: 150 mg per day
Older Adults
  • Initial: 10 mg - 25 mg per day
  • Maximum: 100-150 mg per day. Doses more than 100 mg should be used with caution.

Dosage for neuropathic pain, tension headache, and migraine

Adult
  • Recommended: 25-75 mg once daily or divided into two doses
  • Initial: 10-25 mg in the evening. Doses can be increased with 10-25 mg every 3-7 days.
Older Adults
  • Initial: A starting dose of 10-25 mg in the evening is recommended. Doses above 75 mg should be used with caution.

Dosage for involuntary urination at night

Children (6-10 years)
  • Recommended: 10-20 mg per day taken 1-1.5 hours before bedtime
Children (11 years and above)
  • Recommended: 25-50 mg per day

Minimum Age

6 years

Dosage calculation for children

To calculate the dosage for children please use the weight based dose calculator to calculate the appropriate dosage as per the weight of your child.

Forms

Tablet
Strength: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, and 150 mg
Film-coated tablet
Strength: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, and 150 mg
Oral solution
Strength: 10 mg/5 ml

Missed Dose

A missed dose should be taken as early as you remember it. However, if the time for the next dose is almost there, then the missed dose should be skipped, and the regular dosing schedule should be continued. Avoid taking a repeated dose to make up for a missed one.

Overdose

What to do if you overdose on Amitriptyline?
If you have taken more than the recommended dose of Amitriptyline get medical advice immediately. The toxic effect can be reduced by taking activated charcoal. Activated charcoal is a form of carbon that has small, low-volume pores. These pores help trap chemicals as in the case of poisoning. In the case of moderate intoxication, vomiting, cleaning out the contents of the stomach (gastric lavage) may help to reduce the toxic effects.
Symptoms of an overdose of Amitriptyline
If you use too much of this medicine, it could lead to dangerous levels of the medicine in your body. In such cases, symptoms of an overdose may include:
  • abnormally high fever
  • agitation
  • coma
  • confusion
  • convulsions
  • dilation of the pupil of the eye
  • hallucination
  • heart failure
  • increased heart rate
  • increased heartbeat
  • irregular heart muscle contraction
  • lack of mental function
  • low body temperature
  • low levels of potassium in the blood
  • muscle rigidity
  • nervousness
  • sleepiness
  • slow and ineffective breathing
  • very low blood pressure
  • vomiting
If you think you have overdosed on Amitriptyline, call a poison control center immediately. You can look up the poison control center information from the Poison Center Finder at TabletWise.com.

Precautions while using Amitriptyline

Before you use Amitriptyline, tell your doctor of your medical and health history including the following:
  • a family history of suicide
  • heart disease
  • history of difficulty in urination
  • history of seizures
  • increased activity of thyroid gland
  • low mood or loss of interest in activities caused by depression
  • mood swings
  • nerve damage in an eye (also called angle-closure glaucoma)
  • treatment of mental illness using electroshock therapy
Using this medicine in these patients may worsen their condition. Patients with a family history of suicide and depression are at increased risk for bipolar disorder. In case of a history of heart disease, patients may experience an irregular heartbeat.
Before you use Amitriptyline, discuss with your doctor if you are allergic to it or its ingredients. Your doctor may prescribe an alternative medicine and update your medical records to record this information.
Before having surgery during the use of Amitriptyline, discuss with your doctor and dentist about the medicinal products you use including prescription/non-prescription/herbal medicines.
The use of this medicine may change blood sugar. This medicine either increases or decreases blood sugar levels.

Seizures

Amitriptyline can make you feel sleepy. Be careful when using any machinery, driving a vehicle, or doing any other activity that needs you to be fully alert. The consumption of alcohol with Amitriptyline can worsen the sleepiness. Amitriptyline may cause rarely seizures in some people. If you perform any activities where a loss of consciousness may cause harm to you (or others), you should discuss with your doctor.

Use in Pregnancy

The use of Amitriptyline during pregnancy should only be when required. This medicine may cause harm to infants when used by pregnant women. Use of Amitriptyline may cause a risk to infants including issues with the central nervous system, growth, and formation of the limb. This medicine should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the fetus.

Use while Breastfeeding

The use of Amitriptyline Amitriptyline while breastfeeding should only be when required. This medicine passes into breast milk which may cause serious harmful effects to infants. This medicine should be used during breastfeeding after only considering the importance of the drug to the mother.

Use while Conceiving

It is not known if this medicine is safe for use in women who are conceiving. Consult with your doctor before you use Amitriptyline. No data or studies on the effects of Amitriptyline on human fertility are available.

Alcohol

Limit drinking alcohol with Amitriptyline. Drinking alcohol may cause an increase in suicidal behavior and tendencies.

Increased Risks

This medicine may increase your sensitivity to sunlight. If this happens, use a sunscreen and cover your skin when you are outdoors. Limit your time in the sun.

Side-effects in Older Patients

Amitriptyline may cause increased incidence of side-effects in older patients. Elderly patients may see an increased risk of difficulty in urination, increased heartbeat, constipation, dry mouth, blurred vision or other eye-related issues, memory problems, slowing down of thinking and movement, confusion, sleepiness, delirium, and falls.

