How does amitriptyline work. What are the common side effects of amitriptyline. Can amitriptyline cause weight gain. Why does amitriptyline cause dry mouth. How to manage amitriptyline side effects.

The Mechanism of Action: How Amitriptyline Works

Amitriptyline, a tricyclic antidepressant (TCA), is primarily used to treat major depressive disorder (MDD). It functions by increasing the levels of two crucial neurotransmitters in the brain: serotonin and norepinephrine. These neurotransmitters play a vital role in regulating mood, thoughts, and emotions.

Low levels of serotonin and norepinephrine are often associated with depression, anxiety, and even suicidal thoughts. By elevating these neurotransmitters, amitriptyline aims to alleviate the symptoms of depression and improve overall mental health.

It’s important to note that amitriptyline doesn’t produce immediate effects. Typically, patients may need to wait two to four weeks before noticing significant improvements in their depressive symptoms. This delayed onset of action is common among antidepressants and requires patience during the initial treatment phase.

Off-label Uses of Amitriptyline

While primarily prescribed for depression, amitriptyline has several off-label uses. Healthcare providers may prescribe it for:

• Chronic pain management
• Anxiety disorders
• Insomnia
• Irritable bowel syndrome (IBS)
• Migraine prevention

These diverse applications highlight the versatility of amitriptyline in addressing various medical conditions beyond its primary use as an antidepressant.

Common Side Effects of Amitriptyline: What to Expect

Like all medications, amitriptyline can cause side effects. As an older generation antidepressant, it tends to have a more significant side effect profile compared to newer antidepressants such as selective serotonin reuptake inhibitors (SSRIs). Understanding these potential side effects is crucial for patients and healthcare providers alike.

Weight Changes

Changes in body weight, particularly weight gain, are commonly reported with amitriptyline use. This side effect is believed to be related to the medication’s impact on histamine (h2) receptors. Patients may experience increased appetite and altered eating habits, potentially leading to weight gain.

Is weight gain inevitable with amitriptyline? Not necessarily. While it’s a common side effect, not all patients will experience significant weight changes. Maintaining a balanced diet and regular exercise routine can help mitigate potential weight gain.

Dizziness

Dizziness is another frequently reported side effect of amitriptyline. This sensation of unsteadiness or lightheadedness is likely due to the medication’s effects on the brain. Patients may notice dizziness shortly after taking their dose.

How can one manage dizziness caused by amitriptyline? If dizziness occurs, it’s advisable to sit or lie down until the sensation passes. Avoiding sudden changes in position, such as standing up quickly, can also help prevent dizziness. If the symptom persists or becomes severe, consulting a healthcare provider is recommended.

Headaches

Headaches are a common side effect experienced by some patients taking amitriptyline. These headaches may range from mild to moderate in intensity and often improve over time as the body adjusts to the medication.

Paradoxically, amitriptyline is sometimes prescribed off-label for migraine prevention, highlighting its complex effects on the nervous system. For headache relief, patients can try over-the-counter pain relievers like acetaminophen, but should consult their healthcare provider before combining medications.

Amitriptyline and Dry Mouth: A Common Concern

One of the most frequently reported side effects of amitriptyline is xerostomia, commonly known as dry mouth. This condition occurs due to the medication’s impact on salivary gland function and the perception of oral dryness.

Dry mouth can be more than just an inconvenience. It may lead to difficulties in speaking, chewing, and swallowing. Additionally, reduced saliva production can increase the risk of dental problems, as saliva plays a crucial role in maintaining oral health.

Managing Dry Mouth

For patients experiencing dry mouth while taking amitriptyline, several strategies can help alleviate this side effect:

1. Increase fluid intake throughout the day
2. Chew sugar-free gum to stimulate saliva production
3. Use artificial saliva substitutes
4. Practice good oral hygiene to prevent dental issues
5. Avoid caffeine and alcohol, which can worsen dry mouth

While these measures can help manage dry mouth, persistent or severe symptoms should be discussed with a healthcare provider. In some cases, adjusting the medication dosage or considering alternative treatments may be necessary.

Drowsiness and Somnolence: Amitriptyline’s Sedative Effects

Amitriptyline is known for its sedative properties, which can lead to drowsiness and somnolence in many patients. This side effect is particularly pronounced compared to newer antidepressants and is one of the reasons why amitriptyline is often prescribed for patients who also struggle with insomnia.

The sedative effect of amitriptyline is attributed to its action on histamine receptors in the brain. While this can be beneficial for those with sleep disturbances, it may pose challenges for daytime functioning.

Managing Drowsiness

How can patients cope with the sedative effects of amitriptyline? Here are some strategies:

• Take the medication in the evening to align sedation with natural sleep patterns
• Avoid driving or operating heavy machinery until you know how the medication affects you
• Gradually increase physical activity during the day to combat daytime drowsiness
• Maintain a consistent sleep schedule to optimize the medication’s effects
• Consult with a healthcare provider about adjusting the dosage if drowsiness is excessive

It’s crucial to note that while drowsiness may be pronounced initially, many patients find that this side effect diminishes over time as their body adjusts to the medication.

Gastrointestinal Effects: Navigating Digestive Changes

Amitriptyline can have various effects on the gastrointestinal system, leading to side effects such as constipation, nausea, and changes in appetite. These effects are believed to be related to the medication’s impact on the autonomic nervous system, which regulates digestive processes.

Constipation is particularly common with amitriptyline use due to its anticholinergic properties, which can slow down bowel movements. On the other hand, some patients may experience nausea, especially when first starting the medication.

Strategies for Managing Gastrointestinal Side Effects

To alleviate gastrointestinal discomfort associated with amitriptyline, consider the following approaches:

1. Increase fiber intake through diet or supplements to combat constipation
2. Stay well-hydrated to support digestive health
3. Engage in regular physical activity to promote bowel regularity
4. Take the medication with food to reduce the likelihood of nausea
5. Discuss the use of over-the-counter remedies with a healthcare provider if symptoms persist

As with other side effects, gastrointestinal symptoms often improve as the body adapts to the medication. However, persistent or severe symptoms should be reported to a healthcare provider for further evaluation and management.

