Side effects of amitriptyline

What to know about the side effects of Elavil

Share on PinterestSide effects of amitriptyline may include headaches, dry mouth, and drowsiness.

The most commonly reported side effects of amitriptyline include:

  • dry mouth
  • drowsiness
  • dizziness
  • headaches
  • gastrointestinal upset
  • constipation
  • weight gain

Although less common, the following side effects may also occur:

  • difficulty sleeping
  • difficulty paying attention
  • blurred vision
  • acute angle glaucoma, an eye condition
  • tremors
  • difficulty passing urine
  • decreased sex drive
  • postural hypotension
  • abnormal heart rate

In some cases, amitriptyline may cause the following serious adverse reactions:

  • prolonged QT, which is a problem with the electrical activity of the heart
  • heart arrhythmias
  • heart attack
  • stroke
  • seizures
  • temporary loss of consciousness
  • coma
  • hallucinations
  • delusions
  • paralytic ileus, an intestinal obstruction
  • conditions affecting the bone marrow
  • allergic reaction
  • Interactions

In addition to potentially causing side effects, amitriptyline may interact with other medications a person is taking. Such medications include:

Monoamine oxidase inhibitors

Tricyclic antidepressants can be fatal if a person takes them alongside monoamine oxidase inhibitors (MAOIs).

MAOIs are an older type of antidepressant medication. Although doctors have mostly phased out their use, some may still prescribe them when modern antidepressants are not effective.

Doctors also sometimes use MAOIs off-label to help people manage bipolar disorder and Parkinson’s disease.

Taking MAOIs with amitriptyline or other tricyclic antidepressants can cause dangerously high fever, severe convulsions, and even death.

Examples of MAOIs include:

  • phenelzine
  • tranylcypromine
  • isocarboxazid
  • selegiline
  • moclobemide

People should be careful when switching from an MAOI to a tricyclic antidepressant. In such cases, experts recommend stopping the MAOI and waiting a minimum of 14 days before starting on a minimal dosage of tricyclic antidepressant.

A doctor may increase the amount gradually, if necessary.

Other antidepressants

Share on PinterestA person may have a severe reaction if they take amitriptyline alongside other antidepressants.

Amitriptyline may also cause severe reactions when a person uses it in combination with other antidepressants, such as:

  • phenobarbital (Bellatal, Solfoton)
  • sedatives
  • citalopram (Celexa)
  • fluoxetine (Prozac, Sarafem)
  • fluvoxamine (Luvox)
  • paroxetine (Paxil)
  • sertraline (Zoloft)
  • other selective serotonin reuptake inhibitors (SSRIs)

Central nervous system depressants

Central nervous system (CNS) depressants are drugs that slow brain activity, relax the muscles, and have a calming effect on the body. Doctors sometimes prescribe them to help treat anxiety, acute stress, and sleep disorders.

Examples of CNS depressants include sedatives, tranquilizers, and hypnotics. Amitriptyline can enhance the effects of these drugs, so people should not take both at the same time.

Alcohol is also a CNS depressant. Because amitriptyline can enhance the effect of alcohol, it increases the risk of overdose in people with alcohol addiction.

Heartburn medications

Cisapride is a medication that doctors used to prescribe to treat heartburn. The FDA withdrew the drug in 2000 following reports that it increased the risk of heart problems.

Doctors may still prescribe the drug, but only in rare cases when it is necessary.

Taking amitriptyline alongside cisapride further increases the risk of heart arrhythmias and other serious cardiac events.

Other drug interactions

Amitriptyline also interacts with several other drugs, including:

  • epinephrine, an emergency treatment for severe allergic reactions
  • norepinephrine, a drug that controls dangerously low blood pressure
  • ephedrine, a stimulant that treats low blood pressure during anesthesia
  • dronedarone, a treatment for certain types of heart arrhythmia
  • lithium, a drug that can help treat bipolar disorder

Due to safety concerns, drug manufacturers advise against the use of amitriptyline while taking these drugs.

What is Elavil?

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Bepridil
  • Bromopride
  • Cisapride
  • Clorgyline
  • Dronedarone
  • Furazolidone
  • Grepafloxacin
  • Iproniazid
  • Isocarboxazid
  • Levomethadyl
  • Linezolid
  • Mesoridazine
  • Methylene Blue
  • Metoclopramide
  • Moclobemide
  • Nialamide
  • Pargyline
  • Phenelzine
  • Pimozide
  • Piperaquine
  • Procarbazine
  • Ranolazine
  • Safinamide
  • Saquinavir
  • Selegiline
  • Sparfloxacin
  • Terfenadine
  • Thioridazine
  • Toloxatone
  • Tranylcypromine
  • Ziprasidone

