What is Amitriptyline?

Why is Amitriptyline prescribed?

What are the possible risks or side-effects?

What else should I know about Amitriptyline?

What is Amitriptyline?

Amitriptyline belongs to a group of drugs called tricyclic antidepressants. Although they are still used to treat anxiety and depression, they are also now widely used at lower doses to help block the chronic (long-term) pain of some rheumatic conditions. The main aim of lower-dose amitriptyline is to relieve pain, relax muscles and improve sleep, but it may also help reduce any anxiety or depression resulting from the pain. Low-dose amitriptyline alone will not be enough to treat severe depression.

What type of drug is amitriptyline?

Amitriptyline belongs to a group of drugs called tricyclic antidepressants. It is widely used at lower doses to relieve the chronic (long-term) pain of arthritis and related conditions.

What does it do?

It relieves pain by balancing the chemicals in the central nervous system. It relaxes muscles and improves sleep that is being disturbed by pain, and it may also help with anxiety or depression resulting from the pain.

What is used for?

It is used to treat long-term (chronic) pain caused by arthritis, neck and spine problems, fibromyalgia, chronic headaches and damage to nerve endings in the upper and lower limbs (peripheral neuropathy).

How is it taken?

It is usually taken as tablets or syrup once a day, about two hours before bed time. It may take several weeks before it starts to work. 

Are there any side-effects?

The most common side-effect is a dry mouth, but this usually improves after a few weeks. You may also feel drowsy or spaced out during the day. Reducing the dose may help but some people cannot tolerate even low doses...

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Why is Amitriptyline prescribed?

When rheumatology patients are prescribed amitriptyline it is usually for chronic pain. Causes of chronic pain include arthritis, spinal problems, fibromyalgia, chronic headaches (tension headaches) and damage to nerve endings in the upper and lower limbs (peripheral neuropathy). Chronic pain is associated with changes in the central nervous system (the spinal cord and brain) that lead to failure of adequate pain regulation. This is called ‘pain wind-up’ or pain amplification and it adds to the distress caused by pain. Amitriptyline works by rebalancing the chemicals in the central nervous system.

Is there any reason I will not be prescribed amitriptyline?

Amitriptyline should not be used if you are recovering from a recent heart attack (myocardial infarction) or have a condition called heart block. It also should not be used in people with uncontrolled bipolar disorder (extreme mood swings), or acute porphyria (an enzyme disorder causing severe nerve or skin symptoms), or certain forms of glaucoma (increased pressure within the eyeball).

When and how do I take amitriptyline?

Amitriptyline is available as tablets or syrup, taken daily. As it has a sedative effect and may make you drowsy, it is usually taken an hour or two before bedtime (but no later than 8 pm).

Your doctor will advise you about the correct dose. Usually you will start on a low dose (e.g. 5–10 mg) and gradually increase it to 25 mg daily. However, your doctor may increase the dose to 50 mg or 75mg if the pain is very severe and disturbing your sleep. If you wish to stop taking amitriptyline, because of side-effects or because you feel it is not working, you should discuss this with your doctor. You may be advised to reduce the dose gradually over a few weeks to avoid sleep disturbance.

How long does amitriptyline take to work?

The effect on sleep is usually immediate but the effect on pain and mood takes longer, usually between two and six weeks.

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What are the possible risks or side-effects?

The most common side-effect is a dry mouth, but this usually improves after a few weeks. You may also feel drowsy or spaced out in the morning or during the day, especially if you take the amitriptyline too late at night. Side-effects may be reduced by ensuring you take the dose no later than 8 pm or by starting with a very low dose and building up gradually over a few weeks.

You should always read the patient information leaflet included with your medicines package to keep you informed about any possible side effects of your prescribed medications.

You will need to take care when driving or operating machinery.

Less common side-effects include:

  • difficulty passing urine – this can be a problem in men with prostate problems
  • constipation
  • dizziness – this may occur in older people due to a fall in blood pressure
  • blurred vision
  • some weight gain or weight loss.

If you experience side-effects, it is often worth continuing treatment as they will usually lessen with time. However, if you experience any unusual side-effect, or something that you are particularly concerned about, while on the treatment, you should contact your doctor immediately.

Extra care may be needed if:

  • you are being treated for epilepsy – Amitriptyline may cause more frequent seizures.
  • you have heart problems – If you experience an irregular heartbeat while on amitriptyline you should discuss this with your doctor.
  • you have glaucoma – Regular eye tests with an optician should pick up any problems.

There is no evidence that amitriptyline is addictive or causes dependency, especially at low doses.

Will it affect vaccinations?

You can have vaccinations while on amitriptyline.

Can I drink alcohol while on amitriptyline?

You should minimise alcohol intake as amitriptyline increases the effects of alcohol and may make you drowsy. This is especially important if you are driving or using machinery.

Does amitriptyline affect fertility or pregnancy?

There is no effect on fertility for men or women. Amitriptyline is not generally recommended during pregnancy. However, you should not stop taking it suddenly or without the advice of your doctor.  If you become pregnant or you are planning a family while on amitriptyline you should discuss this with your doctor as soon as possible. If amitriptyline is taken during pregnancy, very rarely the newborn baby’s heart rate is affected or the baby may become restless. Make sure that your obstetrician/ midwife knows that you are taking amitriptyline.

Does it affect breastfeeding?

You should not breastfeed if you are on amitriptyline. The drug may pass into the breast milk and could be harmful to your baby.

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What else should I know about Amitriptyline?

Are there any alternatives?

A number of other drugs are used in the treatment of arthritis and related conditions. Your doctor and rheumatology nurse specialist will discuss these other options with you.

Imipramine (also a tricyclic antidepressant) is less sedative than amitriptyline, so it can be used during the daytime, but it is more likely than amitriptyline to cause a dry mouth and cardiac side-effects. Some people are treated for chronic pain with newer antidepressants called serotonin-noradrenaline reuptake inhibitors (SNRIs) or selective serotonin reuptake inhibitors (SSRIs), either instead of amitriptyline or occasionally in combination with it, particularly if they are also depressed. SNRIs and SSRIs are less sedative than amitriptyline and usually have fewer side-effects.

Will I need any special checks while on amitriptyline?

No special checks are needed while you are on amitriptyline, though if you have glaucoma it is important to keep up your regular eye checks.

Can I take other medicines alongside amitriptyline?

Amitriptyline may be prescribed along with a variety of other drugs in treating your condition. Some drugs interact with amitriptyline, so you should discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you are taking amitriptyline. You should also be aware of the following points:

  • You may be prescribed painkillers (for example codeine or tramadol) alongside amitriptyline, which may make you more drowsy.
  • A combination of an SNRI or SSRI antidepressant and amitriptyline needs careful monitoring (if you are also on treatment for blood pressure and heart problems, discuss this with your doctor as these may need to be monitored more frequently).
  • Do not take over-the-counter preparations or herbal remedies without discussing this first with your doctor, rheumatology nurse specialist or pharmacist.

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