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.

Get The Graedons' Favorite Home Remedies Health Guide for FREE

Join our daily email newsletter with breaking health news, prescription drug information, home remedies AND you'll get a copy of our brand new full-length health guide — for FREE!

  1. Patricia
    central Wisconsin

    Been on this drug to treat fibromalgia since 1997. 10-20mg.HS. It helped. I weaned back to 10 mg, then stopped altogether. Especially when the cost skyrocketed. Dry mouth is the only side effect. However, I decided to go back to 10mg. for muscle relaxation.
    Lately been having horrible leg and foot cramps and tried the home remedies with no results. Somewhere, I read that amitriptyline works for treating leg cramps. So i started 20mg at HS and have been much better. In the week since I doubled the dose, no cramps. I am 76.

  2. Mavis

    I started Amitriptyline 5 years ago with Pregabalin for complex regional pain syndrome. 20mgs and 150mgs, respectively. These drugs did help the pain. Eventually 18 months ago I started to reduce the Pregabalin. Not too bad with side effects. I’m now down to 75mgs. At the same time I reduced the Ami to 10mgs, no terrible side effects. My pain consultant told me to stop the Ami altogether. Now I was seeing the practice nurse for a urine problem, no infection but the urge to pee. I decided in case it was the Amitriptyline I would stop the drug. 4 days later I started feeling nausea after eating in the evening. Not too bad. Then headaches, not all the time. Then needing the toilet but having difficulty going. Then no difficulty going. Stomach pains, all over; low down, high up. Feeling tired, weak. Dizzy. After another 5 days I had a bout of horrible nausea when I just wished I could be sick. It went on for 6 hours before easing off. The next day I was wiped out. Completely off food. I had blood tests with the pee thing, and all results came back normal except for the bilirubin (spelling) which has for the last three blood tests over 5 years has been above the parameters suggested but my GP doesn’t seem worried, just me I suppose. And borderline high cholesterol.

    Today, four days after the horrible nausea attack, I felt fine. I had taken a fiber product, as the toilet situation has turned difficult again. I went to lunch and had leek and spud soup. Then felt really dizzy. Needed the toilet but didn’t. Came home and now feel nausea, a lump in my throat which may be worry I know. I’ve been to the loo, not ‘normal’ weird yellow/green colour (charming). I feel shaky, hot. Also my blood pressure seems to have gone down. What on earth is going on? Back to the surgery I suppose but I’ll hang on for a couple more days to see if it improves. Could it be coming off the Amitriptyline? I’m fed up.

  3. Deborah

    I’ve been taking 20-30 mg amitriptyline nightly for 8 years now for ME. At first it was great. It helped with the headaches and general aches and pains, as well as giving me some sleep at night. But yes, I too piled on the pounds. Not good for someone with restricted amounts of energy. However, I had a relapse at Christmas and I ended up increasing my dose to 40mg, but I soon found that was not enough and I was having to take more and more strong painkillers to get any relief. The GP suggested going upto 50mg and cutting back on the painkillers. Again no difference. Time for a new drug. Went to the Dr’s answer she suggested going onto duloxetine and that it should be fine to just stop the amitriptyline. How wrong was she! The first day was okay, but day 2 was horrendous. The nausea, headaches, restlessness and the shivering. So I’m back on them, trying to cut down little by little.
    Trouble the only other suggestions for pharmaceutical help are duloxetine or gabapentin, both of which are even worse than amitriptyline! I’m not sure what I’m going to do. You can’t get melatonin in the UK easily. So I really don’t know.

  4. Lucy

    I’ve been taking this infernal drug for almost 40 years and it’s time to get it out of my life. Overall, I gained 240lbs and required bariatric surgery, which almost killed me, to compensate. Among other problems, I’ve had two heart attacks from coronary artery vasospasm, diabetes which is resolving as I decrease the dose, and a host of other problems that never need have happened. I’m a retired critical care Registered Nurse and bought into the medical model of treatment for mental illness and it has been my downfall and I believe will also be my premature demise. Modern medicine has had a field day with me and it’s time to stop.

  5. Cara
    Washington, DC

    I am 29yr old female with interstitial cystitis. I have been taking 150mgs for over a year. This works wonders for the IC, but I gained 30lbs on my small frame. I have a constant foggy head, have an extremely hard time thinking clearly, and am often forgetful, have an extremely hard time waking up in the morning and am groggy until 3pm each day. A few times I forgot to take it 2 days in a row and I went to the hospital for severe panic attacks. I’ve been trying to slowly ween myself off of it and am having heavy heart beat, high anxiousness, very sensitive, having crying spells, and short temper. I’m wondering if there’s any other drug that can be taken in substitute that’s easier to help get off of the drug?? I’m only 1mth into weening off and I’m having an extremely hard time.

  6. Charlotte
    Melbourne, Iowa

    I have never been depressed in my life, but I had Shingles and now have neuropathy. Both are awful, but I take famvir for my shingles when they come back on my head and I take nortriptyline every day and evening and it really helps. I am 87 yrs old and still go bowling and play Duplicate Bridge, am a Bronze life master.

  7. Debbie
    United Kingdom

    I am looking into these tablets as my 75 year old Mother takes them and suffers from terrible hallucinations, is highly active in the night although still asleep and often confused she also has started bed wetting. The symptoms are so bad i am having to stay with her. She has been taken into hospital twice now because of this, The first time she was driving back and forth into her bedroom wall (uses an elec chair) both times she’s been treated for an UTI but doesn’t have the symptoms.
    The reason she has been given them is for nerve pain following a leg amputation.

    I really believe medical people need to take much more care what they give to people like the older and the young. Sometimes it’s as if they just dish pills out for speed.

  8. Lois Litalien

    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.

  9. marie

    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.

    • Iftruthbetold
      New Jersey

      Marie, what medication did you use on your toenail? I’m glad it worked for you.

  10. Ross E

    Hi ML
    You never know. This may be worth following up (From Wikipedia):
    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.

  11. ML

    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.


    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.

  13. aasqaone

    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.

What Do You Think?

We invite you to share your thoughts with others, but remember that our comment section is a public forum. Please do not use your full first and last name if you want to keep details of your medical history anonymous. A first name and last initial or a pseudonym is acceptable. Advice from other commenters on this website is not a substitute for medical attention. Do not stop any medicine without checking with the prescriber. Stopping medication suddenly could result in serious harm. We expect comments to be civil in tone and language. By commenting, you agree to abide by our commenting policy and website terms & conditions. Comments that do not follow these policies will not be posted. Learn how your comment data is processed.

Your cart

Shipping and discount codes are added at checkout.