Amitriptyline
Also known as: amitriptyline for pain, amitriptyline for migraine
Amitriptyline is a prescription-only medicine from a group called tricyclic antidepressants, used for nerve pain and to help prevent migraine, and also for depression. The NHS says taking more than the prescribed amount can cause serious effects such as changes in heartbeat and seizures (fits); its depression page says to call 999 now for a fast or irregular heartbeat, a seizure, drowsiness or passing out, difficulty breathing or sudden confusion, and its pain page says to contact NHS 111 for advice.
- Generic name
- Amitriptyline
- Active ingredient
- Amitriptyline (variants: amitriptyline hydrochloride)
- Product type
- Small-molecule medicine
- Drug class
- Tricyclic antidepressants
- Brand names
- UK Amitriptyline · US
- Routes
- Oral
- Dosage forms
- Tablet
- Also known as
- amitriptyline for pain, amitriptyline for migraine
- Usual preparations
- Taken by mouth. (summary of the cited reference, not a prescription)
- Onset and duration
- The NHS says pain relief usually starts to build over 1 or 2 weeks and the full painkilling effect can take 4 to 6 weeks, so it advises allowing at least 6 weeks to see whether it works for pain. Sleep can improve quite soon.
- Monitoring
- The NHS says the doctor usually lowers the dose gradually over several weeks, or longer after long-term use, when treatment stops.
Availability by country
| Country | Status | Note | Source |
|---|---|---|---|
| UK | Prescription only | UK |
Legal status differs between countries and can change; each row cites the document it was taken from and applies only to the country named.
What it is used for
- Nerve pain (neuralgia) and other pain that lasts a long time
- Prevention of migraine
- Depression, where the doses used are higher than those used for pain
How it works in the body
Amitriptyline belongs to a group of medicines called tricyclic antidepressants, which are thought to work by increasing levels of a chemical in the brain called serotonin. For pain, the NHS says it is thought to change how nerves handle pain signals as well as raising serotonin.
Common side effects
- The NHS lists feeling sleepy, dizziness, a dry mouth, constipation and sweating among the common side effects.
- The NHS says common side effects often ease as the body adjusts.
- For a dry mouth the NHS suggests chewing sugar-free gum or sucking sugar-free sweets.
- For dizziness on standing, the NHS suggests getting up slowly.
- The NHS advises not driving, cycling or using tools or machines for the first few days of treatment, until it is known how amitriptyline makes a person feel.
Serious: seek help
- Serious side effects are rare.
- For a fast or irregular heartbeat, yellowing of the skin or eyes, headache with confusion, weakness or muscle cramps, or eye pain, a change in eyesight, or swelling or redness in or around the eye, the NHS says to get advice from a doctor or NHS 111 now.
- Severe constipation, or being unable to pass urine with severe tummy pain, is also listed by the NHS for urgent advice from a doctor or NHS 111.
- The NHS says to call 999 for signs of a stroke, a seizure (fit) or severe chest pain, and not to drive yourself to A&E.
- A serious allergic reaction is rare, but the NHS says to call 999 for swelling of the lips, mouth, throat or tongue, fast or struggling breathing, a tight throat or difficulty swallowing, or a swollen, itchy or blistered skin rash.
- Taking more than the prescribed amount can cause serious effects such as a change in heartbeat and seizures (fits); the NHS pain page advises contacting NHS 111 for advice.
- The NHS depression page says to call 999 now if more than the prescribed amount has been taken and there is a fast or irregular heartbeat, a seizure, drowsiness or passing out, difficulty breathing, or sudden very bad confusion.
- The NHS says to call 999 or go to A&E now for thoughts of harming yourself or ending your life.
- NHS 111 is open 24 hours every day, and Samaritans is a free line on 116 123.
Cautions and interactions
- The NHS lists a past allergic reaction to amitriptyline or another medicine, heart problems, liver or kidney problems and epilepsy among the reasons amitriptyline may not suit a person.
- The NHS says amitriptyline can make some heart problems worse, can increase seizures in epilepsy, and can raise pressure in the eye in glaucoma.
- The NHS depression page also lists problems emptying the bladder among the things to raise with a doctor first.
- The NHS lists taking other antidepressants, being pregnant, trying to get pregnant and breastfeeding among the situations to discuss with the doctor before starting.
- The NHS says alcohol can be drunk with amitriptyline but may add to sleepiness, and it is usually best to stop drinking until it is known how the medicine makes a person feel.
- Stopping suddenly can cause extra side effects such as flu-like symptoms, so the NHS says to talk to the doctor before stopping.
Interactions
Check interactions
Taking Amitriptyline with other medicines? Add them to the checker to see what the official sources say about each pair: the mechanism, general management and monitoring, never a bare "safe".