Cardiovascular Considerations: Amitriptyline’s Impact on Heart Health

Amitriptyline, like other tricyclic antidepressants, can have effects on the cardiovascular system. These effects are particularly important to consider, especially for patients with pre-existing heart conditions or those at increased risk of cardiovascular disease.

One of the primary cardiovascular effects of amitriptyline is its potential to cause orthostatic hypotension, a sudden drop in blood pressure upon standing. This can lead to dizziness, lightheadedness, and in severe cases, fainting.

Monitoring Cardiovascular Health

What precautions should be taken regarding cardiovascular health while on amitriptyline? Here are some key considerations:

• Regular blood pressure monitoring, especially during the initial phase of treatment
• Slow, gradual movements when changing positions to minimize orthostatic hypotension
• Staying well-hydrated to support blood pressure regulation
• Informing healthcare providers about any history of heart conditions before starting amitriptyline
• Reporting any unusual heart palpitations or chest discomfort to a healthcare provider immediately

For patients with pre-existing cardiovascular conditions, close monitoring and potentially alternative treatment options may be necessary. It’s crucial to have open communication with healthcare providers about any cardiovascular concerns or symptoms while taking amitriptyline.

Sexual Side Effects: Addressing Intimate Health Concerns

Like many antidepressants, amitriptyline can have impacts on sexual function. These effects can manifest as decreased libido, difficulties with arousal, or challenges in achieving orgasm. Understanding and addressing these potential side effects is crucial for maintaining overall quality of life and treatment adherence.

The sexual side effects of amitriptyline are thought to be related to its impact on neurotransmitters, particularly serotonin. While these effects can be distressing, it’s important to note that they don’t affect all patients and can often be managed effectively.

Managing Sexual Side Effects

How can patients address sexual side effects associated with amitriptyline? Consider these approaches:

1. Open communication with healthcare providers about sexual concerns
2. Exploring dosage adjustments or timing of medication intake
3. Considering the addition of medications to counteract sexual side effects
4. Engaging in open dialogue with partners about changes in sexual function
5. Exploring non-pharmacological strategies to enhance intimacy and sexual satisfaction

It’s crucial to remember that while sexual side effects can be challenging, they should be weighed against the benefits of effective depression treatment. Discontinuing medication without medical guidance can lead to serious consequences. Always consult with a healthcare provider to explore the best management strategies for individual circumstances.

Amitriptyline Side Effects | hims

An estimated 21 million American adults suffer from depression every year — about 8.4 percent of the entire US adult population. Many of these people are prescribed antidepressants to treat their symptoms and assist with the recovery process. 

Amitriptyline is a medication for depression. It belongs to an older class of medications referred to as tricyclic antidepressants. Although it’s rarely used as a first-line treatment for depression, you may be prescribed amitriptyline if other forms of antidepressant therapy don’t work for you.

Amitriptyline can cause side effects. In fact, as an older type of antidepressant, amitriptyline has a more considerable risk of causing side effects than modern antidepressants, such as selective serotonin reuptake inhibitors (SSRIs).

Below, we’ve explained how amitriptyline works, as well as the side effects you may experience if you’re prescribed this medication.  

We’ve also discussed amitriptyline drug interactions, potential safety risks and other issues you should be aware of before using amitriptyline to treat depression or any other condition.

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How Amitriptyline Works

What is amitriptyline used for? Amitriptyline is a tricyclic antidepressant, or TCA. It’s an FDA-approved medication for treating major depressive disorder (MDD). It’s also used off-label to treat a variety of common medical conditions, such as chronic pain, anxiety, insomnia and irritable bowel syndrome.

Amitriptyline works by increasing levels of the neurotransmitters serotonin and norepinephrine, which are involved in regulating certain aspects of your moods, thoughts and feelings.

Low levels of these neurotransmitters are associatedwith depression, anxiety, a lack of energy and in some cases, suicidal thoughts and/or behavior.  

Experts theorize that by increasing the levels of these neurotransmitters in the brain and body, medications like amitriptyline can help to treat mood disorders such as depression.

Like other antidepressants, the effects of amitriptyline aren’t immediate. For most people, it can take two to four weeks before amitriptyline produces noticeable improvements in the symptoms of depression. 

Amitriptyline is one of many medications for treating depression. Our full list of antidepressants provides more information about how it and similar tricyclic antidepressants function. 

Common Side Effects of Amitriptyline

Like all antidepressants, amitriptyline can cause side effects. In fact, experts regard amitriptyline as having a considerable side effect profile — one reason it’s no longer widely used as a first-line treatment for depression.

Common side effects of amitriptyline include changes in body weight, dizziness, headaches, dry mouth, somnolence (drowsiness) and gastrointestinal issues. These may improve over time as your body adjusts to the effects of the medication. 

Changes in Body Weight

Changes in body weight, including weight gain, are common effects of tricyclic antidepressants such as amitriptyline. While using amitriptyline, you may develop a stronger appetite than usual and make changes in your eating habits, resulting in weight gain.

These effects may occur due to amitriptyline’s effects on histamine (h2) receptors. It’s best to talk to your healthcare provider if you notice a significant change in your appetite, eating habits and/or weight after starting treatment with amitriptyline.

Dizziness

Dizziness is a common side effect of amitriptyline. Feelings of dizziness and unsteadiness are known side effects of many antidepressants and are likely related to the effects of these drugs on your brain.

You may feel dizzy shortly after taking amitriptyline. If you have persistent or severe dizziness, it’s important to inform your healthcare provider.

