Amitriptyline

Amitriptyline (am-ee-trip-tuh-leen) is a type of drug called a tricyclic antidepressant.

These drugs were first created to treat anxiety and depression. But when taken at a low dose, it’s also good for treating pain, especially pain caused by damage to your nerves.

The nervous system controls everything you do, including breathing, walking, thinking, and feeling sensations. It is made up of the nerves in your body, as well as your brain and spinal cord.

Amitriptyline can be prescribed to people who have arthritis and other related conditions such as fibromyalgia and back pain. It can also be given if you have damage to the nerve endings in your limbs, known as peripheral neuropathy.

Amitriptyline works by increasing the amount of serotonin your brain makes.

Serotonin is a chemical, called a neurotransmitter, that the brain sends out to nerves in the body.

Serotonin is thought to improve your mood, sleep and the way your body responds to pain.

The low dose of amitriptyline won’t treat depression, but it should reduce your pain, relax your muscles and improve your sleep.

You may feel a bit better after one or two weeks. But it can take four to six weeks for amitriptyline to work as a painkiller.

You’ll probably take it for as long as it helps your condition. Some people take it for many months, even years, without having any negative effects.

Most people can take amitriptyline. It’s safe to be prescribed to adults or children.

But you should speak to your doctor before taking amitriptyline if you:

• have ever had an allergic reaction to amitriptyline or any other medicine
• have a heart problem – amitriptyline can make some heart problems worse
• have liver or kidney problems
• have epilepsy – amitriptyline can increase seizures or fits
• have ever taken any medicines for depression – some antidepressants can affect the way amitriptyline works
• are pregnant, trying to become pregnant, or breastfeeding
• have an eye problem called glaucoma – amitriptyline can increase the pressure in your eye
• have prostate problems or difficulty peeing
• have type 1 or type 2 diabetes
• have bipolar disorder or schizophrenia
• have thoughts about harming yourself or ending your life
• have a rare blood disorder called porphyria.

Amitriptyline is available on prescription. You can take it as a tablet or as a liquid you can drink. It comes in three different strengths – 10mg, 25mg or 50mg.

You’ll need to take it every day and it’s best to take it in the evening before you go to bed. This is because it can make you feel sleepy. If you find that you’re still feeling sleepy when you wake up in the morning, you could try taking it earlier in the evening.

Amitriptyline doesn’t usually upset the stomach, so you can take it with or without food. It’s best to swallow the tablet whole with a drink of water. If you chew it, it can taste bitter.

Amitriptyline is taken at lower doses for pain relief than when it’s used for depression. Your doctor will usually start you on the lowest dose possible and will increase it if you’re still experiencing pain after several weeks.

Doses for children under 12 years old are based on their weight and symptoms.

Amitriptyline isn’t an addictive medication, but you may get unpleasant side effects if you suddenly stop taking it. For example, you may feel sick, tired or have headaches.

You should talk to your doctor before making any changes to your treatment. They’ll probably recommend that you reduce the dose slowly over several weeks or more, depending on how long you’ve been taking it.

Don’t worry if you forget a dose. Try to take your missed dose as soon as you remember – unless it’s almost time for your next dose or you are going to drive, cycle or use machinery. In these cases, leave out the missed dose and take your next one as usual.

You should never take two doses at the same time, or take an extra dose, to make up for a missed one.

If you struggle to remember when to take your medication, it might be worth setting an alarm to remind yourself.

Taking more than your prescribed dose can cause serious side effects, such as changes to your heartbeat, seizures and fits.

If you think you’ve taken too much amitriptyline, call your doctor straight away or call 111.

Many people take amitriptyline without experiencing any problems. But, like any medication, it can cause side effects.

Many of the more common side effects will improve, once your body gets used to it. If you have very bad side effects, or are worried about your symptoms, you should contact a health professional for advice.

Common side effects include:

• constipation
• dizziness
• dry mouth
• feeling sleepy
• difficulty peeing
• headaches.

Some people also find their appetite and weight changes when they start taking it. Talk to your healthcare team if you have any side effects that worry you.

