Amitriptyline is a tricyclic antidepressant and painkiller (analgesic) that is often prescribed for migraine prevention. Patients with chronic migraine should be given preventive treatment (prophylactic therapy). Prophylactic therapy is warranted when migraine attacks occur more than 4 times per month for the headaches last longer than 12 hours. It can also be prescribed if migraine attacks cause substantial functional impairment, or if conventional treatments for migraine relief are ineffective or cause serious side effects.
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Reviewed by Dr Yasmin Aghajan, MD
Information last reviewed 08/01/19
Amitriptyline (also known as Elavil) is a white, odorless, crystalline compound which is soluble in water. Amitriptyline is used as a preventive medication for migraines. Clinical studies have shown that oral Amitriptyline helps with diabetic neuropathic pain, neurogenic pain syndromes, non-malignant pain (e.g., post-herpetic neuralgia, fibromyalgia).
Amitriptyline is a type of tricyclic antidepressant. That means that it is used primarily to treat depression, but at lower doses it can be effective for reducing the pain associated with migraine. It works by increasing levels of serotonin and norephinephrine in the brain. These chemicals can help improve mood, but they also influence how your nerves receive pain signals. In this way, Amitriptyline is able to reduce migraine pain.
In 2011, a study demonstrated that Amitriptyline was effective at reducing the frequency of migraines by approximately 50% after 8 weeks of taking Amitriptyline.
It can take 4-6 weeks before you experience the full effects of Amitriptyline. Usually, after the first week, you would notice a reduction in migraine pain, but it can take longer. If you do not experience any effects to start with, you should try it for at least 6 weeks to see if it has any effects.
Each tablet for oral administration contains 10 mg, 25 mg, 50 mg, 75 mg, 100 mg or 150 mg amitriptyline hydrochloride. The strengths available through Medzino are 10mg and 25mg, if you require something stronger, we recommend that you speak to a doctor face-to-face. The anti-migraine mechanisms are generally speculative and little understood. Amitriptyline works on nerve cells in the brain and spinal cord. Its effectiveness with regard to migraine headache is unrelated to whether or not the patient suffers from depression.
Please note that different strengths of tablet may contain different coloring agents. In addition, different brands of generic medication may contain different active ingredients.
As a preventive agent for adults with migraine attacks, amitriptyline should initially be taken at low doses 10-25 mg daily. It is best taken at night, due to its potential to cause sleepiness. If tolerated, the dosage can be increased in steps of 10-25 mg every 3-7 days in 1-2 divided doses. The usual dose is 25-75 mg. Doses over 100 mg should be used with caution. Doses above 75 mg should be used with caution in the elderly and patients with cardiovascular disease. The maximum strength per dose should be 75 mg.
Note that after taking Amitriptyline for a long duration, patients should not abruptly stop the treatment as it can cause nausea, headache, and malaise. Furthermore, gradual dosage reduction has been reported to produce symptoms such as irritability, restlessness, nightmares and sleep disturbances. Withdrawal symptoms may occur within 5 days of stopping treatment. They are usually mild, but can be severe in some cases. It is advised to reduce the dose gradually over about 4 weeks or longer if these withdrawal symptoms emerge.
Yes. If an adult ingests 750 mg or more, this can lead to a high level of toxicity. This can be significantly aggravated if you ingest amitriptyline together with alcohol or other psychotropic agents. Symptoms of overdose include low blood pressure, confusion, convulsions, dilated pupils and other eye problems, lack of concentration, drowsiness, hallucinations, impaired heart function, rapid or irregular heartbeat, low body temperature, stupor, unresponsiveness, coma. If you fear that you or someone you know is overdosing, then immediate medical and hospital attention is required.
If you miss a dose of Amitriptyline, take it as soon as you remember. In case you only remember when it is time for your next dose, stick to your regular dose and do not take it twice to make up for the dose you missed. Try to take your doses at the same time each day in order to avoid forgetting it.
Always take Amitriptyline as directed by the prescribing physician. Usually, you would take one tablet once a day at night. You may swallow the tablet with water. Amitriptyline does not need to be taken on an empty stomach.
An overdose of Amitriptyline can be dangerous. You should seek immediate medical advice and call the Poison Control Centre on 1-800-222-1222. Amitriptyline overdose can cause serious symptoms such as:
If you experience any of these symptoms, you should seek immediate medical attention, such as going to the ER.
Common side-effects of amitriptyline:
If any of these side-effects persist or manifest themselves in a severe way, consult your primary care physician or prescriber.
Potential serious side-effects include:
If you experience any of these severe side-effects, contact your doctor immediately or go to an emergency room right away.
Patients should consult their physicians and use amitriptyline with caution if they have a history of cardiovascular disease, chronic constipation, diabetes, epilepsy, bipolar disorder, psychosis, hyperthyroidism, increased intra-ocular pressure, suicidal behavior, pheochromocytoma, prostatic hypertrophy, susceptibility to angle-closure, glaucoma, urinary retention.
Some drugs may interfere with the effects of Amitriptyline. Do not take Amitriptyline at the same time as the following drugs: Arbutamins, Disulfiram, thyroid supplements, NSAIDs (such as Ibuprofen), blood thinners (such as Warfarine), anticholinergic drugs (such as Benztropin, Balladonna, Alkaloids), certain drugs for high blood pressure (such as Clonidine, Guanabenz, and Resperine), Monoamine Oxidase Inhibitors (such as Isocarboxazid, linezolid, Methylene Blue, Moclobemide, Phenelzine, Procarbazine, Rasagiline, Safinamide, Selegiline, Tranylcypromine), Cimetidine, Terbinafine, drugs to treat irregular heart rate (such as Quinidine, Propafenone, Flecainide), antidepressants (such as SSRIs including Paroxetine, Fluoxetine, Fluvoxamine), antihistamines (such as Cetirizine, Diphenhydramine), drugs for sleep or anxiety (such as Alprazolam, Diazepam, Zolpidem), muscle relaxants, and narcotic pain relievers (such as Codeine). Always inform your doctor of the medications you are taking before using this Amitriptyline.
There is little data on whether pregnant women can use Amitriptyline, but it has been shown to cross the placenta, although the effects of this have not been adequately studied. Generally, it is not recommended unless absolutely necessary. In this case, very careful consideration is necessary of both risks and benefits. Do not self-medicate if you are pregnant but talk to your health physician. Regarding breastfeeding, risks to the baby must be considered as Amitriptyline and its metabolites are emitted into breast milk. Due to the benefits of the breast milk for the child in contrast to the benefits of the therapy for the mother, a decision on whether to continue or abort the therapy should be carefully taken with the help of a physician.
Some clinical studies on animals have shown reproductive toxicity. However, there are no data on the repercussions of Amitriptyline for human fertility.
As Amitriptyline works by altering how nerves receive pain signals, it is unlikely to have any effect on migraines which are not painful i.e. ocular migraines or migraines without headaches.
Amitriptyline works by increasing the levels of serotonin in the brain. Serotonin is involved in how nerves interpret pain signals. This mechanism allows Amitriptyline to reduce the pain associated with migraine.
Many people report fatigue as a side effect of Amitriptyline. Therefore, it is important that you know whether you experience this side effect, before you drive after taking Amitriptyline. As Amitriptyline can cause drowsiness or fatigue, some people prefer to take it before going to sleep.
Do not drive after starting Amitriptyline for several days until you know the effects it may have on sleepiness and drowsiness.
Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.
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