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acecainide
  • Aceclofenac
  • Acemetacin
  • Albuterol
  • Alfentanil
  • Alfuzosin
  • Almotriptan
  • Amiodarone
  • Amisulpride
  • Amoxapine
  • Amphetamine
  • Amtolmetin Guacil
  • Anagrelide
  • Apomorphine
  • Aprindine
  • Aripiprazole
  • Aripiprazole Lauroxil
  • Arsenic Trioxide
  • Artemether
  • Asenapine
  • Aspirin
  • Astemizole
  • Atazanavir
  • Azimilide
  • Azithromycin
  • Benzhydrocodone
  • Benzphetamine
  • Bretylium
  • Bromfenac
  • Brompheniramine
  • Bufexamac
  • Buprenorphine
  • Bupropion
  • Buserelin
  • Buspirone
  • Butorphanol
  • Celecoxib
  • Ceritinib
  • Chloral Hydrate
  • Chloroquine
  • Chlorpheniramine
  • Chlorpromazine
  • Choline Salicylate
  • Ciprofloxacin
  • Citalopram
  • Clarithromycin
  • Clofazimine
  • Clomipramine
  • Clonidine
  • Clonixin
  • Clozapine
  • Cocaine
  • Codeine
  • Crizotinib
  • Cyclobenzaprine
  • Dabrafenib
  • Darunavir
  • Dasatinib
  • Degarelix
  • Delamanid
  • Desipramine
  • Deslorelin
  • Desmopressin
  • Desvenlafaxine
  • Deutetrabenazine
  • Dexibuprofen
  • Dexketoprofen
  • Dextroamphetamine
  • Dextromethorphan
  • Diclofenac
  • Diflunisal
  • Dihydrocodeine
  • Dipyrone
  • Disopyramide
  • Dofetilide
  • Dolasetron
  • Domperidone
  • Donepezil
  • Doxepin
  • Doxorubicin
  • Doxorubicin Hydrochloride Liposome
  • Droperidol
  • Droxicam
  • Efavirenz
  • Eletriptan
  • Encorafenib
  • Enflurane
  • Entrectinib
  • Epinephrine
  • Erythromycin
  • Escitalopram
  • Eslicarbazepine Acetate
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Fenoprofen
  • Fentanyl
  • Fepradinol
  • Feprazone
  • Fingolimod
  • Flecainide
  • Floctafenine
  • Fluconazole
  • Flufenamic Acid
  • Fluoxetine
  • Flurbiprofen
  • Foscarnet
  • Frovatriptan
  • Gatifloxacin
  • Gemifloxacin
  • Glasdegib
  • Glycopyrrolate
  • Glycopyrronium Tosylate
  • Gonadorelin
  • Goserelin
  • Granisetron
  • Halofantrine
  • Haloperidol
  • Halothane
  • Histrelin
  • Hydrocodone
  • Hydromorphone
  • Hydroxychloroquine
  • Hydroxytryptophan
  • Hydroxyzine
  • Ibuprofen
  • Ibutilide
  • Iloperidone
  • Imipramine
  • Indomethacin
  • Inotuzumab Ozogamicin
  • Iobenguane I 123
  • Iobenguane I 131
  • Isoflurane
  • Isoproterenol
  • Isradipine
  • Ivabradine
  • Ivosidenib
  • Ketoconazole
  • Ketoprofen
  • Ketorolac
  • Lacosamide
  • Lapatinib
  • Lefamulin
  • Lenvatinib
  • Leuprolide
  • Levalbuterol
  • Levofloxacin
  • Levomilnacipran
  • Levorphanol
  • Lidoflazine
  • Lisdexamfetamine
  • Lithium
  • Lofexidine
  • Lopinavir
  • Lorcainide
  • Lorcaserin
  • Lornoxicam
  • Loxapine
  • Loxoprofen
  • Lumefantrine
  • Lumiracoxib
  • Macimorelin
  • Meclofenamate
  • Mefenamic Acid
  • Mefloquine
  • Meloxicam
  • Meperidine
  • Metaxalone
  • Methadone
  • Methamphetamine
  • Metronidazole
  • Milnacipran
  • Mirtazapine
  • Moricizine
  • Morniflumate
  • Morphine
  • Morphine Sulfate Liposome
  • Moxifloxacin
  • Nabumetone
  • Nafarelin
  • Nalbuphine
  • Naproxen
  • Naratriptan
  • Nefazodone
  • Nefopam
  • Nepafenac
  • Niflumic Acid
  • Nilotinib
  • Nimesulide
  • Nimesulide Beta Cyclodextrin
  • Norepinephrine
  • Norfloxacin
  • Nortriptyline
  • Octreotide
  • Ofloxacin
  • Ondansetron
  • Osimertinib
  • Oxaprozin
  • Oxycodone
  • Oxymetazoline
  • Oxymorphone
  • Oxyphenbutazone
  • Paliperidone
  • Palonosetron
  • Panobinostat
  • Parecoxib
  • Paroxetine
  • Pasireotide
  • Pazopanib
  • Peginterferon Alfa-2b
  • Pentamidine
  • Pentazocine
  • Phenylbutazone
  • Phenylephrine
  • Piketoprofen
  • Pimavanserin
  • Piroxicam
  • Pitolisant
  • Pixantrone
  • Posaconazole
  • Pranoprofen
  • Procainamide
  • Prochlorperazine
  • Proglumetacin
  • Promethazine
  • Propafenone
  • Propoxyphene
  • Propyphenazone
  • Proquazone
  • Protriptyline
  • Quetiapine
  • Quinidine
  • Quinine
  • Rasagiline
  • Remifentanil
  • Revefenacin
  • Ribociclib
  • Risperidone
  • Rizatriptan
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Scopolamine
  • Secretin Human
  • Sematilide
  • Sertindole
  • Sertraline
  • Sevoflurane
  • Sibutramine
  • Siponimod
  • Sodium Phosphate
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate, Monobasic
  • Sodium Salicylate
  • Solifenacin
  • Sorafenib
  • Sotalol
  • Spiramycin
  • Sufentanil
  • Sulfamethoxazole
  • Sulindac
  • Sulpiride
  • Sultopride
  • Sumatriptan
  • Sunitinib
  • Tacrolimus
  • Tapentadol
  • Tedisamil
  • Telavancin
  • Telithromycin
  • Tenoxicam
  • Tetrabenazine
  • Tiaprofenic Acid
  • Tiotropium
  • Tolfenamic Acid
  • Tolmetin
  • Toremifene
  • Tramadol
  • Trazodone
  • Triclabendazole
  • Trifluoperazine
  • Trimethoprim
  • Trimipramine
  • Triptorelin
  • Tryptophan
  • Valdecoxib
  • Vandetanib
  • Vardenafil
  • Vasopressin
  • Vemurafenib
  • Venlafaxine
  • Vilanterol
  • Vilazodone
  • Vinflunine
  • Voriconazole
  • Vortioxetine
  • Zolmitriptan
  • Zotepine
  • Zuclopenthixol