Interactions documented in the official sources cited on each card. The list covers the medicines represented on this site and is not exhaustive; how the interaction data is compiled.
No pair records for this medicine are in the sources currently represented by Anatomy Nexus. Absence from this list does not mean no interaction exists.
Same-class and related medicines
Same class: Tricyclic antidepressants
Medicines that share the class of Amitriptyline. They are separate medicines with their own licences, doses and interactions, not alternative names for Amitriptyline.
Related medicines
Medicines often discussed alongside Amitriptyline: used together, compared with it, or acting on the same problem by a different route.
Key facts
| Fact | Detail |
|---|---|
| Medicine group | Tricyclic antidepressant |
| Used for | Nerve pain, migraine prevention and depression |
| Available as | Prescription only; taken by mouth |
| Time to work as a painkiller | 1 or 2 weeks to start; the full effect can take 4 to 6 weeks |
| Usual time of day | In the evening, because it can make a person sleepy |
| Too much taken | Can cause changes in heartbeat and seizures; NHS depression page: call 999 now if symptoms follow; NHS pain page: contact NHS 111 for advice |
| Help in a crisis | 999 or A&E if in immediate danger; NHS 111 24 hours; Samaritans 116 123 (free) |
What is amitriptyline used for?
Amitriptyline is a prescription-only medicine. It is used to treat nerve pain, called neuralgia, and other pain that lasts a long time. It is also used to help prevent migraines, and it is used to treat depression too. The NHS says the doses used to treat pain are lower than the doses used for depression.
Amitriptyline belongs to a group of medicines called tricyclic antidepressants. The NHS says that when it is used for depression it does not work any better or worse than other antidepressants, although for some people the side effects are a problem and another antidepressant may cause fewer. Which medicine suits a person is a decision for the prescriber.
How does amitriptyline work, and how long does it take?
Tricyclic antidepressants are thought to work by increasing levels of a chemical in the brain called serotonin. For pain, the NHS says amitriptyline is also thought to change how nerves handle pain signals, which is why it can help with nerve pain and with preventing migraine.
The NHS says sleep can improve quite soon, but pain relief usually takes 1 or 2 weeks to begin, and the full painkilling effect can take 4 to 6 weeks. It advises allowing at least 6 weeks to see whether it works for pain. Because amitriptyline can make a person sleepy, the NHS says it is usually taken in the evening. As mood improves in depression, the NHS says a person may also notice sleeping better and getting on with people more easily because of feeling less anxious.
What are the side effects?
The NHS lists feeling sleepy, dizziness, a dry mouth, constipation and sweating among the common side effects, and says they often ease as the body adjusts. For a dry mouth it suggests chewing sugar-free gum or sucking sugar-free sweets, and for dizziness on standing it suggests getting up slowly. It advises not driving, cycling or using tools or machines for the first few days, until it is known how amitriptyline makes a person feel.
Serious side effects are rare. The NHS says to get advice from a doctor or NHS 111 now for a fast or irregular heartbeat, yellowing of the skin or eyes, headache with confusion, weakness or muscle cramps, or eye pain, a change in eyesight, or swelling or redness in or around the eye. It gives the same route for severe constipation, or being unable to pass urine with severe tummy pain. The NHS says to call 999 for signs of a stroke, a seizure (fit) or severe chest pain, and not to drive yourself to A&E. A serious allergic reaction is rare, and the NHS also says to call 999 for it.
What happens if too much is taken?
The NHS pain page says taking more than the prescribed amount can cause serious effects such as a change in heartbeat and seizures (fits), and advises contacting NHS 111 for advice. The NHS depression page says to call 999 now if more than the prescribed amount has been taken and there is a fast or irregular heartbeat, a seizure, drowsiness or passing out, difficulty breathing, or sudden very bad confusion. Where A&E is needed, the NHS says not to drive yourself; call 999 for an ambulance instead.
An NHS formulary note describes amitriptyline as very dangerous in overdose, which is one reason prescribers weigh it carefully where there is a risk of suicide. MedlinePlus, a US service, says an overdose means taking more than the normal or recommended amount of this medicine, and that symptoms can affect the breathing, heart and nervous system, including an irregular heart rate and seizures. It says the person is almost always admitted to hospital.
The NHS says anyone who has thoughts of harming themselves or ending their life should call 999 or go to A&E now. NHS 111 is open 24 hours every day, and Samaritans is a free line on 116 123.
Alcohol, other medicines, pregnancy and who needs extra care
The NHS says alcohol can be drunk with amitriptyline but may add to sleepiness, and it is usually best to stop drinking until it is known how the medicine makes a person feel. Many medicines can interact with amitriptyline, so the prescriber and pharmacist need to know what else a person takes.
