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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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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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