Amitriptyline

Amitriptyline Brand Names

Elavil | EnovaRX | Equipto Amitriptyline | Tryptanol | Vanatrip

What is Amitriptyline

Amitriptyline is a tertiary amine tricyclic antidepressant (TCA) that is metabolized to an active metabolite, nortriptyline.

Tertiary amines are generally more sedating and have greater anticholinergic effects than secondary amines.

Amitriptyline is also related to the skeletal muscle relaxant cyclobenzaprine, although amitriptyline is not believed to possess muscle-relaxant properties.

Amitriptyline is FDA-approved for the treatment of adults with major depressive disorder (MDD). Clinically, amitriptyline is also used to treat neuropathic pain and other conditions.

Amitriptyline was initially approved for the treatment of depression by the FDA in 1961.

The drug is not FDA-approved for use for treating depression in pediatric patients; suggestions for adolescent dosing are provided in manufacturer labels.

An injectable form of the drug was removed from marketing in 2003. The FDA requires a boxed warning detailing the increased risk of suicidality in children, adolescents, and young adults in product labels.

A Patient Medication Guide (MedGuide) should accompany all prescriptions for antidepressants.

Indications

1. bulimia nervosa
2. depression
3. diabetic neuropathy
4. enuresis
5. fibromyalgia
6. insomnia
7. migraine prophylaxis
8. panic disorder
9. postherpetic neuralgia
10. singultus (hiccups)
11. social phobia (social anxiety disorder)

Side Effects

1. abdominal pain
2. agitation
3. agranulocytosis
4. alopecia
5. amblyopia
6. angioedema
7. anorexia
8. anxiety
9. arrhythmia exacerbation
10. asthenia
11. ataxia
12. AV block
13. blurred vision
14. breast enlargement
15. cardiomyopathy
16. confusion
17. constipation
18. cycloplegia
19. delirium
20. depression
21. diarrhea
22. dizziness
23. drowsiness
24. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
25. dysarthria
26. dysgeusia
27. dyspepsia
28. edema
29. EEG changes
30. ejaculation dysfunction
31. eosinophilia
32. erythema
33. fatigue
34. galactorrhea
35. gynecomastia
36. hallucinations
37. headache
38. heart failure
39. hepatic failure
40. hepatitis
41. hyperglycemia
42. hyperhidrosis
43. hypertension
44. hyperthermia
45. hypoglycemia
46. hyponatremia
47. hypotension
48. ileus
49. impotence (erectile dysfunction)
50. increased urinary frequency
51. insomnia
52. involuntary movements
53. jaundice
54. lethargy
55. leukopenia
56. libido decrease
57. libido increase
58. lupus-like symptoms
59. mania
60. memory impairment
61. mydriasis
62. myocardial infarction
63. nausea
64. neuroleptic malignant syndrome-like symptoms
65. neutropenia
66. nightmares
67. ocular hypertension
68. oliguria
69. orthostatic hypotension
70. palpitations
71. paresthesias
72. peripheral neuropathy
73. peripheral vasodilation
74. photosensitivity
75. polydipsia
76. PR prolongation
77. pruritus
78. psychosis
79. purpura
80. QT prolongation
81. rash
82. restlessness
83. rhinitis
84. seizures
85. serotonin syndrome
86. SIADH
87. sinus tachycardia
88. stomatitis
89. stroke
90. suicidal ideation
91. syncope
92. tardive dyskinesia
93. testicular swelling
94. thrombocytopenia
95. tinnitus
96. tongue discoloration
97. torsade de pointes
98. tremor
99. urinary retention
100. urticaria
101. vasculitis
102. ventricular tachycardia
103. visual impairment
104. vomiting
105. weakness
106. weight gain
107. weight loss
108. withdrawal
109. xerostomia

Monitoring Parameters

• blood pressure
• ECG
• heart rate
• LFTs
• serum amitriptyline concentrations
• thyroid function tests (TFTs)