Because amitriptyline can make you drowsy, you should not cycle, drive or use machinery for the first few days of taking it, until you know how it affects you. It may also be best to try it out when you don’t have to get up for work the next day.

In rare cases, people can have serious side effects to amitriptyline. Call your doctor straight away if you have:

• a fast or irregular heartbeat
• yellowing of the skin or the whites of your eyes – these can be signs of liver problems
• a headache, confusion, muscle cramps, generally feeling weak or experiencing a seizure – these can be signs of low sodium levels in your blood
• low blood pressure
• eye pain, changes in your sight, swelling or redness in or around your eye
• very bad constipation or you feel unable to pee and you’re in pain
• weakness on one side of your body
• trouble speaking, thinking or balancing.

As with any medication, there is a very small risk you may have an allergic reaction to amitriptyline. However, this is rare.

You should call 999 or go to A&E if:

• you suddenly get a rash – your skin may become itchy, red, swollen, blistered or begin to peel
• you begin to wheeze
• you feel a tightness across your chest or throat
• you’re having trouble breathing or talking
• your mouth, lips, tongue, face or throat become swollen.

These can be symptoms of a serious allergic reaction, and you must seek medical help straight away.

Amitriptyline is safe to take with most other drugs prescribed for your condition. But some drugs may affect it.

Always check with your doctor if you start taking any new medication. Don’t use complementary treatments, such as herbal remedies, without discussing this first with your doctor, pharmacist or pain specialist.

Talk to the person treating you if you’re taking any other medicines, such as:

• painkillers, such as codeine, morphine or tramadol – these may react with amitriptyline and make you sleepy and less alert
• other antidepressants – some antidepressants, such as serotonin re-uptake inhibitors (SSRIs) or monoamine-oxidase inhibitors (MAOIs), can affect the way amitriptyline works, causing high blood pressure or heart problems. It can also lead to a condition called serotonin syndrome, which is when your serotonin levels are too high
• medicine to treat depression, anxiety, mood disorders or other mental illnesses
• cold or allergy medicines, such as Benadryl and nasal decongestants
• medicine to treat an overactive bladder
• medicine to treat Parkinson’s disease
• medicine to treat stomach problems, motion sickness or irritable bowel syndrome (IBS)
• bronchodilator asthma medication, usually given in an inhaler
• antifungal medicines
• thyroid medicines
• sedatives
• St John’s Wort – a herbal remedy used for depression.

Vaccinations

Amitriptyline shouldn’t interfere with any vaccinations. Just make sure the healthcare professional vaccinating you knows that you’re taking it.

Having an operation

If you are going to have an operation, you should tell your doctor or surgeon that you are taking this medicine.

Amitriptyline can react with some drugs found in general or local anaesthetics, so your doctor may recommend that you stop amitriptyline before surgery.

You should also tell your dentist that you take this medicine if you need local anaesthetic.

You can drink alcohol while you’re taking amitriptyline, but it can make you feel sleepy. It’s best not to drink while you’re getting used to the medication and work out how it affects you.

Amitriptyline doesn’t affect fertility in men or women.

However, some people have sex-related problems while taking amitriptyline, such as:

• swollen breasts
• vaginal bleeding
• erectile and ejaculation problems.

These side effects aren’t common and should pass after a few weeks. If they don’t, and this worries you, speak to your doctor. They can see if another drug may work better.

If you’re a woman who has been through menopause, you should contact your doctor as soon as possible if you experience any vaginal bleeding.

Amitriptyline shouldn't affect any type of contraception, including the combined pill and emergency contraception.

Amitriptyline generally isn’t recommended if you’re pregnant. Your doctor will only prescribe it if you’re pregnant, if the benefits outweigh the risks. If they don’t think it’s right for you, don’t worry, as they will suggest another treatment.

Only a small amount of amitriptyline passes into breast milk, but it’s recommended that you don’t take amitriptyline if you're breastfeeding. If you would like to breastfeed, talk to your doctor. There may be other medicines you can take instead.