Dr. C P Ravi Kumar
Consultant Paediatric Neurologist, The Krishna Institute of Medical Sciences (KIMS), Mahadevapura, Bangalore
What is Amitriptyline ?
Amitriptyline is a tricyclic antidepressant (TCA), works mainly by inhibiting the reuptake of serotonin and norepinephrine, increasing their levels in the brain.
Uses of Amitriptyline:
- Migraine Prophylaxis
- Anxiety & Depression
- Post-traumatic stress disorder
- Insomnia
- Post herpetic Neuralgia (Off-label)
- Eating Disorder (Off-label)
How is Amitriptyline available?
Tablets
Mechanism of action of Amitriptyline
Amitriptyline blocks the membrane pump that reabsorbs norepinephrine and serotonin into nerve cells, prolonging their activity in the synapse. This enhanced signalling is thought to contribute to its effect.
How much time does Amitriptyline take to show action in the body?
Amitriptyline starts to show action in about 4–8 hours after an oral dose.
What is the ideal time to take Amitriptyline?
The best time to take the medication is at bed time. But if it is twice a day, then take 10-12 hours apart as your doctor advices.
To help establish a routine and minimize missed doses, it should be taken at the same time every day.
Should it be taken before food or after food?
Amitriptyline can be taken with or without food, general advise is after food to reduce stomach upset.
How should this medication be taken?
Tablets: Take the whole tablet with a glass of water. Do not crush or break until your doctor says you to do so.
Would this medication cause any side effects?
Medications can be very helpful, but they may also cause side effects. Most people experience none, and if they do, they are usually mild. However, some side effects can be serious — if you notice anything unusual or concerning, contact your doctor or seek medical attention immediately.
Side effects (Adverse effects): Are uncommon Common & Mild:
- Dry mouth
- Drowsiness or sedation
- Constipation
- Blurred vision
- Urinary retention
- Weight gain
- Dizziness or light-headedness
Less common & Serious:
- Cardiac effects: arrhythmias, prolonged QT interval, tachycardia,
- Liver toxicity
- Severe allergic reactions (rash, swelling, difficulty breathing)
- Suicidal thoughts or hallucinations
Does Amitriptyline cause weight gain?
Weight gain can be a side effect; if it becomes bothersome, please consult your doctor.
Can I take other Medicines during the course of Amitriptyline?
You can take other medicines while on amitriptyline, but it is essential to consult your doctor or pharmacist first. Amitriptyline can interact with several drugs, including other antidepressants, certain pain or migraine medications, heart medications, sedatives, and even alcohol, which may increase side effects or cause serious complications. Always inform your healthcare provider about all prescription drugs, over-the-counter medicines, and herbal supplements you are using to ensure safe and effective treatment.
What are the foods to be taken or avoided?
Eat a balanced diet with fruits, vegetables, whole grains, and lean proteins, and avoid alcohol, excessive caffeine, and very heavy or greasy meals, as these can increase side effects like drowsiness, dizziness, or nausea.
Can this medication be taken during pregnancy and breastfeeding?
Pregnancy and breastfeeding considerations
Amitriptyline can be used in pregnancy only if the benefits to the mother outweigh the possible risks to the baby. There are no well-controlled studies, so it should be used with caution.
During breastfeeding, only small amounts pass into milk. It is generally considered safe, but the baby should be monitored for sleepiness or feeding problems.
Is there any risk if I conceive while taking Amitriptyline?
If you become pregnant while taking amitriptyline, the known risk to the baby is low, as no clear link to major birth defects has been established. It is important to consult your doctor promptly to determine whether to continue or adjust the medication.
Can I stop taking medicine if I get better? (withdrawal)
You should not stop taking amitriptyline suddenly, even if you feel better. Stopping abruptly can cause withdrawal symptoms such as dizziness, nausea, headache, mood changes, or sleep problems. The medication should be gradually tapered under a doctor’s supervision to avoid these effects.
MONITORING PARAMETERS OF AMITRIPTYLINE:
- Mental health (suicidal thoughts or worsening mood)
- Dry mouth, constipation, urinary retention, blurred vision
- Cardiovascular status (blood pressure, heart rate; ECG if cardiac risk)
How to cope with side effects of Amitriptyline?
Dry Mouth
- Drink plenty of water.
- Chew sugar-free gum or suck on sugar-free candies.
Drowsiness or Sedation
- Take the medication at bedtime.
- Avoid high risk work such using a saw mill, drilling, driving, operating heavy machinery.
Constipation
- Eat high-fibre foods (fruits, vegetables, whole grains).
- Drink plenty of water.
- Exercise regularly.
Dizziness or Low Blood Pressure
- Stand up slowly from sitting or lying positions.
- Stay hydrated.
Weight Gain
- Monitor diet and maintain regular exercise.
SUMMARY:
Amitriptyline is a tricyclic antidepressant prescribed for migraines, depression, anxiety, PTSD, insomnia, and sometimes off-label for neuropathic pain, or eating disorders. It is usually taken after meals, often at bedtime, to reduce drowsiness, and should be taken consistently as directed by a doctor. Common side effects include dry mouth, drowsiness, constipation, blurred vision, dizziness, and weight gain, while serious effects rare, may involve heart rhythm changes, liver issues, or mood changes. Regular monitoring of mental health, cardiovascular status, and side effects is recommended. The medication should never be stopped abruptly and should be tapered under medical supervision, and it should be used cautiously during pregnancy and breastfeeding.
REFERENCE:
- Dr. Ramya. R, Pharm D, Clinical Pharmacologist, Aster Hospitals, Bengaluru
- Dr Praveen Kumar, B. Pharm, Pharm D(PB), Head Clinical Pharmacologist, Aster Hospitals, Bengaluru
- Dr. C. P. Ravi Kumar Lead & Senior Consultant – Paediatric Neurology KIMS HOSPITALS BENGALURU