Side-effects in Children

Amitriptyline may cause an increased risk of side-effects in children. Children using this medicine may see an increased risk of suicidal thinking and behavior.

Amitriptyline Side-effects

The following side-effects may commonly occur when using Amitriptyline. If any of these side-effects worsen or last for a long time, you should consult with your doctor:
The following side-effects may commonly occur in older patients on the use of Amitriptyline. Discuss with your doctor if any of these side-effects last for a long time or are severe:
Rarely, the use of Amitriptyline may cause the following side-effects:
  • anxiety
  • black tongue
  • breast enlargement
  • cholestatic liver disease
  • collapse conditions
  • convulsions
  • damage of peripheral nerves (also called polyneuropathy)
  • damage to the optic nerve
  • deficiency of granulocytes in the blood
  • diarrhea
  • dilation of the urinary tract
  • disturbed focus
  • dryness of eyes
  • excessive milk production
  • excitement
  • facial swelling
  • hair loss
  • heart muscle disease
  • high blood pressure
  • high fever
  • hives
  • inability to empty the bladder
  • increased and decreased appetite
  • increased eosinophils in the blood (also called eosinophilia)
  • increased or decreased interest in sexual activity
  • inflammation of the air sacs of the lungs (also called alveolitis)
  • insomnia
  • interference with sexual function
  • low level of white blood cells
  • low levels of thrombocytes
  • mental confusion
  • mental illness
  • movement disorder
  • nightmares
  • numbness
  • pain in the upper abdomen
  • painful swelling and sores inside the mouth
  • paranoia
  • parotid swelling
  • purple or red discolored spots on the skin
  • rash
  • ringing in the ear
  • salivary gland enlargement
  • swollen male breast
  • swollen tongue
  • testicular swelling
  • unpleasant taste
  • urinary frequency
  • vomiting
  • weakness
  • weight loss
  • white blood cell accumulation in the lung due to infection (also called Löffler's syndrome)
  • worsening of cardiac failure
The following severe side-effects may also occur when using Amitriptyline:
Your doctor has prescribed Amitriptyline because they judge that the benefit is greater than the risk posed by side-effects. Many people using this medicine do not have serious side-effects. This page does not list all possible side-effects of Amitriptyline.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Warnings

Alcohol Consumption

Patients who consume alcohol are at an increased risk when using this medicine. This medicine increases the effects of alcohol on the body such as drowsiness and dizziness.

Nerve Damage in the Eye

Patients who have existing nerve damage in the eye(s), are at an increased risk when using this medicine. Such patients may have an attack of angle-closure glaucoma.

Abnormal Condition of the Blood

Patients who have an abnormal condition of the blood (blood dyscrasias) are at an increased risk when using this medicine. Patients should avoid Amitriptyline if they have been diagnosed with blood dyscrasias.

Lapp Lactase Deficiency

Patients with Lapp lactase deficiency are at an increased risk when using this medicine. Such patients should not take this medicine.

Glucose-Galactose Absorption Issues

Patients with Glucose-Galactose absorption issues are at an increased risk when using this medicine. Such patients should not take this medicine.

Depression

Patients with depression are at an increased risk when using this medicine. Such patients may experience worsening of their depression and the emergence of suicidal thoughts and behavior. Such patients should be monitored properly and observed closely for these changes.

History of Seizures

Patients with a history of seizures are at an increased risk when using this medicine. Such patients should use this medicine cautiously and consult with their doctor.

History of Difficulty in Urination

Patients with a history of difficulty in urination are at an increased risk when using this medicine. Such patients should use this medicine cautiously.

Heart Disease

Patients with heart disease are at an increased risk when using this medicine. Amitriptyline may cause an increased heartbeat and prolongation in the signaling time of contraction in the heart muscles in such patients.

Overactive Thyroid Gland

Patients who suffer from hyperthyroidism are at an increased risk when using this medicine. Close supervision is required in such patients when using this medicine.

Interactions with Amitriptyline

When two or more medicines are taken together, it can change how the medicines work and increase the risk of side-effects. In medical terms, this is called as a Drug Interaction.
This page does not contain all the possible interactions of Amitriptyline. Share a list of all medicines that you use with your doctor and pharmacist. Do not start, stop, or change the dose of any medicines without the approval of your doctor.

Selective Serotonin Reuptake Inhibitors

Amitriptyline interacts with fluoxetine, sertraline, and paroxetine, which are used to treat depression. Combined usage of these medicines may reduce the effectiveness of Amitriptyline. Take this medicine 5 weeks after withdrawal of selective serotonin reuptake inhibitors (such as fluoxetine).

Cytochrome P450 Inhibitors

There may be an interaction of Amitriptyline with cimetidine, methylphenidate and calcium-channel blockers, which are used to treat and prevent symptoms of heartburn, attention deficit hyperactivity disorder and high blood pressure. These enzyme inhibitors may increase the levels of Amitriptyline in the body and lead to increased side-effects.

