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
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  • 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
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  • 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
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  • Lumateperone
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  • Magnesium Salts
  • Maprotiline
  • Meclizine
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  • Melatonin
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  • Meperidine
  • Meperidine; Promethazine
  • Mephobarbital
  • Mepivacaine
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  • Meprobamate
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  • Metaxalone
  • Methadone
  • Methamphetamine
  • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
  • Methocarbamol
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  • Methylene Blue
  • Methylphenidate
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  • Pentobarbital
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  • Phendimetrazine
  • Phenobarbital
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  • Phentermine; Topiramate
  • Phenylephrine
  • Phenylephrine; Promethazine
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  • Valproic Acid, Divalproex Sodium
  • Vandetanib
  • Vardenafil
  • Vasopressin, ADH
  • Vemurafenib
  • Venlafaxine
  • Verteporfin
  • Vigabatrin
  • Vilazodone
  • Voriconazole
  • Vorinostat
  • Vortioxetine
  • Yohimbine
  • Zaleplon
  • Ziconotide
  • Ziprasidone
  • Zolpidem
  • Zonisamide
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