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acenocoumarol
  • Arbutamine
  • Atomoxetine
  • Bethanidine
  • Carbamazepine
  • Cimetidine
  • Diazepam
  • Dicumarol
  • Fluvoxamine
  • Fosphenytoin
  • Galantamine
  • Guanethidine
  • Phenprocoumon
  • Phenytoin
  • Rifapentine
  • Ritonavir
  • S-Adenosylmethionine
  • St John’s Wort
  • Warfarin


Warnings & Precautions

  • tell your doctor if you are allergic to it, or to other tricyclic antidepressants (such as nortriptyline), or if you have any other allergies.
  • tell your doctor your medical history, especially if you experience:
    • bleeding problems, urinating problems, breathing problems, liver problems, family history of suicide, overactive thyroid (hyperthyroidism), personal or family history of glaucoma (angle-closure type), recent heart attack, personal / family history of mental/mood conditions (such as bipolar disorder, psychosis), seizures, or conditions that may increase your risk of seizures
  • For an overdose, seek medical attention immediately. For non emergencies, contact your local or regional poison control center at 1-800-222-1222.

Drug Interactions

  • Possible drug interactions may occur with with this med and Phenobarbital and MAO inhibitors (severe)
  • Talk with your physician or pharmacist if you are taking other medications.

Dosage & Missed Dose

Amitriptyline comes in a tablet form.

For most adults, the recommended dose is 100-300 milligrams and for elderly patients, it is 25 mg.

Take your next dose as soon as you remember. If it is time for your next dose, skip the missed dose and go back to your regular schedule. Do not double doses.


Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed.


For women, it should be avoided during pregnancy and nursing. As with other medications, if you suspect that you may be pregnant, talk to you physician or pharmacist before using this medication.

More Information

For more information, talk to your doctor, pharmacist or health care provider, or you can visit this website, for additional information from the manufacturer of this drug.

25 Oct Amitriptyline – Elavil

Posted at 22:34h in Headache Fact Sheets by headache

Amitriptyline is included in a group of medications classified as tricyclic antidepressants. Amitriptyline is one of the first successful medications in this class to be developed. It was discovered in the late 1930s before scientists had today’s understanding of the chemistry of the brain. This drug was developed as a way to reduce anxiety. Frequently, people with depression are often very anxious. When amitriptyline was given to patients with anxiety, it also improved the depression. This result prompted further research and the development of newer agents to treat depression. As scientific understanding of the brain progressed, scientists discovered that amitriptyline and related compounds worked on a series of chemicals called neurotransmitters. The antidepressants influenced the production and efficiency of these neurotransmitters.

