amitriptyline (Elavil, Endep)

Amitriptyline is in the class of drugs called tricyclic antidepressants (TCAs) and is used for treating depression. Other drugs in the same class include:

• clomipramine (Anafranil),
• doxepin (Sinequan),
• imipramine (Tofranil),
• trimipramine (Surmontil),
• amoxapine (Amoxapine),
• desipramine (Norpramin), and
• protriptyline (Vivactil).

Individuals with depression may have an imbalance in neurotransmitters, chemicals that nerves make and use to communicate with other nerves. Like all TCAs, amitriptyline increases levels of norepinephrine and serotonin, two neurotransmitters, and blocks the action of acetylcholine, another neurotransmitter. It is believed that by restoring the balance of these different neurotransmitters in the brain that depression is alleviated (for example, the mood is elevated). Amitriptyline was approved by the FDA in May 1983.

Is amitriptyline available as a generic drug?

GENERIC AVAILABLE: Yes

Do I need a prescription for amitriptyline?

Yes

Amitriptyline is used for treating major depression. It is used off-label for treating:

• Postherpetic neuralgia
• Migraine prophylaxis
• Eating disorder

Sometimes troublesome side effects include:

• fast heart rate,
• blurred vision,
• urinary retention,
• dry mouth,
• constipation,
• sexual dysfunction
• weight gain or loss, and
• low blood pressure on standing (orthostatic hypotension).

Rare side effects include:

• rash,
• hives,
• seizures, and
• hepatitis.

Amitriptyline is used with caution in patients with seizures since it can increase the risk of seizures.

Amitriptyline also is used with caution in patients with prostate enlargement because of the risk of increasing the inability to urinate.

Amitriptyline can cause elevated pressure in the eyes of some patients with glaucoma.

If amitriptyline is discontinued abruptly, dizziness, headache, nausea, and restlessness may occur. Withdrawal symptoms may occur when even a few doses are missed. Therefore, it is recommended that the dose of antidepressant be reduced gradually when therapy is discontinued.

Amitriptyline may be taken with or without food. The recommended adult dose is 100-300 mg daily in divided doses or at bedtime. The initial dose is 50-100 mg at bedtime that may be increased by 25 or 50 mg at bedtime as needed. The lowest effective dose should be used.

Amitriptyline should not be used with monoamine oxidase inhibitors (MAOIs). High fever, convulsions and even death can occur when these two types of drugs are used together.

Epinephrine should not be used with amitriptyline, since together they can cause severe high blood pressure.

Alcohol blocks the antidepressant action of amitriptyline but increases its sedative effect. Cimetidine (Tagamet) can increase blood levels of amitriptyline and its side effects by preventing the elimination of amitriptyline.

Safety of amitriptyline in pregnancy and children is not established.

Amitriptyline is secreted in human milk and potentially can adversely affect the nursing infant.

What preparations of amitriptyline are available?

PREPARATIONS: Tablets: 10, 25, 50, 75, 100, and 150 mg.

How should amitriptyline be stored?

Amitriptyline should be stored at room temperature in a tight, light resistant container. Storage should be avoided at temperatures above 30 C (86 F).