Headaches

Headaches are a frequently reported side effect of amitriptyline. Like dizziness, headaches are common with antidepressants and may occur as a result of the effects of this type of medication on your brain. Headaches related to amitriptyline use may improve over time.

Interestingly, amitriptyline and other antidepressants are occasionally prescribed off-label to stop migraine headaches. 

If you develop a headache after your dose of amitriptyline, try to rest and take in plenty of fluids to keep yourself hydrated. Over-the-counter pain relief drugs such as acetaminophen (Tylenol®) may help to provide relief.

Dry Mouth

Amitriptyline can cause xerostomia, or dry mouth. This is a common side effect of medications used in the treatment of depression. It’s caused by the effects of these drugs on the function of your salivary glands (the glands that produce saliva) and on your perception of oral dryness.

If you develop a dry mouth while using amitriptyline, try increasing your fluid intake, chewing on sugar-free gum or sucking sugar-free candy to stimulate saliva production. Limiting your intake of caffeine, alcohol and other substances that can dry out your mouth may also help.

If this side effect persists or is severe, talk to your healthcare provider. They may suggest using a saliva substitute lozenge, spray or gel to relieve your symptoms.

Somnolence (Drowsiness)

Somnolence, or sleepiness, is one of the most common side effects of amitriptyline. You may feel more tired than usual after taking amitriptyline and experience symptoms such as daytime sleepiness.

In fact, because of its sedative effects, amitriptyline is sometimes prescribed off-label as a sleep aid for people with insomnia or nighttime anxiety.

If you’re prescribed amitriptyline, do not drive a car or operate any machinery that could cause injury until you’re familiar with how this medication makes you feel.

Gastrointestinal Issues

Amitriptyline may cause or aggravate gastrointestinal health issues, such as nausea, vomiting and constipation. You may feel like you have an upset stomach after using your medication or eating a meal.

If you experience persistent nausea, vomiting or constipation after starting amitriptyline, talk to your healthcare provider before using any over-the-counter or prescription medications to treat these symptoms.

Other Amitriptyline Side Effects

In addition to the common side effects listed above, amitriptyline may cause other side effects, including some that may require medical attention. Your risk of certain adverse events may be higher if you have other medical conditions, including certain forms of mental illness. 

More severe adverse effects of amitriptyline include: 

• Confusion and/or delirium

• Orthostatic hypotension (low blood pressure after standing up)

• Tachycardia (fast heart rate) or arrhythmia (irregular heartbeat)

• Acute angle-closure glaucoma (sudden onset eye pain)

• Reduced seizure threshold

• Hyperhidrosis (excessive sweating)

• Decreased interest in sexual intercourse

• Muscle spasms that affect your jaw, back and neck

• Slowed speech and/or difficulty speaking

• Increased risk of bone injuries

• Numbness or weakness in your limbs

• Severe chest pain

• Urinary retention

• Fainting

• Seizures

Although uncommon, amitriptyline may induce mania in people with bipolar disorder or a family history of psychiatric disorders that involve manic symptoms.

Contact your healthcare provider as soon as you can if you experience any severe side effects from amitriptyline.

Amitriptyline Interactions and Safety Risks 

Amitriptyline is generally safe when used as directed. However, it can interact with several other widely used medications, including some used to treat depression and other mental illnesses. 

Like other antidepressants, amitriptyline can cause serotonin syndrome — a dangerous increase in serotonin levels — when used with other medications that increase serotonin.

Symptoms of serotonin syndrome include irregular heart rhythms, high blood pressure, unusual or excessive sweating, dilated pupils, muscle stiffness, elevated body temperature, hyperactive bowel sounds, increased alertness and agitation.

When severe, serotonin syndrome can potentially cause seizures, respiratory failure, coma and even death.

To prevent serotonin syndrome, amitriptyline should not be used with other medications that can increase serotonin levels, including other antidepressants and some medications for Parkinson’s disease.

It’s especially important to take care when using amitriptyline if you’ve recently used monoamine oxidase inhibitors (MAOIs) — an older class of antidepressants that can cause interactions up to 14 days after their use is discontinued.

Amitriptyline should not be taken with medications that increase QTc (the interval between your heart contracting and relaxing). Many antiarrhythmic medications, antihistamines, beta-blockers, diuretics and other medications can affect your QT interval.

Amitriptyline should also not be used if you have an arrhythmia (heart rate or rhythm issue), any history of QTc prolongation, heart failure or have recently suffered a myocardial infarction (heart attack) or any other medical issue that causes significant cardiovascular symptoms.

To avoid interactions and safety issues, make sure to inform your healthcare provider about any medications you currently use or have recently used, as well as your full medical history, before using amitriptyline.  

Sun Sensitivity

Amitriptyline may cause your skin to become more sensitive to sunlight, meaning you may get a sunburn faster when you’re exposed to bright, direct sunlight. 

Try to limit the amount of time you spend in bright, direct sunlight while using amitriptyline. Wear protective clothing that covers as much of your skin as possible and make sure to apply an SPF 30+, broad-spectrum sunscreen on sunny days. 

Amitriptyline Withdrawal Effects

Like other antidepressants, amitriptyline should not be stopped abruptly. If you suddenly stop using Amitriptyline, you may experience withdrawal symptoms such as nausea, reduced levels of energy and nausea. 

These flu-like symptoms are referred to as antidepressant discontinuation syndrome. They can potentially occur with amitriptyline and other medicines for major depression.

If you’re prescribed amitriptyline to treat depression, it’s important to continue using it after you start to feel better. Stopping treatment early may cause your depression to come back.

If you’d like to stop using amitriptyline, your healthcare provider will help you to gradually taper your dosage to reduce your risk of experiencing withdrawal symptoms.

Black Box Suicide Warning

Like other antidepressants, amitriptyline is associated with an increased risk of suicidal ideation and behavior in children, teenagers and adults under 25 years of age. As such, this medication carries a “black box” warning from the FDA.

