NOTE: Retrieved from 29 Oct 2015 using the Wayback Machine on 17 Apr 2025.

Amitriptyline

Brand & Generic Names; Drug Classes

US brand name: Elavil

Generic name: amitriptyline

Drug Class(es)

Primary drug class: Antidepressants

Additional drug class(es): Tricyclic & Tetracyclic Antidepressants

Approved & Off-Label Uses (Indications)

Elavil’s US FDA Approved Treatment(s)

Depression.

Uses Approved Overseas but not in the US

N/A

Off-Label Uses of Elavil

Dysthymia (constant, mild depression)

Neuropathic and chronic pain

Vulvodynia - depression caused and/or accompanied by vaginal pain. It didn’t work all that well, unlike Pamelor (nortripyline).

Somatoform pain disorder (where they think it’s all in your head)

Although the data are mixed when it comes to phantom limb pain. In this study it didn’t do much good, but in this study both amitriptyline and Ultram (tramadol) worked just fine.

Migraines

Post traumatic stress disorder (PTSD)

Panic/Anxiety disorders

Insomnia

Irritable Bowel Syndrome (IBS)

When & If Elavil Will Work

Elavil’s Usual Onset of Action (when it starts working)

TCAs generally take 7 to 28 days to be effective, although you’ll feel something - usually side effects - the next day.

Likelihood of Working

As far as amitriptyline’s approved use goes, the odds favor relief for endogenous (biologically caused) depression - i.e. being depressed for no good reason other than your brain hating you.

Taking and Discontinuing

How to Take Elavil

Initial dose for outpatients (you’re not crazy enough to be hospitalized) should be 50 mg at bedtime. You can increase it by 25 mg a night every week until you get to a maximum of 150 mg a night. You can also try it in a divided dose. Elavil (amitriptyline) is approved for dosages of 200 - 300 mg a day for hospitalized patients and used to be prescribed up to 400 mg a day for inpatients. Personally I wouldn’t trust it above 150 mg a day. Not that it’s particularly more dangerous than other TCAs (see comments), as long as you’re not taking a bunch of other drugs, including a potent CYP2D6 inhibitor, and aren’t a poor CYP2D6 metabolizer. If amitriptyline isn’t doing anything at all for you by the time you reach 100 mg a day, try something else. If it’s sort of working for you, try Pamelor (nortriptyline HCl), or another TCA if you haven’t already.

How to Stop Taking Elavil (discontinuation / withdrawal)

Your doctor should be recommending that you reduce your dosage by 25–50 mg a day every five days if you need to discontinue it. While TCAs don’t have a discontinuation syndrome as such, they can trigger mania if discontinued too quickly, regardless of your being bipolar or not. Any antidepressant can do that, it’s just more likely to happen with a TCA than other antidepressants.

Elavil’s Potential Side Effects

Potential Side Effects All Crazy Meds Have

No matter which neurological and/or psychiatric drug you take, you’ll probably get one or more of these side effects. These will usually be gone, or at least will diminish to the point where you barely notice it most of the time, within a week or two.

Headache

Drowsiness / fatigue - even when taking stimulants in some circumstances.

Insomnia, instead of or alternating with the drowsiness.

Nausea

Assorted other minor GI complaints (constipation, diarrhea, etc.)

Generally feeling spacey / out of it.

All crazy meds can, and probably will affect your dreams as well. There is no way of telling if that will be good or bad, let alone if this side effect is permanent or temporary.

Any of the above side effects you see listed again below means they’re even more likely to happen and/or stick around longer and/or are worse than most other meds.

Typical Potential Side Effects

The usual for TCAs - headache, nausea, dry mouth, sweating, blurry vision, sleepiness or insomnia, constipation, and weight gain. Expect the sedation to hang around for awhile and the dry mouth and constipation to be permanent. The weight gain usually isn’t that bad.

Uncommon Potential Side Effects

Urinary hesitancy (Guys over 40 can freak out with prostate cancer hypochondria.)

Heart palpitations

No libido and other sexual dysfunctions

Nightmares - more so than other meds

The urinary hesitancy is something that meds with a positive effect on norepinephrine tend to do. It can be permanent, or happen at random.

Freaky Rare Side Effects

Black tongue (one of my father’s rollerderby buddies used to get that from drinking too much)

Sleepwalking (somnambulism)

Reversible brain death. That was after an overdose, but I couldn’t resist. “Reversible brain death” reads like something from a Reanimator script.

Not all side effects have been listed here, just the most likely and most interesting. For all reported side effects, see Elavil’s PI Sheet.

What You Really Need to be Careful About

Heart palpitations, arrhythmia, and similar cardiac weirdness.

Pregnancy Category

C-Use with caution

Elavil’s Noted Drug-Drug, Drug-Food & Drug-Supplement Interactions

Alcohol. TCA + booze = dead.

Antabuse (disulfiram). Elavil (amitriptyline) + the drug that prevents alkies from drinking = delirious and potentially dead. Some people can’t win for losing.

Check for Other Drug-Drug, Drug-Food & Drug-Supplement Interactions Elavil may have at Drugs.com’s drug-drug and drug-food interaction checker

It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on teh Faecesbooks.

Learn more about drug-everything interactions on our page of tips about taking crazy meds.

All text here was written by Jerod Poore. End of archived pages for amitryptiline.