Contraindications

• abrupt discontinuation
• acute myocardial infarction
• agranulocytosis
• alcoholism
• anticholinergic medications
• bipolar disorder
• bradycardia
• breast-feeding
• carbamazepine hypersensitivity
• cardiac arrhythmias
• cardiac disease
• children
• closed-angle glaucoma
• coadministration with other CNS depressants
• congenital heart disease
• contact lenses
• coronary artery disease
• diabetes mellitus
• driving or operating machinery
• electroconvulsive therapy (ECT)
• ethanol ingestion
• females
• geriatric
• heart failure
• hepatic disease
• hypertension
• hyperthyroidism
• hypocalcemia
• hypokalemia
• hypomagnesemia
• hypothyroidism
• ileus
• increased intraocular pressure
• leukopenia
• long QT syndrome
• malnutrition
• mania
• MAOI therapy
• myocardial infarction
• neonates
• orthostatic hypotension
• pheochromocytoma
• pregnancy
• prostatic hypertrophy
• QT prolongation
• radiographic contrast administration
• schizophrenia
• seizure disorder
• seizures
• suicidal ideation
• sunlight (UV) exposure
• surgery
• thyroid disease
• tobacco smoking
• tricyclic antidepressant hypersensitivity
• urinary retention

Interactions

• Abarelix
• Abiraterone
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Dichloralphenazone; Isometheptene
• Acetaminophen; Diphenhydramine
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Propoxyphene
• Acetaminophen; Pseudoephedrine
• Acetaminophen; Tramadol
• Acetazolamide
• Acetylcholine Chloride
• Acrivastine; Pseudoephedrine
• Albendazole
• Alfentanil
• Alfuzosin
• Alosetron
• Alprazolam
• Amantadine
• Ambenonium Chloride
• Amifampridine
• Amiodarone
• Amitriptyline; Chlordiazepoxide
• Amlodipine; Celecoxib
• Amobarbital
• Amoxapine
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Amphetamine
• Amphetamine; Dextroamphetamine
• Amphetamines
• Anagrelide
• Anticholinergics
• Apomorphine
• Apraclonidine
• Aprepitant, Fosaprepitant
• Aripiprazole
• Arsenic Trioxide
• Artemether; Lumefantrine
• Articaine; Epinephrine
• Asenapine
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Oxycodone
• Atazanavir
• Atazanavir; Cobicistat
• Atomoxetine
• Atropine
• Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Atropine; Edrophonium
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Azelastine
• Azelastine; Fluticasone
• Azithromycin
• Baclofen
• Barbiturates
• Bedaquiline
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Belladonna; Opium
• Benzhydrocodone; Acetaminophen
• Benzodiazepines
• Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Benzphetamine
• Benztropine
• Bepridil
• Bethanechol
• Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
• Bismuth Subsalicylate; Metronidazole; Tetracycline
• Boceprevir
• Brexpiprazole
• Brimonidine
• Brimonidine; Brinzolamide
• Brimonidine; Timolol
• Brivaracetam
• Brompheniramine
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Dextromethorphan; Guaifenesin
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Brompheniramine; Pseudoephedrine
• Bupivacaine
• Bupivacaine Liposomal
• Bupivacaine; Lidocaine
• Buprenorphine
• Buprenorphine; Naloxone
• Bupropion
• Bupropion; Naltrexone
• Buspirone
