Patient Information Overview

Generic name: Amitriptyline hydrochloride
Category: Antidepressant Medication

Why is Amitriptyline prescribed?

Amitriptyline is prescribed for the relief of symptoms of mental depression. It is a member of the group of drugs called tricyclic antidepressants. Some doctors also prescribe Amitriptyline to treat bulimia (an eating disorder), to control chronic pain, to prevent migraine headaches, and to treat a pathological weeping and laughing syndrome associated with multiple sclerosis.

Most important fact about Amitriptyline

You may need to take Amitriptyline regularly for several weeks before it becomes fully effective. Do not skip doses, even if they seem to make no difference or you feel you don't need them.

How should you take Amitriptyline?

Take Amitriptyline exactly as prescribed. You may experience side effects, such as mild drowsiness, early in therapy. However, they usually disappear after a few days. Beneficial effects may take as long as 30 days to appear.

Amitriptyline may cause dry mouth. Sucking a hard candy, chewing gum, or melting bits of ice in your mouth can provide relief.

--If you miss a dose...

Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at the same time.

If you take a single daily dose at bedtime, do not make up for it in the morning. It may cause side effects during the day.

--Storage instructions...

Keep Amitriptyline in a tightly closed container. Store at room temperature. Protect from light and excessive heat.

What side effects may occur when taking Amitriptyline?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Amitriptyline.

Older adults are especially liable to certain side effects of Amitriptyline, including rapid heartbeat, constipation, dry mouth, blurred vision, sedation, and confusion, and are in greater danger of sustaining a fall.

• Side effects of Amitriptyline may include: Abnormal movements, anxiety, black tongue, blurred vision, breast development in males, breast enlargement, coma, confusion, constipation, delusions, diarrhea, difficult or frequent urination, difficulty in speech, dilation of pupils, disorientation, disturbed concentration, dizziness on getting up, dizziness or light-headedness, drowsiness, dry mouth, excessive or spontaneous flow of milk, excitement, fatigue, fluid retention, hair loss, hallucinations, headache, heart attack, hepatitis, high blood pressure, high fever, high or low blood sugar, hives, impotence, inability to sleep, increased or decreased sex drive, increased perspiration, increased pressure within the eye, inflammation of the mouth, intestinal obstruction, irregular heartbeat, lack or loss of coordination, loss of appetite, low blood pressure, nausea, nightmares, numbness, rapid and/or fast, fluttery heartbeat, rash, red or purple spots on skin, restlessness, ringing in the ears, seizures, sensitivity to light, stomach upset, strange taste, stroke, swelling due to fluid retention in the face and tongue, swelling of testicles, swollen glands, tingling and pins and needles in the arms and legs, tremors, vomiting, weakness, weight gain or loss, yellowed eyes and skin
• Side effects due to rapid decrease or abrupt withdrawal from Amitriptyline include: Headache, nausea, vague feeling of bodily discomfort
• Side effects due to gradual dosage reduction may include: Dream and sleep disturbances, irritability, restlessness These side effects do not signify an addiction to the drug.

Why should this drug not be prescribed?

If you are sensitive to or have ever had an allergic reaction to Amitriptyline or similar drugs such as Norpramin and Tofranil, you should not take this medication. Make sure your doctor is aware of any drug reactions you have experienced.

Do not take Amitriptyline while taking other drugs known as MAO inhibitors. Drugs in this category include the antidepressants Nardil and Parnate.

Unless you are directed to do so by your doctor, do not take this medication if you are recovering from a heart attack.

Special warnings about Amitriptyline

Do not stop taking Amitriptyline abruptly, especially if you have been taking large doses for a long time. Your doctor probably will want to decrease your dosage gradually. This will help prevent a possible relapse and will reduce the possibility of withdrawal symptoms.

Amitriptyline may make your skin more sensitive to sunlight. Try to stay out of the sun, wear protective clothing, and apply a sun block.

