Amitriptyline is used to treat depression.
This medicine may also be used to treat neuropathic pain (pain caused by damage or injury to the nerves). It may also be used to prevent headaches that last for hours or may be continuous and migraine (severe throbbing pain or pulsating sensation usually affecting one side of the head that is often accompanied by nausea, vomiting, and sensitivity to light and sound).
Amitriptyline may be used to treat other conditions as decided by your doctor.
Take Amitriptyline exactly as directed by your doctor or according to the instructions on the label. Do not take more or less than instructed by your doctor.
You may take this medicine with or without food. It is best to take it in the evening. Try to take it at the same time each day.
Amitriptyline is available as a tablet and oral solution.
If you are taking the tablet, swallow it whole with a glass of water.
If you are taking the oral solution, use the measuring spoon or cup provided to measure your dose.
The dose of this medicine will be decided by your doctor. Your doctor will advise you on the treatment timeframe depending on the type of your condition and response to the medication.
Do not stop taking this medicine suddenly as it may worsen your condition. Your doctor will gradually reduce the dose before stopping it completely. Follow your doctor's instructions carefully.
Amitriptyline must be taken regularly for it to be effective. Continue taking this medicine even when you feel better. Do not stop taking it unless instructed by the doctor.
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your normal dosing schedule.
DO NOT double a dose under any circumstances.
If you often forget to take your medicine, let your doctor and pharmacist know.
Alert your doctor if you have the following conditions:
- recovering from a recent heart attack
- any degree of heart block or heart rhythm disorder
- severe liver disease
as Amitriptyline may not be suitable for you.
Do not give this medicine to children below 6 years old unless instructed by the doctor.
Do not take Amitriptyline if you are currently taking or have taken a medicine that is used to treat depression known as a monoamine oxidase inhibitor (MAOI) such as isocarboxazid, phenelzine, and tranylcypromine in the last 14 days.
Do not take Amitriptyline with cisapride (medicine used to treat heartburn [burning pain in your chest caused by food or acid from your stomach that backs up into your mouth]).
Inform your doctor if you have the following conditions:
- heart disease or blood vessel problems
- imbalance of essential minerals in the body e.g. low potassium level in the blood
- history of self-harm or having thoughts of self-harm
- other mental disorders e.g. bipolar disorder (a condition that causes extreme mood changes between feeling very high [mania] and very low [depression]), paranoia (a disorder characterised by delusions and extreme fear and distrust of others)
- current or history of epilepsy (fits or seizures)
- diabetes
- myasthenia gravis (muscle weakness disorder)
- increased pressure in the eye
- prostate enlargement or inability to completely empty the bladder when urinating
- stomach or bowel problem e.g. pyloric stenosis (thickening and narrowing of the stomach outlet), paralytic ileus (bowel obstruction caused by slow movement or paralysis of the intestines)
- thyroid disease
- phaeochromocytoma (rare tumour of the adrenal gland causing high blood pressure)
- kidney disease
- mild to moderate liver disease
Let your doctor know if you are pregnant or breastfeeding.
Be sure to check with your doctor or pharmacist before giving Amitriptyline to a child aged 6 years or older and the elderly. Children or elderly people may be more sensitive to the side effects.
Notify your doctor if you have recently undergone or will undergo electroshock therapy (also known as electroconvulsive therapy or ECT).
Medicines for depression such as Amitriptyline may increase the risk of suicidal thoughts and behaviour. As depression and some psychiatric disorders are themselves associated with an increased risk of suicide, it is important for you or your family members to monitor your condition, especially at the start of treatment and if your dosage is still being adjusted. If you experience new or sudden changes in mood, behaviour, thoughts or feelings or a worsening of your depression with suicidal thoughts or attempts, harm to self or harm to others, contact your doctor immediately.
Some genetic traits can affect this medicine's efficacy. Individuals who are ultrarapid or rapid metabolisers of CYP2C19 or ultrarapid metabolisers of CYP2D6 may respond poorer to this medicine, while individuals who are poor metabolisers of either CYP2C19 or CYP2D6 may have higher risk of experiencing the side effects of Amitriptyline. Although not routinely done, your doctor may advise you to undergo genetic testing to check if this medicine is best suited for you. If you know you have any of the gene types mentioned, inform your doctor.
If you are going to have an operation, including minor surgery and dental work, inform your doctor or dentist that you are taking this medicine.
Why is it important to keep my appointments with the doctor?
Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.
- Routine tests (e.g. heart rate, sugar and electrolyte levels) may be done while you are being treated with this medicine. Your doctor will advise you about how often you need to have these tests.
- Your blood pressure may fall to unsafe levels without you noticing it. Monitor your blood pressure during treatment.
What lifestyle changes should I make to cope with depression?
Regular exercise and eating a healthy diet will help increase energy and hormones in the body such as serotonin, endorphins and other feel-good chemicals that minimise mood swings. Get enough sleep, as lack of sleep may cause irritability, moodiness, sadness, and tiredness.
Amitriptyline may cause drowsiness, dizziness, and difficulty concentrating or focusing. If affected, do not drive or take part in any activity in which you need to be alert.
This medicine may cause your blood pressure to fall suddenly when you get up from a sitting or lying down position and you may feel giddy. To minimise this problem, stand up slowly.
Other side effects include any of the following: headache, dry mouth, nausea, constipation, changes in taste, weight gain, stuffy nose, feeling thirsty, tiredness, and excessive sweating.
Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:
- having thoughts of self-harm
- unusual changes in mood or behaviour (worsening depression, being agitated, or having compulsive and impulsive behaviour); seeing, hearing, or feeling things that are not existent
- severe eye pain, seeing halos or coloured rings around lights, eye redness, severe headache
- chest pain or pressure, fast or irregular heartbeat
- trouble passing urine
- confusion, weakness, change in balance, memory problems
Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.
Do not take Amitriptyline if you are currently taking or have taken medicine that is used to treat depression known as a monoamine oxidase inhibitor (MAOI) such as isocarboxazid, phenelzine, and tranylcypromine in the last 14 days.
Do not take this medicine with cisapride (medicine for heartburn).
Inform your doctor and pharmacist if you are taking any of these medicines:
- strong painkillers e.g. tramadol, buprenorphine, morphine
- medicines for high blood pressure e.g. guanethidine, clonidine, methyldopa, diltiazem, sotalol
- medicines for irregular heartbeat e.g. quinidine, amiodarone
- certain medicines for cold or allergy e.g. astemizole, terfenadine
- certain medicines for mood disorders e.g. pimozide, sertindole, thioridazine
- other medicines to treat depression e.g. duloxetine, fluoxetine, paroxetine
- medicines for epilepsy (fits or seizures) e.g. carbamazepine, phenobarbital
- water pills or medicines for water retention e.g. furosemide
- halofantrine (medicine for malaria)
- cimetidine (medicine that reduces stomach acid production)
- rifampicin (medicine to treat TB, a lung infection known as tuberculosis)
- birth control pills
- St. John's wort (herbal medicine)
This list does not include all medicines that may interact with Amitriptyline.
Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements, and medicines that you buy without a prescription.
Avoid alcohol. Amitriptyline may worsen the dizziness and drowsiness caused by alcohol intake.
Store in a cool, dry place away from the reach of children.
Protect from light
Medicines must not be used past the expiry date.