• Butabarbital
• Butorphanol
• Cannabidiol
• Capsaicin; Metaxalone
• Carbamazepine
• Carbetapentane; Chlorpheniramine
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbetapentane; Pseudoephedrine
• Carbetapentane; Pyrilamine
• Carbidopa; Levodopa
• Carbidopa; Levodopa; Entacapone
• Carbinoxamine
• Carbinoxamine; Dextromethorphan; Pseudoephedrine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carbinoxamine; Phenylephrine
• Carbinoxamine; Pseudoephedrine
• Cariprazine
• Carisoprodol
• Celecoxib
• Cenobamate
• Ceritinib
• Cetirizine
• Cetirizine; Pseudoephedrine
• Cevimeline
• Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
• Chlophedianol; Guaifenesin; Phenylephrine
• Chlorcyclizine
• Chlordiazepoxide
• Chlordiazepoxide; Clidinium
• Chloroquine
• Chlorpheniramine
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dextromethorphan
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
• Chlorpromazine
• Chlorthalidone; Clonidine
• Chlorzoxazone
• Cholinergic agonists
• Cimetidine
• Cinacalcet
• Ciprofloxacin
• Cisapride
• Citalopram
• Clarithromycin
• Clemastine
• Clobazam
• Clofazimine
• Clonazepam
• Clonidine
• Clorazepate
• Clozapine
• Cobicistat
• Cocaine
• Codeine
• Codeine; Guaifenesin
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• COMT inhibitors
• Conjugated Estrogens
• Conjugated Estrogens; Bazedoxifene
• Conjugated Estrogens; Medroxyprogesterone
• Crizotinib
• Cyclizine
• Cyclobenzaprine
• Cyproheptadine
• Dacomitinib
• Dantrolene
• Darifenacin
• Darunavir
• Darunavir; Cobicistat
• Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
• Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
• Dasatinib
• Degarelix
• Delavirdine
• Desflurane
• Desloratadine; Pseudoephedrine
• Desmopressin
• Desvenlafaxine
• Deutetrabenazine
• Dexchlorpheniramine
• Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
• Dexmethylphenidate
• Dextroamphetamine
• Dextromethorphan
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Guaifenesin
• Dextromethorphan; Guaifenesin; Phenylephrine
• Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
• Dextromethorphan; Guaifenesin; Pseudoephedrine
• Dextromethorphan; Promethazine
• Dextromethorphan; Quinidine
• Diazepam
• Dicyclomine
• Dienogest; Estradiol valerate
• Diethylpropion
• Diethylstilbestrol, DES
• Dihydrocodeine; Guaifenesin; Pseudoephedrine
• Dimenhydrinate
• Diphenhydramine
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Diphenhydramine; Phenylephrine
• Disopyramide
• Disulfiram
• Dofetilide
• Dolasetron
• Dolutegravir; Rilpivirine
• Donepezil
• Donepezil; Memantine
• Dopamine
• Doxylamine
• Doxylamine; Pyridoxine
• Dronabinol
• Dronedarone
• Droperidol
• Drospirenone; Estradiol
• Drospirenone; Ethinyl Estradiol
• Drospirenone; Ethinyl Estradiol; Levomefolate
• Duloxetine
• Edrophonium
• Efavirenz
• Efavirenz; Emtricitabine; Tenofovir
• Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
• Elagolix; Estradiol; Norethindrone acetate
• Elbasvir; Grazoprevir
• Eliglustat
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
• Emtricitabine; Rilpivirine; Tenofovir alafenamide
• Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
• Encorafenib
