Amitriptyline

• 50-75mg a day either in divided doses or as a single night time dose increasing to 150-200mg a day.
• A maintenance dose of 50-100mg at night should be given to lessen the chances of relapse.

Adolescents and elderly

• 25-50mg a day either in divided doses or as a single night time dose.
• A maintenance dose of 25-50mg may be sufficient.

Nightly bedwetting

Children only (for no longer than 3 months treatment):

• 11-16 years - 25-50mg at night.
• 7-10 years - 10-20mg at night.
• Under 7 years - Not recommended.

Could it interact with other tablets?

Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription. Especially:

• altretamine (to treat some types of cancer)
• apraclonidine and brimonidine (to treat glaucoma)
• baclofen (a muscle relaxant)
• disulfiram (to treat alcohol addiction)
• painkillers such as nefopam, tramadol, codeine, dihydrocodeine
• medicines to treat some heart conditions such as amiodarone, diltiazem, disopyramide, procainamide, propafenone, quinidine, sotalol, verapamil.
• medicines to treat angina that you spray or dissolve under your tongue (eg glyceryl trinitrate “GTN”, isosorbide dinitrate)
• rifampicin or linezolid (to treat infections)
• carbamazepine or phenobarbital (to treat epilepsy)
• terfenadine (to treat allergies or hayfever)
• methylphenidate (to treat attention deficit/hyperactivity disorder (ADHD))
• any medicines to treat high blood pressure such as guanethidine, debrisoquine, bethanidine or clonidine or diuretics (“water” tablets)
• medicines to treat some mental illnesses such as clozapine, pimozide, thioridazine chlorpromazine, haloperidol, prochlorperazine, sulpiride
• cimetidine (to treat ulcers)
• ethchlorvynol (to help you sleep)
• entacapone or selegiline (to treat Parkinson’s disease)
• oral contraceptives (“the pill”)
• sibutramine (to suppress appetite)
• sympathomimetic medicines such as adrenaline (epinephrine), ephedrine, isoprenaline, noradrenaline (norepinephrine), phenylephrine and phenylpropanolamine (these may be present in many cough and cold remedies)
• ritonavir (to treat HIV).

Herbal supplements should be used with caution and only after informing your doctor first.

What are the possible risks or side-effects?

Stop taking Amitriptyline tablets and contact your doctor at once if you experience the following:

• allergic reaction
• a skin rash - which may be itchy
• sensitivity to the sun or sun lamps
• puffy, swollen face or tongue, which may be severe causing shortness of breath, swelling, shock and collapse.

Tell your doctor if you notice any of the following side effects or notice any other effects not listed:

Blood:

Bone marrow depression or reduction in some blood cells (you may experience a sore throat, mouth ulcers and recurring infections, bleeding or bruising easily).

Endocrine system and metabolism:  

Disturbances in sexual function or sex drive, breast swelling in men and women, swelling of the testicles, production or over-production of breast milk, changes in blood sugar levels, increased appetite and weight gain. Inappropriate secretion of the hormone ADH (antidiuretic hormone), which may make you urinate more frequently.

Brain and central nervous system:

Dizziness, tiredness or sleepiness, weakness, headache, difficulty concentrating, confusion, difficulty, sleeping, nightmares, slight hyperactivity, exaggerated behaviour, delusions, seeing things that are not there, anxiety, excitement, disorientation (not knowing where you are), restlessness, pins and needles, lack of co-ordination, shaky movements, tremor, fits. Anticholinergic effects (dry mouth, fever, constipation, blurred or double vision, difficulty passing water (urine), dilation of the pupil of the eye, glaucoma and blockage of the small intestine).

Heart:

Feeling faint when getting up (postural hypotension), increased blood pressure, fast/racing heart, palpitations, heart attack, stroke, irregular or slow heart-beats and very low blood pressure.

Stomach and intestines:

Feeling or being sick, diarrhoea, loss of appetite, inflammation of the mucus membranes in the mouth, swollen saliva glands, abdominal pains, black tongue, impairment of taste.

Liver:

Hepatitis, including changes in liver function (as seen in blood tests), jaundice (yellowing of the skin and/or whites of the eyes).

Other:

Increased sweating, hair loss, ringing in the ears, increased need to urinate.

Withdrawal symptoms:

Feeling sick, malaise and headache, dream and sleep disturbances, irritability and restlessness. Mania or hypomania (exaggerated mood and/or elation) may occur 2-7 days after stopping the tablets.

If taken to treat bed-wetting:

Drowsiness, mild sweating, itching, changes in behaviour and “Anticholinergic effects” (as described above).

Tell your doctor if you notice any of the above side effects or any other effects not listed.

Can I drink alcohol while taking it?

You are advised not to drink alcohol with this medicine.

Always ask your doctor/pharmacist however as this may depend on what other tablets you are taking.

What if I’m pregnant/breastfeeding?

• Amitriptyline is not recommended during pregnancy, especially during the first and third trimesters unless there are compelling reasons, and in these patients the benefits should be weighed against possible hazards to the foetus, child or mother.

Breast feeding mothers: Amitriptyline is detectable in breast milk. Because of the potential for serious adverse reactions in infants from amitriptyline, a decision should be made whether to discontinue breast feeding or discontinue the drug.

If you have any more questions please ask your Pharmacist.

Remember to keep all medicines out of reach of children
Please Note: We have made every effort to ensure that the content of this information sheet is correct at time of publish, but remember that information about drugs may change. This sheet does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet which comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects which may be relevant in your particular case.

References:

https://en.wikipedia.org/wiki/Tricyclic_antidepressant

http://www.drugs.com/amitriptyline.html

https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682388.html

http://www.arthritisresearchuk.org/arthritis-information/drugs/amitriptyline.aspx

http://www.rxlist.com/elavil-drug.htm