If you’re under 25 years of age, using amitriptyline or other antidepressants may cause changes in your mental health and an increased risk of suicidality. Your mental health provider may ask to see you frequently for follow-up visits while you’re using this medication.

Other Options for Treating Depression

Although amitriptyline is generally effective at treating depression, it’s rarely used as a first-line treatment due to its significant risk of causing side effects.

Because of this, your healthcare provider will likely recommend a more modern antidepressant medication, such as an SSRI or serotonin-norepinephrine reuptake inhibitor (SNRI) before you use a tricyclic antidepressant such as amitriptyline. 

Your healthcare provider may also recommend using a newer antidepressant if you’re prone to side effects or experience an allergic reaction to amitriptyline.

Other Antidepressants

For most people, depression can be managed with SSRIs or SNRIs — modern antidepressants that work by increasing your serotonin levels. These medications are more selective than older drugs such as amitriptyline and have a lower risk of causing dangerous side effects.

We offer several SSRIs and SNRIs online, including fluoxetine (Prozac®), sertraline (Zoloft®), paroxetine (Paxil®), citalopram (Celexa®), escitalopram (Lexapro®), duloxetine (Cymbalta®) and venlafaxine (Effexor®). 

We also offer bupropion (Wellbutrin®), an atypical antidepressant that’s often used when other antidepressant drugs cause unwanted sexual side effects.  

Psychotherapy

Psychotherapy, or talk therapy, often helps to reduce the severity of depression symptoms. In fact, many people with depression benefit from taking part in psychotherapy while they’re also using medication.

Several different forms of talk therapy are commonly used to treat clinical depression, such as cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). Our guide to the different types of therapy covers many common techniques used in depression treatment. 

We offer therapy online, allowing you to connect with a licensed counselor and access help from the privacy of your home. 

Lifestyle Changes

For many people, the symptoms of depression can become less severe and overwhelming with simple habits and lifestyle changes. 

Healthy habits for treating depression include getting at least 30 minutes of daily exercise, going to sleep and waking up on a consistent schedule, eating a balanced diet and spending time with close friends and family members.

Many people with depression also benefit from avoiding alcohol, cigarettes and illicit drugs that can interfere with recovery.

Our guide to self-help strategies for depression goes into more detail about habits and lifestyle changes that you can make to improve your wellbeing and make progress as you recover from depression. 

Learn More About Treatments for Depression

Although amitriptyline isn’t commonly used as a first-line treatment for depression, your mental health provider may suggest using it if other medications aren’t fully effective at controlling your symptoms.

If you experience side effects from amitriptyline that are severe or persistent, it’s best to let your healthcare provider know. They may adjust your dosage of amitriptyline or suggest switching to a different medication. 

Interested in learning more about treating depression? Our guide to depression treatments goes into more detail about your options, from antidepressants to psychotherapy, lifestyle changes and more.  

If you’re feeling depressed and want to seek expert help right away, you can also connect with a licensed psychiatry provider from home using our online psychiatry service.

11 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

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8. Volpi-Abadie, J., Kaye, A.M. & Kaye, A.D. (2013). Serotonin Syndrome. The Ochsner Journal. 13 (4), 533–540. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865832/
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Amitriptyline: an antidepressant medicine – NHS

1. About amitriptyline for depression

Amitriptyline is an antidepressant medicine. It’s used to treat low mood and depression.

This medicine is only available on prescription. It comes as tablets and as a liquid.

Amitriptyline is also used for some types of pain and to prevent migraines. Find out more about amitriptyline for pain and migraine.

2. Key facts

• Amitriptyline is an antidepressant medicine. It works by increasing levels of a chemical called serotonin in your brain. This can improve your mood.
• You may start to feel better after 1 to 2 weeks but it can take 4 to 6 weeks for amitriptyline to work fully.
• Side effects such as a dry mouth and constipation are common. They’re usually mild and go away after a couple of weeks.
• It’s best to take amitriptyline in the evening or before you go to bed. This is because it can make you feel sleepy.
• Amitriptyline can cause side effects if you stop taking it suddenly. Talk to your doctor if you want to stop taking it.

3. Who can and cannot take amitriptyline

Most adults can take amitriptyline. It can also be taken by young people aged 16 to 17 years for depression or low mood.

Amitriptyline is not suitable for some people. To make sure it’s safe for you, check with your doctor if you:

• have ever had an allergic reaction to amitriptyline or any other medicine
• have a heart problem – amitriptyline can make some heart problems worse
• have a rare blood disorder called porphyria
• have liver problems
• have epilepsy or are having electroconvulsive treatment (ECT) – amitriptyline may increase your risk of having a fit or seizure
• are pregnant, trying to get pregnant or breastfeeding
• have glaucoma – amitriptyline can increase the pressure in your eye
• have thoughts about harming yourself or ending your life
• have problems emptying your bladder
• have type 1 or type 2 diabetes

If you have diabetes, amitriptyline can make it more difficult to keep your blood sugar stable. Monitor your blood sugar more often for the first few weeks of treatment with amitriptyline and adjust your diabetes treatment if necessary. Speak to your doctor if your blood sugar levels are causing you concern.

4. How and when to take amitriptyline for depression

You’ll usually take amitriptyline once a day. It’s best to take it before bedtime because it can make you feel sleepy. If you find that you are still feeling drowsy in the morning you could try taking it earlier in the evening.

Dosage and strength

Amitriptyline tablets come in different strengths of 10mg, 25mg or 50mg.

Amitriptyline liquid also comes in 3 different strengths containing 10mg, 25mg or 50mg of amitriptyline in a 5ml spoonful.

The usual dose of amitriptyline for depression in adults is 50mg to 100mg a day. This may go up to 150mg a day if you need a stronger dose, but only under the supervision of a specialist.