• Enflurane
• Entacapone
• Entrectinib
• Ephedrine
• Epinephrine
• Eribulin
• Erythromycin
• Erythromycin; Sulfisoxazole
• Escitalopram
• Esketamine
• Eslicarbazepine
• Estazolam
• Esterified Estrogens
• Esterified Estrogens; Methyltestosterone
• Estradiol
• Estradiol Cypionate; Medroxyprogesterone
• Estradiol; Levonorgestrel
• Estradiol; Norethindrone
• Estradiol; Norgestimate
• Estradiol; Progesterone
• Estrogens
• Estropipate
• Eszopiclone
• Ethanol
• Ethinyl Estradiol
• Ethinyl Estradiol; Desogestrel
• Ethinyl Estradiol; Ethynodiol Diacetate
• Ethinyl Estradiol; Etonogestrel
• Ethinyl Estradiol; Levonorgestrel
• Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
• Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
• Ethinyl Estradiol; Norelgestromin
• Ethinyl Estradiol; Norethindrone
• Ethinyl Estradiol; Norethindrone Acetate
• Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
• Ethinyl Estradiol; Norethindrone; Ferrous fumarate
• Ethinyl Estradiol; Norgestimate
• Ethinyl Estradiol; Norgestrel
• Ethosuximide
• Etomidate
• Everolimus
• Ezogabine
• Fedratinib
• Felbamate
• Fentanyl
• Fexofenadine; Pseudoephedrine
• Fingolimod
• Flavoxate
• Flecainide
• Fluconazole
• Flumazenil
• Fluoxetine
• Fluoxetine; Olanzapine
• Fluphenazine
• Flurazepam
• Fluvoxamine
• food
• Fosamprenavir
• Foscarnet
• Fospropofol
• Gabapentin
• Galantamine
• Gemifloxacin
• Gemtuzumab Ozogamicin
• Gilteritinib
• Givosiran
• Glasdegib
• Glycopyrrolate
• Glycopyrrolate; Formoterol
• Goserelin
• Granisetron
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Guaifenesin; Phenylephrine
• Guaifenesin; Pseudoephedrine
• Guanabenz
• Guanfacine
• Guanidine
• Guselkumab
• Halofantrine
• Halogenated Anesthetics
• Haloperidol
• Halothane
• Histrelin
• Homatropine; Hydrocodone
• Hydantoins
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydromorphone
• Hydroxychloroquine
• Hydroxyzine
• Hyoscyamine
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Ibuprofen; Oxycodone
• Ibuprofen; Pseudoephedrine
• Ibutilide
• Idelalisib
• Iloperidone
• Imatinib
• Indacaterol; Glycopyrrolate
• Inotuzumab Ozogamicin
• Iobenguane I 131
• Isavuconazonium
• Isoflurane
• Isoniazid, INH
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Itraconazole
• Ivosidenib
• Ixabepilone
• Ketamine
• Ketoconazole
• Labetalol
• Lacosamide
• Lamotrigine
• Lapatinib
• Lasmiditan
• Lefamulin
• Lemborexant
• Lenvatinib
• Leuprolide
• Leuprolide; Norethindrone
• Levetiracetam
• Levocetirizine
• Levodopa
• Levofloxacin
• Levomethadyl
• Levomilnacipran
• Levorphanol
• Levothyroxine
• Levothyroxine; Liothyronine (Porcine)
• Levothyroxine; Liothyronine (Synthetic)
• Lidocaine
• Lidocaine; Prilocaine
• Linezolid
• Liothyronine
• Lisdexamfetamine
• Lithium
• Lofexidine
• Lomefloxacin
• Long-acting beta-agonists
• Loperamide
• Loperamide; Simethicone
• Lopinavir; Ritonavir
• Loratadine; Pseudoephedrine
• Lorazepam
• Lorcaserin
• Loxapine
• Lumacaftor; Ivacaftor
• Lumacaftor; Ivacaftor
• Lumateperone
• Macimorelin
• Magnesium Salts
• Maprotiline
• Meclizine
• Mefloquine
• Melatonin
• Mepenzolate
• Meperidine
• Meperidine; Promethazine
• Mephobarbital
• Mepivacaine
