Amitriptyline: Effective Relief for Chronic Pain and Depression
| Product dosage: 50mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 90 | $0.39 | $35.26 (0%) | 🛒 Add to cart |
| 120 | $0.35 | $47.01 $42.14 (10%) | 🛒 Add to cart |
| 180 | $0.32 | $70.52 $56.76 (20%) | 🛒 Add to cart |
| 270 | $0.29 | $105.78 $78.26 (26%) | 🛒 Add to cart |
| 360 | $0.27
Best per pill | $141.04 $98.04 (30%) | 🛒 Add to cart |
Synonyms | |||
Amitriptyline is a tricyclic antidepressant (TCA) with a well-established profile for managing major depressive disorder and various chronic pain conditions. Its dual-action mechanism modulates serotonin and norepinephrine reuptake, offering both mood stabilization and analgesic benefits. Clinically trusted for decades, it remains a cornerstone in neuropathic pain protocols and treatment-resistant depression. This product card provides a comprehensive, evidence-based overview for healthcare professionals.
Features
- Active ingredient: Amitriptyline hydrochloride
- Available in 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, and 150 mg oral tablets
- Chemical class: Tricyclic antidepressant (dibenzocycloheptadine derivative)
- Half-life: 10–28 hours (active metabolite nortriptyline: 18–44 hours)
- Bioavailability: ~50% due to first-pass metabolism
- Excretion: Primarily renal, with some biliary elimination
Benefits
- Provides significant relief from neuropathic pain, including diabetic neuropathy and post-herpetic neuralgia
- Effective in the management of major depressive disorder, especially in cases resistant to SSRIs
- May reduce the frequency and severity of chronic migraine and tension-type headaches
- Can improve sleep architecture due to sedative properties, beneficial in patients with comorbid insomnia
- Often prescribed at lower doses for chronic pain, minimizing typical antidepressant side effects
- Cost-effective compared to many newer antidepressants and analgesics
Common use
Amitriptyline is FDA-approved for the treatment of depression. It is also widely used off-label for numerous conditions, including neuropathic pain (e.g., peripheral neuropathy, fibromyalgia), migraine prophylaxis, tension-type headache, irritable bowel syndrome (IBS), and interstitial cystitis. Its use in low doses for pain management is supported by clinical guidelines, leveraging its neuromodulatory and analgesic effects without full antidepressant dosing.
Dosage and direction
Dosage must be individualized based on indication, patient response, and tolerability. For depression, initial dosing is typically 25–50 mg orally at bedtime, titrated upward by 25 mg every 3–7 days to a usual maintenance dose of 50–150 mg daily. For neuropathic pain or migraine prophylaxis, lower doses are common (10–50 mg at bedtime). Elderly patients and adolescents may require lower starting doses (e.g., 10 mg). Administration at bedtime is recommended to capitalize on sedative effects and mitigate daytime drowsiness. Full therapeutic effect may take 2–4 weeks.
Precautions
Use with caution in patients with cardiovascular disease, due to risk of QT prolongation, tachycardia, and orthostatic hypotension. Regular ECG monitoring is advised in susceptible individuals. Amitriptyline may lower seizure threshold; caution in patients with epilepsy or undergoing ECT. May cause drowsiness or blurred vision—advise against driving or operating machinery until response is known. Screen for bipolar disorder prior to initiation, as antidepressants may induce manic episodes. Use cautiously in patients with glaucoma, urinary retention, or hepatic impairment.
Contraindications
Hypersensitivity to amitriptyline or other TCAs. Concomitant use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy due to risk of serotonin syndrome. Acute recovery phase after myocardial infarction. Severe liver impairment.
Possible side effect
Common: Dry mouth, drowsiness, dizziness, constipation, blurred vision, weight gain, orthostatic hypotension.
Less common: Urinary retention, increased intraocular pressure, tachycardia, sweating, confusion (especially in elderly).
Rare: Agranulocytosis, seizures, hepatotoxicity, neuroleptic malignant syndrome (NMS)-like events, hyponatremia.
Many side effects are dose-dependent and may diminish over time.
Drug interaction
- MAOIs: Risk of serotonin syndrome, hypertensive crisis.
- SSRIs/SNRIs: Increased serotonergic effects.
- Anticholinergics: Additive effects (e.g., confusion, dry mouth, constipation).
- CNS depressants (e.g., alcohol, benzodiazepines, opioids): Enhanced sedation.
- Antihypertensives: May reduce efficacy.
- CYP2D6 inhibitors (e.g., fluoxetine, quinidine): Increased amitriptyline levels.
- Sympathomimetics: Increased risk of hypertension.
- Warfarin: May potentiate anticoagulant effect.
Missed dose
If a dose is missed, take it as soon as remembered unless it is close to the next scheduled dose. Do not double the dose to catch up. Consistent nightly administration is recommended to maintain steady plasma levels.
Overdose
Amitriptyline overdose can be life-threatening, presenting with symptoms such as severe drowsiness, agitation, confusion, tachycardia, hypotension, respiratory depression, cardiac arrhythmias, seizures, and coma. Management includes supportive care, ECG monitoring, activated charcoal if presented early, and sodium bicarbonate for QRS widening. Contact poison control or emergency services immediately.
Storage
Store at room temperature (15–30°C or 59–86°F) in a tightly closed container, protected from light and moisture. Keep out of reach of children and pets.
Disclaimer
This information is intended for healthcare professionals and is not a substitute for clinical judgment. Prescribers should review full prescribing information and consider individual patient factors. Patients must use amitriptyline only under medical supervision. Off-label uses should be evidence-based and carefully documented.
Reviews
Amitriptyline is consistently rated well in clinical settings for its efficacy in neuropathic pain and treatment-resistant depression. Many specialists appreciate its dual utility and cost-effectiveness. However, side effect profile—particularly anticholinergic effects and weight gain—can limit tolerability for some patients. Overall, it remains a valuable tool in neurology and psychiatry.