Skip to main content

Amitriptyline

Pronunciation: a-mee-TRIP-ti-leen
Brand names: Elavil, Endep, Vanatrip
Dosage form: tablets (10mg, 25mg, 50mg, 75mg, 100mg, 150mg)
Drug class: Tricyclic antidepressants

Medically reviewed by Melisa Puckey, BPharm. Last updated on Mar 8, 2024.

What is amitriptyline?

Amitriptyline is a tricyclic antidepressant used to treat symptoms of depression (FDA approved), and amitriptyline is used off-label for insomnia, migraine prevention, ADHD, eating disorders, bipolar disorder, anxiety, psychotic disorders, and some types of pain. Amitriptyline may work by increasing chemical messengers (neurotransmitters) serotonin and norepinephrine that communicate between brain cells and help regulate mood.

The first amitriptyline brand was Elavil, which was FDA-approved on April 7, 1961, and has since been discontinued. Other amitriptyline brand names include Vanatrip and Endep, which have also been discontinued. Amitriptyline is now available as a generic medication. Amitriptyline is from the drug class tricyclic antidepressants (TCA).

Amitriptyline is available in combination with chlordiazepoxide for the treatment of patients with moderate to severe depression associated with moderate to severe anxiety. Amitriptyline, in combination with perphenazine, is FDA-approved for types of severe anxiety and/or agitation.

Amitriptyline side effects

Common amitriptyline side effects

Common amitriptyline side effects may include dry mouth, vision changes, sleepiness (sedation), tiredness, appetite or weight changes, constipation, diarrhea, nausea, vomiting, upset stomach, mouth pain, unusual taste, black tongue, urinating less than usual, breast swelling (in men or women), lower sex drive, impotence, or difficulty having an orgasm.

Serious amitriptyline side effects

Allergic reactions: Get emergency medical help if you have signs of an allergic reaction to amitriptyline, including difficulty breathing, hives, or swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Warnings

You should not use amitriptyline if you have recently had a heart attack.

Do not use amitriptyline if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine.

You may have thoughts about suicide when you first start taking an antidepressant such as amitriptyline, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Amitriptyline may trigger an angle closure glaucoma attack in a patient with anatomically narrow angles who does not have a patent iridectomy.

Before taking this medicine

You should not use this medicine if you are allergic to amitriptyline or any of the inactive ingredients or:

Do not use amitriptyline if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

Tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone.

To make sure amitriptyline is safe for you, tell your doctor if you have ever had:

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Tell your doctor if you are pregnant or breastfeeding.

Amitriptyline is not approved for use by anyone younger than 12 years old.

How should I take amitriptyline?

Take amitriptyline exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

It may take up to 4 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve.

If you need surgery, tell your surgeon you currently use amitriptyline. You may need to stop for a short time.

Do not stop using amitriptyline suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using amitriptyline.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

Amitriptyline Dosing information

Usual Adult Amitriptyline Dose for Depression:

Outpatients: 

Inpatients:

Comments:

Usual Geriatric Dose for Depression:

Dose: 10 mg orally 3 times a day AND 20 mg orally once a day at bedtime

Comments:

Usual Pediatric Dose for Depression:

Aimitripyline dose 12 years or older: 10 mg orally 3 times a day AND 20 mg orally once a day at bedtime

Comments:

Available as amitriptyline 10mg tablets, amitriptyline 25mg tablets, 50mg tablets, 75mg tablets 100mg tablets and 150mg tablets.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of amitriptyline can be fatal.

Overdose symptoms may include irregular heart rhythm, feeling like you might pass out, seizures, or coma.

What to avoid

Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with amitriptyline.

Avoid driving or hazardous activity until you know how amitriptyline will affect you. Your reactions could be impaired.

Avoid exposure to sunlight or tanning beds. Amitriptyline can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

What other drugs will affect amitriptyline?

Taking amitriptyline with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking amitriptyline with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.

Tell your doctor about all your other medicines, especially:

This list is not complete. Other drugs may affect amitriptyline, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Storage

Store at 20-25ºC (68 -77ºF); excursions permitted to 15-30 ºC (59-86 ºF). [See USP Controlled Room Temperature].

Popular FAQ

In the treatment of depression, you should feel some relief from amitriptyline in 2 to 4 weeks, but it may take up to 8 to 12 weeks to feel the full therapeutic effects. For nerve-related (neuropathic) pain, lower doses of amitriptyline are typically used and it also may take up to 6 weeks to feel the full effects. If you have concerns about how well your medicine is working, contact your doctor for further advice.

Yes, weight gain has been reported as a common side effect with amitriptyline and may occur in 1% to 10% of patients. Amitriptyline is a tricyclic antidepressant (TCA) and other drugs in this class have been associated with weight gain. TCAs block histamine receptors which may be responsible for increased appetite and weight gain.

Yes, amitriptyline, an oral tricyclic antidepressant, has been reported to cause high blood pressure (hypertension), but how often this occurs was not reported. Other heart side effects, like fast heart beat, orthostatic hypotension (low blood pressure upon standing), fainting, heart rhythm changes and heart attack have also been reported. Some side effects, like orthostatic hypotension and heart rhythm changes, are common to the tricyclic antidepressant class.

Amitriptyline will stay in your system for about 2 to 6 days after your last dose, but its clinical effect may wear off before this time. Amitriptyline has a half-life ranging from 10 to 28 hours. The half-life of a drug is the time it takes for the blood concentration of a drug to reduce by one-half. It takes about 5 half-lives for a drug to be fully eliminated from your body. So, after about 50 to 140 hours (about 2 to 6 days), most of amitriptyline is gone from your body.

Amitriptyline is not addictive or habit-forming, but it may cause sudden withdrawal symptoms if you stop treatment abruptly. Side effects from rapid withdrawal can include headache, nausea, trouble sleeping, abnormal dreams, irritability, and restlessness. Talk to your doctor about the best way to stop treatment.

Common antidepressants used for orthopedic pain relief may include SSRIs like fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft), SNRIs such as duloxetine (Cymbalta), or tricyclic antidepressants (TCAs) like amitriptyline (Elavil) or nortriptyline (Pamelor). Continue reading

More FAQ

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use amitriptyline only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.