Overview

Amitriptyline belongs to an older class of antidepressants. Under the brand name Elavil, it used to be one of the most frequently prescribed antidepressants. It is now prescribed generically more frequently.

It belongs to a class of compounds called TCAs (tricyclic antidepressants) that includes amoxepine (Asendin), clomipramine (Anafranil), desipramine (Norpramin, Pertofrane), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil).

The extraordinary popularity of drugs such as Prozac, Paxil, and Zoloft has led to dramatic decline in the TCA class of antidepressants. Yet many people still benefit from such compounds.

Amitriptyline and some of its cousins are also prescribed for anxiety and depression as well as to relieve chronic pain associated with arthritis, fibromyalgia, neuropathy or neuralgia (nerve damage), and migraine headache.

Anafranil is prescribed primarily for obsessive compulsive disorder (OCD)

Side Effects and Interactions

Side effects associated with amitriptyline and many other TCAs include dizziness, drowsiness, constipation, dry mouth, blurred vision, super sensitivity to sunlight, sexual difficulties, urinary retention difficulties, weight gain, heart palpitations, low blood pressure, confusion, forgetfulness, weakness, disorientation, or hallucinations. Some of these adverse effects may disappear over time.

Less common complications to watch out for are changes in blood sugar, anxiety, irritability, sleep disturbances, twitching, tremors, tingling of arms and legs, skin rash, digestive upset, or breast enlargement in men and women. Changes in heart rhythm, stroke or seizures are rare but potentially serious reactions. Report any symptoms to your physician promptly.

Amitriptyline and most other TCAs interact with quite a few other medications.

Combining different categories of antidepressants (TCAs and Prozac-like drugs) can be quite dangerous as TCA blood levels can rise leading to toxicity (confusion, dizziness, delirium, seizures, etc.).

The antidepressants Nardil or Parnate can also become extremely hazardous when taken together with TCAs.

Tagamet (cimetidine) and Tegretol (carbamazepine) may also produce an overdose effect if combined with amitriptyline or other TCAs.

The blood pressure medicine Catapres (clonidine) may lose its effectiveness if taken with amitriptyline or other TCAs. Blood pressure could soar out of control and lead to hypertensive crisis.

There is a concern that ginkgo biloba could possibly make a person more vulnerable to seizures, so it probably should not be taken together with other drugs known to increase the risk of seizures, such as amitriptyline.

Interactions between the herb St.John’s wort and amitriptyline are possible. Switching between antidepressants and herbal treatment calls for medical guidance (physicians can find a suggested protocol for gradual substitution of St. John’s wort in Hyla Cass’s book, St. John’s Wort: Nature’s Blues Buster).

Check with your pharmacist and physician to make sure amitriptyline or any TCA is safe in combination with any other drugs and herbs you take.

Taking the Medicine

Taking TCAs with food may reduce stomach upset.

Because amitriptyline and related compounds can be sedating, physicians frequently prescribe them at bedtime.

Special Precautions

People with a history or risk of seizures may be more vulnerable to attacks while on TCAs.

Other conditions that pose special risks include glaucoma, heart disease, irregular heart rhythms, hyperthyroidism, kidney or liver disease, and urination problems.

Amitriptyline and many other TCAs are quite sedating. This means they can make driving or other tasks dangerous.

Older people may be especially susceptible to complications such as drowsiness, dizziness and confusion.

Sudden discontinuation of amitriptyline or similar antidepressants may cause withdrawal symptoms such as headache, dizziness, nausea, sleeping problems and general feelings of disorientation and discomfort.

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  1. Lois Litalien
    Idaho
    Reply

    I have two things to address that have been great help to me. First I have had a horrible time with severe leg cramps that can’t be walked or stretched out. My Naturepathic Dr. suggested I take Emergen-C dietary supplement which has been a Tremendous help..thankfully… reccomended to start with 2 pkg. each evening at different intervals then after a few days then one each day. Once in a while I will have cramps after like a hike or rigorus exercise, so I keep on hand the Amish Formula called Stops Leg and Foot Cramps in about One Minute that WORKS within a minute or so, it is carried by many Health Food stores or can be ordered on line (www.StopsLegCramps.com). I works like a miracle really!! My Dr said they are using it in the nursing homes for older people that are so plagued with leg and foot cramping.

    I had toe fungus that was in over half the nail , very thick. My poditrist suggested I cut the nail short as possible,which he did, then file the top of the nail down (I use and emery board) and then apply the topical medicine, then file each and every time before applying. It seemed no time I had it all cleared up.

    I hopeing you will share with others.

  2. marie
    Reply

    I was prescribed the 10mls dose three daily eight years ago for Fibromyalgia. It helped a lot at first then a few years ago my condition worsened I decided the drug was no longer helping me so weaned myself off and took really ill. Couldn’t sleep depression so started taking them again and my symptoms improved immediately.
    I have finally got off them but it took two years. Now maybe it’s coincidental but I know I got ill every time I cut down the dose.
    I was told the dose I was on was completely non addictive. Add to this my age over 60 I kept forgetting to take them and if I hadn’t linked this to the amitriptyline I would have thought I’d contacted a serious disease.

  3. Ross E
    Reply

    Hi ML
    You never know. This may be worth following up (From Wikipedia):
    Dextromethorphan/quinidine
    Dextromethorphan/quinidine (trade name: Nuedexta) is the first FDA-approved drug for the treatment of PBA. Treatment with dextromethorphan/quinidine significantly decreased laughing and crying episodes in patients with amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS) as compared with placebo in a 12-week, randomized, double-blind study
    Regardless, my very best wishes.
    Ross

  4. ML
    Reply

    Hi,
    I have been working my way up to 150 mg of Elavil due to severe crying outburst due to my Multiple Sclerosis.
    It has gotten rid of the PBA (sudden outbursts of crying for ANO reason) but it has made me terribly confused and forgetful. I have become horribly forgetful that its embarrassing. I cant remember from one day to the next big or small things. I have tried lowering my dose to 100mg, but then I’m crying my eyes out, so 150 works the best for me. I just want to know if anyone else has the problem of forgetfulness to a horrible degree. There are no other drugs to stop the PBA but I couldn’t tell you what I did yesterday.
    Does anyone else have this problem of severe forgetfulness?? Thanks for any help you can provide.

  5. AASQAONE
    Reply

    Hello K.S. I suffer with Spinal Adhesive Arachnoiditis, your symptoms sound very familiar, I have been taking 50Mg twice a day of Tramadol, it has no side effects. I also have peripheral neuropathy muscle spasms are negligible, it has been good for me. Have been taking for several years now no problems with bladder, bowel or kidneys, in fact they are normal.
    regards
    AASQAONE.

  6. aasqaone
    Reply

    Hello Tom the best thing for reflux which I had for years and taking tagamet plus something to counteract side effects. I have been using Bi-carbonate of soda (baking soda), a small glass and small tea spoon in water when ever problem occurs and voila reflux and indigestion is gone in about 15 minutes. You can purchase at the supermarket in with all the cake mixers. Its most powerful ingredient is the alkaline which the the body needs and has powerful effect of freeing up the esophagus and swallowing is so much easier.
    cheers
    AASQAONE

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