• Mepivacaine; Levonordefrin
• Meprobamate
• Mesoridazine
• Mestranol; Norethindrone
• Metaxalone
• Methadone
• Methamphetamine
• Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
• Methocarbamol
• Methohexital
• Methscopolamine
• Methsuximide
• Methyldopa
• Methylene Blue
• Methylphenidate
• Metronidazole
• Metyrapone
• Metyrosine
• Midazolam
• Midostaurin
• Mifepristone
• Milnacipran
• Minocycline
• Mirabegron
• Mirtazapine
• Mitotane
• Molindone
• Monoamine oxidase inhibitors
• Morphine
• Morphine; Naltrexone
• Moxifloxacin
• Nabilone
• Nalbuphine
• Naproxen; Pseudoephedrine
• Nefazodone
• Neostigmine
• Nicotine
• Nilotinib
• Nitroglycerin
• Non-Ionic Contrast Media
• Norepinephrine
• Norfloxacin
• Octreotide
• Ofloxacin
• Olanzapine
• Ombitasvir; Paritaprevir; Ritonavir
• Ondansetron
• Oritavancin
• Orphenadrine
• Osilodrostat
• Osimertinib
• Oxaliplatin
• Oxazepam
• Oxcarbazepine
• Oxybutynin
• Oxycodone
• Oxymorphone
• Ozanimod
• Paliperidone
• Panobinostat
• Paroxetine
• Pasireotide
• Pazopanib
• Peginterferon Alfa-2b
• Pentamidine
• Pentazocine
• Pentazocine; Naloxone
• Pentobarbital
• Perampanel
• Perphenazine
• Perphenazine; Amitriptyline
• Phendimetrazine
• Phenobarbital
• Phentermine
• Phentermine; Topiramate
• Phenylephrine
• Phenylephrine; Promethazine
• Physostigmine
• Pilocarpine
• Pimavanserin
• Pimozide
• Pitolisant
• Porfimer
• Posaconazole
• Pralidoxime
• Pramipexole
• Pramlintide
• Pregabalin
• Prilocaine
• Prilocaine; Epinephrine
• Primaquine
• Primidone
• Procainamide
• Procarbazine
• Prochlorperazine
• Promethazine
• Propafenone
• Propantheline
• Propofol
• Propoxyphene
• Pseudoephedrine
• Pyridostigmine
• Quazepam
• Quetiapine
• Quinidine
• Quinine
• Racepinephrine
• Ranolazine
• Rasagiline
• Remifentanil
• Reserpine
• Ribociclib
• Ribociclib; Letrozole
• Rifampin
• Rifapentine
• Rilpivirine
• Risperidone
• Ritonavir
• Rivastigmine
• Rolapitant
• Romidepsin
• Ropinirole
• Rufinamide
• Safinamide
• Saquinavir
• Scopolamine
• Secobarbital
• Segesterone Acetate; Ethinyl Estradiol
• Selpercatinib
• Serotonin-Receptor Agonists
• Sertraline
• Sevoflurane
• Short-acting beta-agonists
• Sibutramine
• Simeprevir
• Siponimod
• Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
• Solifenacin
• Sorafenib
• Sotalol
• Sparfloxacin
• St. John’s Wort, Hypericum perforatum
• Sufentanil
• Sunitinib
• Suvorexant
• Tacrine
• Tacrolimus
• Tamoxifen
• Tapentadol
• Tedizolid
• Telaprevir
• Telavancin
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• Telotristat Ethyl
• Temazepam
• Terbinafine
• Terfenadine
• Tetrabenazine
• Tetracaine
• Thalidomide
• Thiethylperazine
• Thiopental
• Thioridazine
• Thiothixene
• Thyroid hormones
• Tiagabine
• tobacco
• Tolcapone
• Tolterodine
• Topiramate
• Toremifene
• Tramadol
• Trazodone
• Triazolam
• Trifluoperazine
• Trihexyphenidyl
• Triprolidine
• Triptorelin
• Trospium
• Valerian, Valeriana officinalis
• Valproic Acid, Divalproex Sodium
• Vandetanib
• Vardenafil
• Vasopressin, ADH
• Vemurafenib
• Venlafaxine
• Verteporfin
• Vigabatrin
• Vilazodone
• Voriconazole
• Vorinostat
• Vortioxetine
• Yohimbine
• Zaleplon
• Ziconotide
• Ziprasidone
• Zolpidem
• Zonisamide