Subsequent work revealed that one of the neurotransmitters, serotonin, is involved in mood and emotion, pain regulation, and the regulation of the blood vessels in migraine. Another neurotransmitter, norepinephrine, is also involved in pain processing in the brain.

Amitriptyline influences the body’s use of serotonin and norephinephrine thus leading to improvement in depression and several types of chronic pain. It is used to treat chronic tension-type headache as well as migraine headache. Its effectiveness in treating any of these conditions, especially headache, is not related to whether or not the individual has depression.

Although side effects, such as dry mouth, increased appetite and constipation may occur, consultation with the physician may help minimize the likelihood and severity of these effects. It can cause sedation and can be taken at night to help sleep.

Amitriptyline Dosage

Medically reviewed by Last updated on Sep 11, 2019.

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  • Dosage
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Applies to the following strengths: 10 mg; 50 mg; 75 mg; 100 mg; 25 mg; 150 mg; 10 mg/mL

Usual Adult Dose for:

  • Depression

Usual Geriatric Dose for:

  • Depression

Usual Pediatric Dose for:

  • Depression

Additional dosage information:

  • Renal Dose Adjustments
  • Liver Dose Adjustments
  • Dose Adjustments
  • Precautions
  • Dialysis
  • Other Comments

Usual Adult Dose for Depression

-Initial dose: 75 mg orally per day in divided doses; this may be increased to 150 mg/day (if needed)
-Maintenance dose: 40 to 100 mg orally per day
-Maximum dose: 150 mg/day
Alternate outpatient treatment regimen: 50 to 100 mg orally as a single dose at bedtime; this may be increased by 25 or 50 mg as needed at bedtime to a total of 150 mg/day
-Initial dose: 100 mg orally per day
-Maintenance dose: 40 to 100 mg orally as a single dose at bedtime
-Maximum dose: 300 mg/day

-Dose increases should preferably be made in the late afternoon or at bedtime due to the sedative effect.
-The full therapeutic effect may take as long as 30 days to develop.
-Maintenance doses should be reduced to the lowest amount that will maintain relief of symptoms when satisfactory improvement has been obtained.
-Maintenance therapy should be continued for 3 months or longer to lessen the possibility of relapse.
Use: Relief of symptoms of depression

Usual Geriatric Dose for Depression

10 mg orally 3 times a day AND 20 mg orally once a day at bedtime

-The full therapeutic effect may take as long as 30 days to develop.
-Elderly patients should be monitored carefully and serum levels obtained as clinically appropriate.
-Dose adjustments should be made according to clinical response.
Use: Relief of symptoms of depression

Usual Pediatric Dose for Depression

12 years or older: 10 mg orally 3 times a day AND 20 mg orally once a day at bedtime

-The full therapeutic effect may take as long as 30 days to develop.
-Dose adjustments should be made according to clinical response.
Use: Relief of symptoms of depression

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Use with caution

Dose Adjustments

Switching TO/FROM this drug FROM/TO a MAOI used to treat psychiatric disorders:
-Allow a medication-free interval of at least 14 days.
-Treatment should be started cautiously and the dose should be gradually increased until an optimal response is achieved.


-Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders.
-Anyone considering the use of this drug or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older.
-Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior.
-Families and caregivers should be advised of the need for close observation and communication with the prescriber.
-This drug is not approved for use in pediatric patients.
Safety and efficacy have not been established in patients younger than 12 years.
Consult WARNINGS section for additional precautions.


Data not available

Other Comments

Administration advice:
-Tablets should be taken with water.
Storage requirements:
-Tablets: Protect from light.
-The risk of serotonin syndrome with the use of non-IV methylene blue formulations or IV doses much lower than 1 mg/kg is unknown.
-Treatment may be more effective in patients with endogenous depression compared to patients with other depressive states.
-Cardiovascular: Blood pressure, ECG (especially in pediatric patients prior to starting treatment)
-Other: Drug levels, especially in those receiving doses over 100 mg/day.
-Psychiatric: Patients should be monitored for worsening and emergence of suicidal thoughts.
Patient advice:
-Patients should be advised to avoid abrupt discontinuation of this drug.
-Patients should tell their healthcare provider(s) about all the medicines that they take, including prescription and non-prescription medicines.
-This medicine may increase the risk of suicidal thoughts and behavior. Patients should be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Patients should report any behavior of concern to their healthcare provider(s) as soon as possible.
-Patients should be advised to speak to a healthcare provider if they are pregnant, intend to become pregnant, or are breastfeeding.
-Patients should be cautioned accordingly since this drug may impair the mental and/or physical abilities required for the performance of operating an automobile or machinery.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

More about amitriptyline

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Consumer resources

  • Amitriptyline
  • Amitriptyline (Advanced Reading)

Other brands: Elavil, Vanatrip

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