Amitriptyline is a tricyclic antidepressant used to treat depression and a range of physical and psychological conditions. Although amitriptyline can be a safe and effective treatment, it may cause side effects and can be dangerous or fatal in overdose. Always take amitriptyline exactly as prescribed and report any serious side effects to the prescribing doctor.
- Amitriptyline is a tricyclic antidepressant, typically prescribed in doses ranging from 10 mg to 150 mg per day (up to 300 mg in certain cases).
- Side effects can occur with amitriptyline use, particularly with high doses, and serious side effects may require professional intervention.
- Amitriptyline can be fatal in overdose.
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Elavil (amitriptyline) uses
Amitriptyline is a tricyclic antidepressant, available as a generic medication. Branded medications, such as Elavil, were available in the United States but have been discontinued. [1]
Amitriptyline is approved by the Food and Drug Administration (FDA) to treat depression in adults. It is also used for purposes not FDA-approved, known as off-label, such as: [2]
- Post-traumatic stress disorder (PTSD)
- Chronic pain, such as diabetic neuropathy and fibromyalgia
- Anxiety
- Insomnia
- Irritable bowel syndrome (IBS)
- Migraine prophylaxis
Common side effects of amitriptyline
Amitriptyline can cause side effects, particularly at the start of treatment or after increasing the dose. Side effects may be milder with low doses, such as those used to treat pain and migraine, and can improve in a shorter time. [3]
Common side effects of amitriptyline include: [1][2][3]
- Feeling tired
- Dry mouth
- Drowsiness
- Dizziness
- Shaking
- Restlessness
- Trouble sleeping
- Unusual dreams
- Headache
- Changes in heart rate
- Tingling in the hands or feet
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Change in appetite
- Urinary retention
- Sweating
- Sexual dysfunction
If any of the above side effects persist for more than a couple of weeks or worsen, contact a doctor, as you may require a change in dosage or medication.
Serious side effects and risks
In some cases, serious side effects can occur, which may require professional treatment or medication changes. If any of the following side effects occur, contact the prescribing doctor immediately: [1][2][4]
- Feeling very dizzy or fainting
- Difficulty speaking
- Chest pain
- Trouble breathing
- Extreme changes in heartbeat
- Swelling of the face, mouth, or tongue
- Numbness in the arms or legs
- Rash or hives
- Fever
- Uncontrollable shaking
- Unexplained bleeding or bruising
- Seizures
- Hallucinations
- Delusions
- Severe confusion
- Muscle spasms
- Yellowing skin or eyes
Serotonin syndrome
Serotonin syndrome is a serious and potentially fatal condition caused by dangerously high levels of serotonin. While rarer with amitriptyline use alone, it is more likely when amitriptyline is used in combination with other serotonergic substances, such as other antidepressants, lithium, tramadol, fentanyl, or triptans. [4]
If signs of serotonin syndrome emerge, contact a doctor or 911 immediately. Signs of serotonin syndrome can include: [2][4]
- Shaking
- Rigidity
- Agitation
- Hallucinations
- Delirium
- Hyperthermia
- Flushing
- Seizures
- Vomiting
- Diarrhea
Suicidal thoughts and psychiatric side effects
Amitriptyline can cause suicidal thoughts and behaviors, particularly at the start of treatment and in those under the age of 24. People taking amitriptyline, and their families or caregivers, should be made aware of this risk and how to recognize concerning symptoms. This should be reported to a doctor immediately for monitoring. [4]
Amitriptyline may cause the onset of a manic episode, particularly in those with a history of bipolar disorder. As such, people should be screened for bipolar disorder before starting amitriptyline treatment, as alternative medications may be better suited. [2][4]
Other psychological effects of amitriptyline can include psychotic symptoms such as hallucinations or delusions, anxiety, restlessness, irritability, agitation, and panic attacks. It may be necessary to change the dosage or medication if these symptoms occur. [1][4]
Cardiovascular risks and monitoring heart health
Amitriptyline can cause cardiac effects, such as arrhythmias, QT prolongation, tachycardia, palpitations, and hypertension. While rare, heart attack and stroke may also be a risk when using this medication. As such, amitriptyline may not be suitable for people with a history of heart issues, or doses should be lowered and carefully monitored. [4]
What research says about prolonged and long-term use
Long-term amitriptyline use can be safe and effective, particularly when used in low doses. Long-term treatment should include regular reviews to check the effectiveness of the medication, if dose changes are required, or if adverse effects have emerged. [5]
There may be some risks associated with long-term use, such as the potential for abuse and addiction. Although abuse and addiction are rare, some reports describe amitriptyline abuse in order to achieve a euphoric state or ‘high’, along with physical and psychological symptoms of addiction. [6]
There are also some observational reports that chronic and high-dose amitriptyline use can result in cognitive impairments. Further research is needed, but this could potentially increase the risk of dementia and other neurodegenerative diseases. [7]
Amitriptyline withdrawal
Discontinuing amitriptyline treatment can result in the onset of withdrawal symptoms. This may be more likely with abrupt cessation, and it is recommended to reduce the dosage gradually. [4] Amitriptyline withdrawal symptoms can include irritability, insomnia, restlessness, nausea, fatigue, and headache. [1][4]Â
Managing and reducing side effects
Because of the risk of side effects when commencing amitriptyline treatment, doctors will typically prescribe a low dose initially, which can be gradually increased every three to seven days until an effective therapeutic dose is reached. Side effects will be monitored, and doses can be adjusted if required. [2]
Amitriptyline causes a sedative effect, so it is often preferable to administer the medication at bedtime to reduce daytime sleepiness. It is also recommended to avoid or limit alcohol while taking amitriptyline. [2]
Making dietary changes can help with nausea and other gastrointestinal symptoms, such as eating more fibrous foods if experiencing constipation. Ensuring adequate hydration can also help relieve some gastrointestinal side effects and can help with urination difficulties, dry mouth, fatigue, and dizziness. [3]
Side effects that are persistent or troubling may not be adequately managed at home and might require professional support.
Amitriptyline toxicity and overdose
Taking too much amitriptyline or combining amitriptyline with other substances can result in overdose. Amitriptyline overdose can cause serious or even fatal consequences and may require urgent medical treatment. Signs of amitriptyline overdose can include: [1][4]
- Extreme changes in heartbeat
- Seizure
- ConfusionÂ
- Hallucinations
- Extreme sedation
- Rigidity
- Vomiting
- HyperthermiaÂ
- Loss of consciousness
In the event of amitriptyline overdose, call 911 immediately.Â
When to seek emergency help
In some circumstances, emergency help may be needed. If an overdose is suspected, call 911 for emergency medical attention. If serious side effects occur, including seizures, psychotic symptoms, suicidal thoughts, or trouble breathing, call a doctor or 911 for emergency assistance.