Young people aged 16 to 17 years and older people sometimes start on a lower dose of 25mg to 50mg a day to reduce the chance of side effects.

The maximum dose of amitriptyline is 150mg per day.

Sometimes, when you’re just starting treatment, you may be told to take a lower dose, 2 or 3 times a day, until you get used to the medicine. This is because taking a smaller dose 2 or 3 times a day for a while can reduce the chance of you having side effects.

How to take it

Amitriptyline does not usually upset your stomach, so you can take it with or without food.

Swallow the tablets whole with a drink of water. If you chew them, they taste bitter.

The liquid comes with a plastic syringe or spoon to help you measure out the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

What if I forget to take it?

If you take amitriptyline once a day and forget a dose, leave your missed dose and take your next one the next day at the usual time.

If you take amitriptyline 2 or 3 times a day and forget a dose, take it as soon as you remember unless it’s close to the time for your next dose.

Never take 2 doses at the same time to make up for a forgotten dose.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

The amount of amitriptyline that can lead to an overdose varies from person to person.

Taking more than your prescribed dose of amitriptyline can:

• make you feel agitated
• make you sick (vomiting)
• cause shaking
• cause a fast heart rate
• cause fits or seizures (shaking and jerking uncontrollably)

Urgent advice: Contact 111 for advice now if:

• you’ve taken more than your prescribed dose of amitriptyline

Go to 111. nhs.uk or call 111

If you need to go to A&E do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the amitriptyline packet, or the leaflet inside it, plus any remaining medicine with you.

5. Side effects

Like all medicines, amitriptyline can cause side effects in some people, but many people have no side effects or only minor ones. Some of the common side effects of amitriptyline will gradually improve as your body gets used to the medicine.

Common side effects

Keep taking the medicine but talk to your doctor or pharmacist if these common side effects bother you or do not go away:

• constipation
• dizziness
• dry mouth
• feeling sleepy, tired or weak
• difficulty peeing
• headaches

Serious side effects

It happens rarely, but some people have a serious side effect after taking amitriptyline.

Call a doctor straight away if:

• your heartbeat becomes fast or irregular
• the whites of your eyes turn yellow, or your skin turns yellow although this may be less obvious on brown or black skin, or you have dark pee – these can be signs of a liver problem
• you have constant headaches, long lasting confusion or weakness, and frequent muscle cramps – together, these can be a sign of low sodium levels in your blood. In severe cases low sodium levels can lead to a fit or seizure
• you have thoughts about harming yourself or ending your life
• you have eye pain, a change in your eyesight, or swelling or redness in or around your eye
• you have constipation that lasts a long time, or problems peeing which are causing stomach ache

Immediate action required: Call 999 and ask for an ambulance if:

• you have weakness on one side of your body
• you have trouble speaking or thinking
• you lose your balance or have blurred eyesight

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to amitriptyline.

Immediate action required: Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you’re breathing very fast or struggling to breathe (you may become very wheezy or feel like you’re choking or gasping for air)
• your throat feels tight or you’re struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who’s unwell may also have a rash that’s swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of amitriptyline. For a full list see the leaflet inside your medicines packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

6. How to cope with side effects of amitriptyline

What to do about:

• constipation – eat more high-fibre foods such as fresh fruit and vegetables and cereals. Try to drink several glasses of water or other non-alcoholic drinks every day. If you can, it may also help to increase your level of exercise.
• feeling dizzy – this is probably due to low blood pressure. Drink plenty of water or other non-alcoholic drinks. Do not stand up too quickly after you have been sitting or lying down. Do not drive until you stop feeling dizzy.
• dry mouth – try sugar-free gum or sugar-free sweets.
• feeling sleepy or tired – take amitriptyline in the evening and try to cut down the amount of alcohol you drink. Do not drive, cycle or use tools or machinery if you’re feeling sleepy. Talk to your doctor if this does not help.
• difficulty peeing – try to relax when you pee. Do not try to force the flow of urine. If you still cannot go, try again later. Talk to your doctor urgently if you cannot pee at all.
• headaches – make sure you rest and drink plenty of fluids. Try not to drink too much alcohol. Paracetamol and ibuprofen may help if you need pain relief. Talk to your doctor if the headaches last longer than a week or are severe.

7. Pregnancy and breastfeeding

Amitriptyline and pregnancy

If you are already taking amitriptyline, you may be advised to continue taking it during pregnancy, especially if you take it to treat depression.

If you become pregnant while taking amitriptyline, speak to your doctor. Do not stop taking your medicine unless your doctor tells you to.

Your doctor can explain how taking amitriptyline can help you and how it might affect you. They will also help you choose the best treatment for you and your baby.

Amitriptyline and breastfeeding

If your doctor or health visitor says your baby is healthy, you can take amitriptyline while breastfeeding.

Amitriptyline passes into breast milk in very small amounts, so it’s unlikely to cause any harm to your baby.

It’s important to keep taking amitriptyline to keep you well. Breastfeeding will also benefit both you and your baby.

If you notice that your baby is not feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, then talk to your midwife, health visitor or doctor as soon as possible.

Non-urgent advice: Tell your doctor if you’re:

• trying to get pregnant
• pregnant
• breastfeeding

For more information about how amitriptyline can affect you and your baby during pregnancy, find out more on the Best Use of Medicines in Pregnancy (BUMPS) website.

8. Cautions with other medicines

Many medicines and amitriptyline can affect each other and increase the chances of side effects.

Always check with your doctor or a pharmacist before starting any new medicine while you are taking amitriptyline.

Taking amitriptyline with opioid medicines can increase your risk of becoming very drowsy and having breathing problems. Opioid medicines include:

• codeine
• morphine
• dihydrocodeine
• buprenorphine
• fentanyl
• oxycodone

Tell your doctor if you have ever taken any other medicines for depression. Some antidepressants can affect the way amitriptyline works and cause very high blood pressure. This can happen even after you have stopped taking them.