Antiarrhythmic Agent

Amitriptyline may interact with quinidine, which is used to treat an irregular heartbeat. Taking Amitriptyline and Quinidine together may increase the possibility of an irregular heartbeat.

Centrally Acting Antihypertensives

Your doctor's guidelines may need to be followed while taking this medicine along with guanethidine, betanidine, reserpine, clonidine, and methyldopa, which are used to treat high blood pressure. Amitriptyline blocks the antihypertensive effect of these medicines. Patients should not take both medicines together.

Monoamine Oxidase Inhibitors

Special instructions need to be followed while taking this medicine along with monoamine oxidase inhibitors, which are used to treat anxiety and depression. Combined usage of these medicines may cause fever, state of anxiety, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea. Patients should take Amitriptyline at least 14 days after taking monoamine oxidase inhibitors.

Sedative-Hypnotic Carbinols

Your doctor's guidelines may need to be followed while taking this medicine along with ethchlorvynol, which is used to treat insomnia. Combined usage of these medicines may cause severe confusional state (transient delirium). Patients should be cautious when taking both medicines together.

Histamine H2 Antagonists

Special instructions need to be followed while taking this medicine along with cimetidine, which is used to treat heartburn and stomach ulcers. Cimetidine reduces the breakdown of this medicine in the liver thereby delays the elimination of Amitriptyline.

Anticholinergic Agents

Amitriptyline interacts with anticholinergic agents, which are used to treat allergic conditions, drug-induced movements and gastrointestinal disorders. Combined usage of this medicine with anticholinergic agents may cause abnormal high fever and blockage of the intestine due to paralysis of the intestinal muscles (also called, paralytic ileus). Careful monitoring of dose is required in this combination.

Alcohol Antagonist Drug

There may be an interaction of Amitriptyline with disulfiram, which is used to treat severe conditions of alcohol dependence. Using this medicine with disulfiram may lead to delirium.

Central Nervous System Depressants

Amitriptyline may interact with barbiturates, which are used to slow down the brain activity and to treat anxiety, depression, and insomnia. This medicine enhances the sleep-inducing (sedative effect) of central nervous system depressants. Patients should take necessary precautions while taking both medicines together.

Analgesics

Your doctor's guidelines may need to be followed while taking this medicine along with tramadol, which is used to relieve moderate to severe pain. Combined usage of this medicine with tramadol increases the risk of seizures and serotonin syndrome. Amitriptyline changes how tramadol is processed by the body and this may lead to very high levels of tramadol in the body.

Antipsychotic Drugs

Special instructions need to be followed while taking this medicine along with thioridazine, which is used for the treatment of abnormal behavior and schizophrenia. Usage of Amitriptyline with thioridazine cause thioridazine to be not absorbed by the body. This leads to an increased risk of heart-related side-effects. Patients should not take both medicines together.

Opioid Analgesics

Amitriptyline interacts with methadone, which is used to treat pain due to cancer. Combined usage of this medicine with methadone may increase the risk of serious heart problems. Patients should be cautious when taking both medicines together.

Antifungal Drugs

There may be an interaction of Amitriptyline with fluconazole and terbinafine, which are used to treat fungal infections. Combined usage of this medicine with anti-fungal drugs increase the levels of Amitriptyline in the body. This may lead to a loss of consciousness and abnormal heart rhythm.

Sympathomimetic Agents

Amitriptyline may interact with adrenaline, ephedrine, and isoprenaline, which are used to lower blood pressure and treat a heart attack. Amitriptyline increases the effects of sympathomimetic agents. Patients should not take both the medicines together.

Traveling With Medication

  • Ensure that you carry enough doses of each of your prescription medicines to last the entire trip. The best place to store your medicines is in the carry on baggage. However, while flying, if carrying liquid medicines, make sure you do not go over the limits imposed for carry-on liquids.
  • While traveling overseas, make sure that you can carry each of your prescription medicines legally to your destination country. One way to ensure this is by checking with your destination country's embassy or website.
  • Make sure that you carry each of your medicines in their original packaging, which should typically include your name and address, and the details of the prescribing doctor.
  • If your travel involves crossing time zones, and you are required to take your medicine as per a fixed schedule, make sure that you adjust for the change in time.

Expired Medication

Taking a single dose of expired Amitriptyline is unlikely to cause a side-effect. However, please discuss with your doctor or pharmacist, if you feel unwell or sick. An expired medicine may become ineffective in treating your prescribed conditions. To be on the safe side, it is important not to use an expired drug. You are much safer by always keeping a fresh supply of unexpired medicines.

Safe Disposal of Medication

  • If there are disposal instructions on the package, please follow the instructions.
  • If there are medicine take-back programs in your country, you should contact the respective authority to arrange for the disposal of the medicine. For example, in the USA, the Drug Enforcement Administration regularly hosts National Prescription Drug Take-Back events.
  • If there are no take-back programs, mix the medicine with dirt and place them in a sealed plastic bag. Throw the plastic bag in your household trash. Separately, remove all personal information including the prescription label from the medicine packaging and then dispose off the container.
  • If specifically indicated on the medicine package that it needs to be flushed down the toilet when no longer needed, perform the required step.

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