The NHS lists a past allergic reaction to amitriptyline or another medicine, heart problems, liver or kidney problems and epilepsy among the reasons amitriptyline may not suit a person. It says amitriptyline can make some heart problems worse, can increase seizures in epilepsy, and can raise pressure in the eye in glaucoma. Its depression page also lists problems emptying the bladder. The NHS includes taking other antidepressants, being pregnant, trying to get pregnant and breastfeeding among the situations to discuss with the doctor before starting, so that the benefits and risks can be weighed for each person.
Stopping amitriptyline
Stopping suddenly can cause extra side effects, including flu-like symptoms such as feeling sick, muscle pain and feeling tired or restless. The NHS says not to stop suddenly without talking to a doctor, and the doctor usually lowers the dose gradually over several weeks, or longer after long-term use. The prescriber decides when treatment is reviewed and when it ends. In the NHS description, a gradual reduction over several weeks is the usual approach rather than an abrupt stop.
For pain, the NHS advises allowing at least 6 weeks before judging whether amitriptyline is working, and a Northern Care Alliance leaflet on migraine suggests a 3-month trial before judging whether it helps. The NHS says sleep can improve quite soon even though pain relief is slower to start.
Frequently asked questions
Is amitriptyline an antidepressant if it is prescribed for pain?
Amitriptyline belongs to a group of medicines called tricyclic antidepressants. It is used to treat nerve pain and to help prevent migraines, and also to treat depression. The NHS says the doses used to treat pain are lower than the doses used for depression. For pain, the NHS says it is thought to change how nerves handle pain signals.
How long does amitriptyline take to work for pain?
The NHS says pain relief usually takes 1 or 2 weeks to begin and the full painkilling effect can take 4 to 6 weeks. It advises allowing at least 6 weeks to see whether it works for pain. Sleep can improve quite soon. Because it can make a person sleepy, it is usually taken in the evening.
Can alcohol be drunk while taking amitriptyline?
The NHS says alcohol can be drunk with amitriptyline but may add to sleepiness. It is usually best to stop drinking until it is known how the medicine makes a person feel. The prescriber and pharmacist need to know about other medicines a person takes, because many can interact with amitriptyline.
What should happen if too much amitriptyline has been taken?
Taking more than the prescribed amount can cause serious effects such as a change in heartbeat and seizures (fits). The NHS depression page says to call 999 now if there is a fast or irregular heartbeat, a seizure, drowsiness or passing out, difficulty breathing, or sudden very bad confusion. The NHS pain page advises contacting NHS 111 for advice. Where A&E is needed, the NHS says not to drive yourself.
Is it all right to stop amitriptyline suddenly?
Stopping suddenly can cause extra side effects, including flu-like symptoms. The NHS says to talk to a doctor before stopping. The doctor usually lowers the dose gradually over several weeks, or longer after long-term use.
Can amitriptyline be taken in pregnancy or while breastfeeding?
The NHS lists being pregnant, trying to get pregnant and breastfeeding among the situations to discuss with the doctor before starting amitriptyline. The prescriber weighs the benefits and risks for each person.
Connected pages in detail
What each linked page on Anatomy Nexus covers, in a line, for Amitriptyline.
Conditions
- Migraine A recurrent headache disorder with attacks of moderate to severe throbbing pain, typically one-sided, lasting 4 to 72 hours.
Symptoms
- Headache Pain felt anywhere in the head.
- Dizziness An umbrella word for several sensations: vertigo (the room spins, an inner-ear or brain problem), light-headedness (about to faint.
Medications
- Sertraline and SSRIs A selective serotonin reuptake inhibitor (SSRI) antidepressant used for depression, anxiety disorders, panic and obsessive-compulsive disorder.
- Citalopram A selective serotonin reuptake inhibitor antidepressant used for depression and panic disorder, taken once daily.
- Gabapentin A prescription medicine used to treat epilepsy and nerve pain.
- Pregabalin Pregabalin is a prescription medicine used for nerve pain, epilepsy and generalised anxiety disorder.
- Duloxetine Duloxetine is an antidepressant medicine that is also used for anxiety and nerve pain.
- Mirtazapine Mirtazapine is an antidepressant, prescribed mainly for depression and sometimes for obsessive compulsive disorder (OCD) and anxiety.
- Venlafaxine Venlafaxine is an antidepressant called a serotonin and noradrenaline reuptake inhibitor (SNRI), used for depression.
Drug classes
- Tricyclic antidepressants Tricyclic antidepressants are a group of medicines that includes amitriptyline, nortriptyline, imipramine and clomipramine.