Mixing amitriptyline with herbal remedies and supplements

Do not take St John’s wort, a herbal remedy for depression, while you’re taking amitriptyline as this will increase your risk of side effects.

There’s very little information about taking amitriptyline with other herbal remedies and supplements. They are not tested in the same way as medicines.

Important:
Medicine safety

Tell your doctor or pharmacist if you’re taking any other medicines, including herbal medicines, vitamins or supplements.

9. Common questions about amitriptyline

How does amitriptyline work in depression?

Amitriptyline is from a group of medicines called tricyclic antidepressants. They are thought to work by increasing levels of a chemical called serotonin in your brain. This can improve your mood.

When will I feel better?

You may find you are feeling better after a couple of weeks, although it usually takes between 4 and 6 weeks before you feel the full benefit of the medicine.

Do not stop taking amitriptyline after 1 or 2 weeks just because you feel it is not helping your symptoms. Give the medicine at least 6 weeks to work.

How will it make me feel?

Antidepressants like amitriptyline help to gradually lift your mood so you feel better. You may notice that you sleep better and get on with people more easily because you’re less anxious. Hopefully you’ll take little things that used to worry you in your stride.

Amitriptyline will not change your personality or make you feel euphorically happy. It will simply help you feel like yourself again.

Do not expect to feel better overnight though. Some people feel worse during the first few weeks of treatment before they begin to feel better.

How long will I take it for?

Once you’re feeling better it’s likely that you will keep taking amitriptyline for several more months. Most doctors recommend that you take antidepressants for 6 months to a year after you’ve stopped feeling depressed. Stopping before then can make depression come back.

Talk to your doctor about the risks and benefits of taking amitriptyline for longer than a few months. It will depend on:

• how bad your symptoms are
• whether it’s a one-off problem or it keeps coming back
• how well amitriptyline works for you
• any bad side effects you’ve had

Are there any long-term side effects?

Although there is a lot of information on the short-term effects of taking amitriptyline, less is known about the long-term effects. There may be an increased risk of confusion and possibly dementia in people taking medicines like amitriptyline but more research needs to be done. If you’re worried about this, talk to your doctor.

Your doctor will check with you regularly to make sure your treatment is still working and that you are not having problems with side effects.

Is it addictive?

Amitriptyline is not addictive but you can get withdrawal side effects if you stop taking it suddenly.

Do not stop taking it without talking to your doctor first.

What will happen when I stop taking it?

If you’ve been feeling better for 6 months or more, your doctor may suggest coming off amitriptyline.

Your doctor may recommend reducing your dose gradually over several weeks, or longer if you have been taking amitriptyline for a long time.

This is to help prevent any withdrawal side effects you might get as a reaction to coming off the medicine. These include:

• feeling dizzy
• feeling sick
• numbness or tingling in the hands or feet
• trouble sleeping
• feeling agitated or anxious
• headaches
• shaking

Important

Do not stop taking amitriptyline suddenly, or without talking to your doctor first.

Will I gain or lose weight?

Amitriptyline can change how hungry you feel. Some people feel more hungry when they’re taking it, while others feel less hungry. So your weight may change when you first start taking it.

If you start to have problems with your weight while taking amitriptyline, talk to your doctor or a pharmacist.

Can I drive or ride a bike?

Some people feel sleepy while they’re taking amitriptyline. It’s best to stop driving and cycling for the first few days of treatment until you know how this medicine makes you feel.

It’s an offence to drive a car if your ability to drive safely is affected. It’s your responsibility to decide if it’s safe to drive. If you’re in any doubt, do not drive.

Talk to your doctor or pharmacist if you’re unsure whether it’s safe for you to drive while taking amitryptyline. GOV.UK has more information on the law on drugs and driving.

Is amitriptyline better than other antidepressants?

Amitriptyline does not work any better or worse than other antidepressants. However, for some people, the side effects are a problem and they may have fewer side effects with another antidepressant. Sometimes people respond better to one antidepressant than to another.

Talk to your doctor if you are not feeling any better after taking amitriptyline for 6 weeks, or sooner if the side effects are still a problem.

Are there other treatments that will help?

Antidepressants, including amitriptyline, are just one of several approaches to treating depression. Other potential treatments include:

• talking therapy (such as cognitive behavioural therapy (CBT))
• exercise programmes
• help to get a good night’s sleep

Choosing a treatment that’s most suitable for you depends on:

• how long you’ve had depression
• your symptoms
• whether you’ve had depression before
• whether previous treatment has worked
• how likely you are to stick with your treatment
• the potential side effects
• your preferences and priorities

Can I drink alcohol with it?

You can drink alcohol while taking amitriptyline but it may make you feel sleepy. It might be best to stop drinking alcohol until you see how the medicine makes you feel.

Is there any food or drink I need to avoid?

You can eat and drink normally while taking amitriptyline. However, it might be best to stop drinking alcohol until you see how the medicine makes you feel.

Will it affect my contraception?

Amitriptyline does not affect any type of contraception, including the combined pill and emergency contraception.

Will it affect my sex life?

The good effects of amitriptyline may, after a while, improve your sex life as your mood lifts and you become interested in life and relationships again.

Some of the possible negative effects include:

• having problems with getting an erection and problems ejaculating
• having some vaginal bleeding

Sexual side effects are not common and should pass after the first couple of weeks. If they do not, and this is a problem for you, go back to your doctor to see if there’s another antidepressant you can try.

If you get vaginal bleeding after the menopause make an appointment to see your doctor as soon as possible.

Will it affect my fertility?

There’s no evidence that amitriptyline affects either male or female fertility.

Will recreational drugs affect it?

Cannabis with amitriptyline can give you a fast heartbeat. Cannabis can also make drowsiness worse, especially if you’ve just started taking amitriptyline.