Amitriptyline may cause you to become drowsy or less alert; therefore, you should not drive or operate dangerous machinery or participate in any hazardous activity that requires full mental alertness until you know how this drug affects you.

While taking this medication, you may feel dizzy or light-headed or actually faint when getting up from a lying or sitting position. If getting up slowly doesn't help or if this problem continues, notify your doctor.

Use Amitriptyline with caution if you have ever had seizures, urinary retention, glaucoma or other chronic eye conditions, a heart or circulatory system disorder, or liver problems. Be cautious, too, if you are receiving thyroid medication. You should discuss all of your medical problems with your doctor before starting Amitriptyline therapy.

Before having surgery, dental treatment, or any diagnostic procedure, tell the doctor that you are taking Amitriptyline. Certain drugs used during surgery, such as anesthetics and muscle relaxants, and drugs used in certain diagnostic procedures may react badly with Amitriptyline.

Possible food and drug interactions when taking Amitriptyline

Amitriptyline may intensify the effects of alcohol. Do not drink alcohol while taking this medication.

If Amitriptyline is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important that you consult with your doctor before taking Amitriptyline in combination with the following:

• Airway-opening drugs such as Sudafed and Proventil
• Antidepressants that raise serotonin levels, such as Paxil, Prozac, and Zoloft
• Other antidepressants, such as amoxapine
• Antihistamines such as Benadryl and Tavist
• Barbiturates such as phenobarbital
• Certain blood pressure medicines such as Catapres
• Cimetidine (Tagamet)
• Disulfiram (Antabuse)
• Drugs that control spasms, such as Bentyl and Donnatal
• Estrogen drugs such as Premarin and oral contraceptives
• Ethchlorvynol (Placidyl)
• Major tranquilizers such as Mellaril and Thorazine
• MAO inhibitors, such as Nardil and Parnate
• Medications for irregular heartbeat, such as Tambocor and Rythmol
• Painkillers such as Demerol and Percocet
• Parkinsonism drugs such as Cogentin and Larodopa
• Quinidine (Quinidex)
• Seizure medications such as Tegretol and Dilantin
• Sleep medicines such as Halcion and Dalmane
• Thyroid hormones (Synthroid)
• Tranquilizers such as Librium and Xanax
• Warfarin (Coumadin)

Special information if you are pregnant or breastfeeding

The effects of Amitriptyline during pregnancy have not been adequately studied. If you are pregnant or planning to become pregnant, inform your doctor immediately. This medication appears in breast milk. If Amitriptyline is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment is finished.

Recommended dosage for Amitriptyline

ADULTS

The usual starting dosage is 75 milligrams per day divided into 2 or more smaller doses. Your doctor may gradually increase this dose to 150 milligrams per day. The total daily dose is generally never higher than 200 milligrams.

Alternatively, your doctor may want you to start with 50 milligrams to 100 milligrams at bedtime. He or she may increase this bedtime dose by 25 or 50 milligrams up to a total of 150 milligrams a day.

For long-term use, the usual dose ranges from 40 to 100 milligrams taken once daily, usually at bedtime.

CHILDREN

Use of Amitriptyline is not recommended for children under 12 years of age.

The usual dose for adolescents 12 years of age and over is 10 milligrams, 3 times a day, with 20 milligrams taken at bedtime.

OLDER ADULTS

An overdose of Amitriptyline can prove fatal.

• Symptoms of Amitriptyline overdose may include: Abnormally low blood pressure, confusion, convulsions, dilated pupils and other eye problems, disturbed concentration, drowsiness, hallucinations, impaired heart function, rapid or irregular heartbeat, reduced body temperature, stupor, unresponsiveness or coma
• Symptoms contrary to the effect of this medication are: Agitation, extremely high body temperature, overactive reflexes, rigid muscles, vomiting

If you suspect an overdose, seek medical attention immediately.

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Reviewed: 01/2006