What to Know About Amitriptyline (Elavil)

A cartoon of a medication bottle on top of the words "Your Guide to Amitriptyline"

Depression can be overwhelming, especially without the right treatment. Luckily, there is a wide variety of antidepressants that are proven to be effective in treating mental health conditions. It’s often helpful to understand the science behind antidepressants before beginning to take one.  

Below is important information regarding amitriptyline (often known by the brand name Elavil), a relatively common antidepressant. 

What is Amitriptyline (Elavil)?

What is Amitriptyline? How does it work? 

Amitriptyline is an antidepressant primarily used to treat depression and low mood. Previously sold under the brand name Elavil, this drug is also used for certain kinds of pain such as migraines, fibromyalgia, and neuropathic pain.

In particular, amitriptyline belongs to a class of drugs, called tricyclic antidepressants (TCAs). It works by modulating certain chemicals, called neurotransmitters, in your brain. This includes serotonin and norepinephrine – both of which affect mood, pain and, anxiety.

How should Amitriptyline be used?

Amitriptyline is often taken orally, between 1–4 times a day. If you only take Amitriptyline once a day, doctors typically recommend taking it right before you go to bed, because it can cause drowsiness. It comes in 10 mg, 25 mg, 50 mg, 75 mg, 100 mg or 150 mg tablets. The typical starting dose for outpatient adults is 75 mg a day, though your doctor may start lower and gradually increase your dose as you continue with the medication, depending on how you respond. It may take several weeks before you notice the full effects of the drug, but do not stop taking the medication or change doses without first talking to your doctor. 

If you miss a dose, take your medication as soon as you remember. However, do not take it within a few hours of your next dose or take two doses at once as this may cause significant side effects, and may not be safe. 

If you take amitriptyline and have been feeling better for 6 months or more, your doctor might suggest coming off of the antidepressant — although a longer course of treatment may be appropriate. This process usually involves reducing your dose gradually over several weeks (sometimes longer, if you have been taking the medication for a long time). Gradually reducing the dose—also called “tapering”—helps reduce any negative reactions associated with coming off of amitriptyline too quickly. This is also referred to as a “discontinuation syndrome.”

What are some side effects?

The most common side effects of amitriptyline include: 

  • Drowsiness
  • Dry mouth
  • Blurred vision
  • Constipation
  • Appetite changes or weight gain
  • Difficulty urinating

Some serious (usually uncommon) side effects include:

  • Dizziness
  • Seizure or convulsions
  • Unusual bleeding or bruising
  • Eye pain, redness, or swelling
  • Fever or chills
  • Fast or irregular heartbeat
  • Muscle spasms or stiffness 
  • Stomach pain
  • Numbness, swelling, redness, speech and vision problems (these may be signs of a blood clot)

Call 911 or seek emergency care immediately if you notice any of these severe side effects.

Why do these side effects occur? 

Any medication can potentially lead to side effects, and an individual’s likelihood of having side effects depends on many factors: including their age, lifestyle, and the type of medication itself. Side effects may occur because drugs often have broad or poorly targeted effects, or the drug target itself may have many downstream effects on the body. As pharmaceutical development advances in a certain drug class, the medicine is often refined to have fewer side effects. 

Amitriptyline is a relatively old drug that works on factors that affect mental health (like neurotransmitter levels) to create results, but this means that there can often be unintended consequences or side effects. 

Many non-serious side effects of mental health medications like amitriptyline go away after a few weeks as your body gets used to the medication. However, if a side effect persists, is intolerable, or severely hinders your ability to go about your daily life, talk to your doctor, because this might be a sign of a deeper problem. 

How do your genes relate to amitriptyline?

Genetics can affect your body’s response to medication. Research suggests that the CYP2D6 genotype influences treatment outcomes for those taking amitriptyline. This means that some people with a certain variation of the CYP2D6 gene might be slow metabolizers for amitriptyline. Being a slow metabolizer means that your body will break down amitriptyline more slowly than others, which means the drug sticks around longer and may lead to side effects. For slow metabolizers, a doctor might opt to prescribe a different medication or prescribe a lower dosage. 

One way to predict whether you’ll have a positive outcome while taking amitriptyline is by taking a genetic test to determine what genetic variations you have and how they affect medication metabolization. Your DNA can help your doctor rule out less suitable medications and make more informed dosing decisions so that you can get better, faster.

Special Precautions

  • Low levels of magnesium and potassium can increase the risk of side effects. Talk to your doctor if you have these issues
  • Talk to your doctor if you have heart rhythm problems, especially if you’re known to have QT prolongation.
  • Amitriptyline can make you feel drowsy or dizzy and may also blur your vision. Alcohol can worsen these side effects. Avoid drinking alcohol and speak to your doctor before consuming cannabis.
  • Amitriptyline passes into breast milk. Speak to your doctor before nursing.
  • If you are pregnant or planning a pregnancy, make sure to consult your doctor.
  • If you have diabetes, make sure to monitor your blood sugar levels. Amitriptyline can make blood sugar levels harder to manage.

Allergic reactions to amitriptyline are very rare, but if you show signs of an allergic reaction (hives, difficulty breathing, swelling), call 911 or go to the nearest emergency department.

Some medications, vitamins, or herbs may interfere with the way amitriptyline works. Make sure to tell your doctor about all other medications you are taking before taking amitriptyline to avoid these interactions. For full details, see the FDA’s full list of precautions.

Looking to find the right medication for your mental health? Join Prairie today to be connected to board-certified psychiatrists and affordable medication options. 

Authors

  • Dr. Mike Hoaglin is a practicing mental health physician, advisor, and digital health expert passionate about clinical transformation and the microbiome. Dr. Hoaglin earned his medical degree from the Perelman School of Medicine at the University of Pennsylvania, with residency training at The Brooklyn Hospital Center and Duke University Medical Center.

  • Prairie Health is an online psychiatry service focused on reducing all barriers to mental healthcare and modernizing treatment. Prairie specializes in helping adults with depression or anxiety get better through online psychiatry appointments, genetics-informed medication plans and ongoing support, all from the comfort of home.

Published
Categorized as Medication

By Mike Hoaglin

Dr. Mike Hoaglin is a practicing mental health physician, advisor, and digital health expert passionate about clinical transformation and the microbiome. Dr. Hoaglin earned his medical degree from the Perelman School of Medicine at the University of Pennsylvania, with residency training at The Brooklyn Hospital Center and Duke University Medical Center.