Methadone and other opiates (for example, heroin) can increase the risk of severe drowsiness if you’re taking amitriptyline.

It can be dangerous to take amitriptyline with:

• stimulants like MDMA (ecstasy) or cocaine
• hallucinogens like LSD
• novel psychoactive substances (previously called legal highs), like mephedrone

Find out more the side effects of some recreational drugs on the Frank website.

Important

Amitriptyline has not been properly tested with recreational drugs. Talk to your doctor if you think you might use recreational drugs while taking amitriptyline.

Dry mouth and prescription drugs

Many factors affect oral health. The immune defense of the oral cavity depends on how balanced the processes occurring in the mouth are. All this affects the digestive function, the functioning of the endocrine system, protection against infections, the mineral state of the teeth and, ultimately, the functions of the body as a whole ^[1] .

Causes and risk factors for dry mouth

One of the factors affecting the physiology of the processes that occur in the oral cavity is the intake of medications. All of them have side effects, among which dryness in the oral cavity may occur. This condition in medicine is called “xerostomia”, and it is a significant risk factor for bacterial imbalance in the mouth, the development of dental diseases and pathologies of the oral mucosa, periodontal disease, as well as a deterioration in the quality of life of patients.

A secondary consequence of dry mouth often becomes halitosis — an unpleasant odor felt by the patient and others when breathing and talking ^[2] .

Interestingly, dry mouth may not always be xerostomia. For many patients, this feeling is associated with neurosis, stress, but in fact their salivary glands work normally THEM. Sechenov ^[3]

The number of patients complaining of dry mouth increases with age. According to sources, at a young age, no more than 25% of dental patients indicate constant dry mouth. After 50 years, the number of people with a similar complaint increases to 52%. This is primarily due to the physiology of aging: in the salivary glands, glandular tissue is gradually replaced by fatty tissue (the so-called “fatty degeneration”), less saliva is produced. In addition, in older people, the number of large and small active glands that produce saliva in large quantities decreases. They are replaced by small glands with low secretory activity ^[3] .

Dental risks associated with dry mouth

Due to xerostomia, the dental and general medical status of patients can significantly change. With a lack of saliva, it becomes more difficult to chew and swallow food. Dryness provokes disturbances in the microbial balance in the mouth, as a result of which the formation of plaque on the teeth is accelerated, the risk of caries and periodontal diseases increases. Bad breath, dry chapped lips, reduced articulation affect the social life of a person, reduce his attractiveness in the eyes of others, which cannot pass without a trace for the nervous system. With xerostomia, it is difficult to wear removable and non-removable prostheses, dental crowns and other orthopedic structures in the mouth cause feelings of excess, heavy, interfere. Typical complications of xerostomia can be:

Medications and dry mouth: just the facts

The course of drug xerostomia can be aggravated by dry mouth associated with age (in people over 60), as well as with some somatic, autoimmune and neurological diseases, genetic characteristics of the body. Between 600 and 1,800 medications have been reported to cause xerostomia, and some studies have found that more than 80% of patients taking medication have some degree of dry mouth ^[4] .

In people taking pharmacological agents, as well as in older patients, xerostomia was much more common than in other populations. The problem of drug xerostomia is relevant at any age, but it is especially pronounced in people with chronic diseases and in the elderly. This is due to the appointment of a large number of drugs (polypharmacy): 5-10 drugs taken at the same time is quite common. At the same time, evidence continues to accumulate that drug use and dry mouth are closely related, and this is a serious dental problem ^[1] .

In addition to taking medications, dry mouth can be caused by some medical procedures: radiation and chemotherapy, inhalation of medicinal solutions, corticosteroids. Patients in groups taking these drugs are advised to prevent dry mouth, and understanding of the need for these interventions should be maintained ^[4] .

Some pharmacological groups that cause xerostomia

Drugs that cause dry mouth are called xerogenic.

• Diuretics, or diuretics.

• Antihistamine or anti-allergic preparations.

• Antidepressants, neuroleptics.

• Antihypertensives.

• Decongestants (remedies for the common cold).

• Sedatives, sedatives.

• Antiparkinsonian drugs.

• Migraine tablets.

• Anticancer drugs, cytostatics.

• Anticonvulsants.

• Muscle relaxants.

• Appetite suppressants.

• NSAIDs.

• Systemic retinoids.

• Antiretrovirals.

• Cytokines ^[4] .

They belong to different groups, and the manifestation of this effect in the mouth can be associated both with a direct effect on the work of the salivary glands, mucous membranes, and be indirect, for example, through the reaction of the nervous system ^[1] .

What to do if drug-induced dry mouth occurs

Drug-induced xerostomia is a reversible phenomenon. Despite the fact that when taking medications, it is due to their influence, you should not stop treatment or change the dosage or frequency recommended by your doctor. It is necessary to draw the attention of a specialist to dry mouth and related problems. Depending on the course of the disease, he will be able to select drugs for dry mouth associated with the underlying causes (illness, side effects). Must visit and dentist : he will tell you how and with what you can reduce the risks of complications and diseases associated with increased dryness in the oral cavity.

The treatment of xerostomia is a multifaceted process. It includes medical methods, local therapy, physiotherapy. Depending on the underlying causes, drugs that stimulate the formation of saliva, its artificial substitutes, and means for normalizing the state of the autonomic nervous system can be selected ^[3] .

People with xerostomia are advised to drink more fluids in small portions, water can be acidified with lemon juice, cranberries, etc. Saliva production is stimulated by sugar-free chewing gum, sour candies, natural acid fruit chips, ginger, irrigation solutions. Mucous membranes, corners of the mouth must be moistened with appropriate means – hygienic lipstick, cream, medicated oils with the addition of vitamins that stimulate reparative (healing) processes.

