Amitriptyline is an antidepressant medication that is prescribed to treat various conditions. Doses will depend on the condition being treated, as well as individual factors and requirements. Always take amitriptyline exactly as it is prescribed to help prevent adverse effects.
- Amitriptyline is a tricyclic antidepressant, used to treat depression and various other conditions.
- Treatment is usually commenced at a low dose and increased as required, before reducing to a maintenance dose.
- It is important to take amitriptyline as prescribed and not to change your dosage unless instructed by a physician.Â
Amitriptyline dosage overview
Amitriptyline is a tricyclic antidepressant (TCA) approved by the Food and Drug Administration (FDA) to treat depression in adults. It is also used off-label to treat a range of other conditions, including post-traumatic stress disorder (PTSD), anxiety, sleep disorders, chronic pain conditions, irritable bowel syndrome (IBS), and migraine prophylaxis. [1]
Elavil is the name of a branded version of this medication, which has been discontinued in the United States and is no longer on the market. Generic versions of amitriptyline are still available. [2]
Amitriptyline dosage will vary depending on the condition and the needs of the individual. Typically, treatment commences on a low dose, which is increased as required. This can help to reduce the risk of adverse effects.
Maximum dosage and safety limits
The maximum daily dosage should not exceed 150 mg for outpatient treatments and 300 mg for inpatient treatments. Once symptoms have improved, the daily dosage should be reduced to the lowest effective dose. Maintenance doses often range from 40 to 100 mg. [2]
Maximum daily doses are lower for adolescents and the elderly, or those with certain health conditions such as impaired liver or kidney function. A daily dose of 50 mg may be sufficient. [3]
Dosage by condition
Amitriptyline can be used to treat depression or for other off-label purposes. Doses can vary depending on the condition and the individual’s response to the medication.Â
Amitriptyline for depression
Treatment can commence with 75 mg per day, split into three doses. This can be increased up to 150 mg per day if required. Alternatively, treatment can commence with a single daily dose of 50 mg to 100 mg, taken at bedtime, which can be increased by 25 mg to 50 mg if needed, up to a maximum of 150 mg. [3]
Individuals receiving inpatient care may require higher doses, starting with an initial dose of 100 mg per day, which can be increased up to 300 mg. [3]
As symptoms improve, the dose should be reduced to the lowest effective dose. Maintenance doses can range from 40 mg to 100 mg. [1][2]
Elderly and pediatric (12 years+) patients will be prescribed 10 mg three times per day and a bedtime dose of 20 mg. [2]
Amitriptyline for pain relief (neuropathic, fibromyalgia)
For adults and children aged 12 and older, amitriptyline can commence at 10 mg per day, which can be increased up to a maximum of 75 mg per day. [4]
Amitriptyline for sleep disorders
Doses of between 10 mg to 25 mg, taken at bedtime, can be used to help insomnia and other sleep disorders. [5]
Amitriptyline for migraines
Amitriptyline is initiated at 10 mg per day, taken at night, which can be increased by 10 mg increments as required, up to a maximum of 100 mg per day, although 10 mg to 25 mg is often an effective dose. [6]
Special considerations and contraindications
Some people may require lower doses of amitriptyline or may be advised to use caution while using the medication, and for some, it is not a suitable medication. For example: [1][3]
- Elderly and pediatric individuals should be given lower doses.
- People with impaired liver or kidney function may require lower doses, and amitriptyline should be used with caution and monitored carefully.
- People who are pregnant or breastfeeding may be advised not to use amitriptyline due to potential risks to the baby, unless the benefits outweigh the risks.
- Amitriptyline may not be suitable for people with a history of heart conditions.
- Amitriptyline should be used with caution in people with seizure disorders, angle-closure glaucoma, or urinary retention.
- People with a history of mania or suicidal ideation should be monitored carefully during treatment, as amitriptyline can cause the onset of a manic episode and may cause suicidal thoughts.
- Amitriptyline can interact with other substances and medications. Monoamine oxidase inhibitors (MAOIs) should not be used with amitriptyline. Other interactions can include other antidepressants, antihistamines, and alcohol. It is important to inform the prescribing doctor of any recent or current medications before commencing amitriptyline.
Dose-dependent side effects
Side effects can occur when commencing amitriptyline treatment or when increasing the dosage. These side effects tend to be mild and typically only last a few days or weeks, and will go away on their own. Any side effects that persist or become problematic should be reported to the prescribing doctor, and a change in treatment may be required.
Higher doses may be more likely to cause side effects, including oversedation, extreme changes in heartbeat, unusual bleeding or bruising, seizures, hallucinations, and uncontrollable shaking. These effects should be reported immediately. [3]
Safe and proper use
Amitriptyline should be taken exactly as prescribed. It can be prescribed in one to four doses per day and should be taken at the same time each day. Never take more than prescribed. If you miss a dose, take it as soon as you remember. However, if it is close to the next dose time, skip the missed dose and continue as prescribed. Do not take two doses at once.
Amitriptyline should be stored safely, where it cannot be accessed by children or pets. Do not share amitriptyline with others, even if they have the same symptoms.
Amitriptyline misuse and overdose risks
Amitriptyline is not considered a drug of abuse and has low addiction potential. However, it might be misused alongside other medications to enhance or alter effects. Misusing amitriptyline can increase the risk of adverse effects, serotonin syndrome, and overdose. Amitriptyline overdose can be serious and even life-threatening. Signs of overdose include: [1][3]
- Extreme sedation
- Loss of consciousness
- Seizure
- Extremely high pulse
- Dilated pupils
- Trouble breathingÂ
- Chest pain
If an amitriptyline overdose is suspected, call 911 immediately.
How to take amitriptyline safely
Take amitriptyline exactly as prescribed. If you think your dosage needs to be adjusted, consult with the prescribing doctor, who can make changes as required. Never increase or decrease your dose without professional guidance.Â
Amitriptyline causes sedating effects quickly, with antidepressant effects emerging after around three or four days. It can take up to one month for the full antidepressant effects to occur. As such, it is important to continue taking the medication as prescribed to ensure it can have its proper effects. [3]
If serious adverse effects occur, contact your doctor immediately, as you may need a change of dosage or medication. In particular, if you experience suicidal thoughts or concerning changes in mood and behavior, contact a doctor immediately. [1]
When stopping amitriptyline, do not stop taking the medication abruptly, as this can cause unpleasant withdrawal symptoms. Instead, consult with a physician who will advise on gradual dosage reductions. [3]