List of sources

1. Pozdnyakova AA Features of diagnosis, clinical manifestations and correction of xerostomic syndrome in patients with diseases of the oral mucosa. Dissertation for the degree of Candidate of Medical Sciences // GOU VPO “Perm State Medical Academy named after Academician E. A. Vagner” of the Ministry of Health of the Russian Federation. URL: https://psma.ru/index.php?option=com_mtree&task=att_download&link_id=22&cf_id=24 (accessed 10.09.2020).

2. Xerostomia. Modern view on the problem, Gorobets S. M., Romanenko I. G., Bobkova S. A., Dzherelei A. A., Kryuchkov D. Yu., Gorobets O. V., Melnichenko D. I. // TMBV. 2019. No. 2. URL: https://cyberleninka.ru/article/n/kserostomiya-sovremennyy-vzglyad-na-problemu (date of access: 09/01/2020).

3. Arakelyan MG Comparative evaluation of agents facilitating manifestations of xerostomia. Dissertation for the degree of candidate of medical sciences. // Ministry of Health of the Russian Federation Federal State Budgetary Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University// URL: https://www.sechenov.ru/upload/medialibrary/845/dissertatsiya_arakelyan_m.g._02.2017.pdf.2020).

4. Dental aspects of the manifestation of adverse drug reactions, Gorobets SM, Romanenko IG, Dzherelei AA, Bobkova SA, Kryuchkov D. Yu., Gorobets OV // TMBV. 2018. No. 3. URL: https://cyberleninka.ru/article/n/stomatologicheskie-aspekty-proyavleniya-nezhelatelnyh-lekarstvennyh-reaktsiy (date of access: 09/01/2020).

Arpimed

Amitriptyline should be taken exactly as prescribed by your doctor. If you have any doubts, you should consult your doctor or pharmacist.

Not all dosing regimens are possible with different dosage forms and doses of the drug.

The appropriate formulation and dose of the drug must be selected for starting 3 and subsequent increasing doses.

Depression

Adults :

The recommended starting dose is 25 mg twice a day. Depending on the clinical effect, the dose may be increased up to 150 mg/day divided into two doses.

Elderly patients (over 65 years of age) and patients with cardiovascular disease

The recommended starting dose is 10-25 mg per day. Depending on the clinical effect, the dose may be increased to 100 mg / day, divided into two doses. If you are taking 100mg to 150mg of the drug, you may need to see your doctor more often.

Use in children and adolescents

Amitriptyline is not recommended for children and adolescents to treat depression. See section 2 for more information. in accordance with the symptoms and the body’s response to treatment.

Adults :

The recommended starting dose is 10-25 mg in the evening.

The recommended daily dose is 25-75 mg.

Depending on the clinical effect, the dose may be gradually increased. If you are taking more than 100mg/day, you may need to see your doctor more often. Take the drug once a day or divide the dose into two doses, your doctor will tell you.

Elderly patients (over 65 years of age) and patients with cardiovascular diseases

The recommended starting dose is 10-25 mg in the evening.

Depending on the clinical effect of the drug, the dose may be gradually increased.

If you are taking more than 75 mg/day, you may need to see your doctor more often.

Use in children and adolescents

Amitriptyline is not recommended for use in children and adolescents for the treatment of neuropathic pain, chronic tension headache and migraine prophylaxis. For more information, see What you need to know before you use Amitriptyline.

Bedwetting

Use in children and adolescents

Recommended dose for children:

• Children under 6 years: See section “Do not take Amitriptyline Tablets”
• Children 6 to 10 years: 10-20 mg daily. In this age group, appropriate release forms are used.
• Children 11 years of age and older: 25-50 mg.

The dose should be increased gradually.

Should be taken 1 to 1.5 hours before bedtime.

Before starting treatment, your healthcare provider should perform an ECG to check for signs of abnormal heartbeat.

Your doctor will re-evaluate your condition after 3 months of treatment and, if necessary, perform a repeat ECG.

Do not stop taking this medicine without your doctor’s advice.

Special patient populations

Patients with liver disease or known to be “slow metabolisers” are usually given lower doses.

Your healthcare provider may take blood samples to check your amitriptyline level (see What you need to know before you use amitriptyline).

How and when to take Amitriptyline

The drug should be taken during or after a meal.

Tablets should be swallowed whole with water. Tablets should not be chewed.

Treatment period

Do not change the dose of the drug or stop taking the drug without consulting a doctor.

Depression

As with other drugs used to treat depression, this too can take several weeks before you feel any improvement in your condition.

In the treatment of depression, the duration of treatment is individual and is usually at least 6 months. The duration of treatment is determined by your doctor.

Continue taking Amitriptyline for as long as your doctor tells you to. The disease may persist for a long time. If you stop treatment too soon, the symptoms of the disease may recur.

Neuropathic pain, chronic headaches tension type and migraine prevention

It may take a few weeks for your condition to improve.

Talk to your doctor about the duration of treatment and continue taking the drug until the doctor stops it.

Bedwetting

Your doctor will determine if you need to continue treatment after 3 months of taking the drug.

If you have taken more Amitriptyline than recommended

If you have taken more Amitriptyline than prescribed by your doctor, contact your doctor or the nearest hospital emergency department immediately, even if you do not experience any discomfort or symptoms of poisoning. Take the medicine package with you if you go to the doctor or hospital.

Overdose symptoms include:

• dilated pupils
• rapid or irregular heartbeat
• difficulty urinating
• dry mouth or tongue
• intestinal obstruction
• fits
• fever
• anxiety
• confusion
• hallucinations
• involuntary movements
• low blood pressure, weak pulse, pallor
• shortness of breath
• cyanosis of the skin
• heart rate decrease
• drowsiness
• loss of consciousness
• coma
• various heart diseases such as cardiac conduction block, heart failure, hypotension, cardiogenic shock, metabolic acidosis, hypokalemia.

If you forget to take Amitriptyline

Take your next dose at the usual time. Do not take a double dose to make up for a missed one.