Adapted from The Faculty of Pain Medicine, Royal College of Anaesthetists, Patient information booklet 2017. The original can be found online at:https://fpm.ac.uk/sites/fpm/files/documents/2019-08/Amitriptyline2017.pdf
Why have I been prescribed amitriptyline?
• Amitriptyline is used to treat many types of persistent pain.
• It is especially good for nerve pain, such as burning, shooting or
stabbing pain, and for pain that keeps you awake at night.
• Amitriptyline belongs to the group of medicines called tricyclic
antidepressants that are also used to treat depression.
• The dose of amitriptyline needed for pain relief is usually much lower
than that prescribed for depression.
• You may notice that information from the manufacturer does not
mention pain. However, amitriptyline has been used to treat pain for
many years. For more information please read ‘Use of medicines outside
of their UK marketing authorisation in pain management and palliative
medicine – information for patients’ by the British Pain Society.
How does amitriptyline work?
• Amitriptyline works by changing the amount of specific nerve
transmitters in the nervous system, reducing pain messages arriving
in the brain.
When should I take it?
• It is best to take amitriptyline in the evening. Start by taking it 2-3
hours before going to bed, if you find that you feel drowsy the next
morning, try taking it earlier in the evening.
How is amitriptyline taken?
• The tablets should be swallowed whole, with a glass of water.
• Amitriptyline may be taken on an empty or full stomach.
• You will be told how much to start taking and when to increase the
dose.
• Do not take more than prescribed.
How long will it take to work?
• Every patient is different. You may notice some initial benefit within
2 weeks, however it may take up to 2 months for a full effect. Your doctor may need to increase the dose to get the maximum effect.
• Amitriptyline does not work for everyone. If you do not feel any
improvement in your pain, do not suddenly stop taking the tablets
but speak to your doctor.
What are the possible side effects?
• Most side effects are mild and it is expected that they reduce after a
few doses.
• Common side effects include; drowsiness, dizziness, dry mouth,
constipation and sweating. If you have these side effects and they
are severe contact your doctor or pharmacist for advice.
• Less common side effects include fainting, trembling, irregular
heartbeat, blurred vision or problems passing water. If any of these
side effects occur contact your doctor or pharmacist for advice.
Can I take this medication long-term?
• Yes, if it helps. You may wish to reduce treatment every so often,
to check if your pain is still a problem. This should be done with
the advice of your GP or pain specialist, gradually reducing your
medication over a period of time.
Can I drink alcohol?
• Alcohol increases the sedative effects of amitriptyline, it is best not
to drink alcohol when you start taking it. Once settled on a steady
dose, you may drink alcohol in moderation but it may make you more
drowsy than normal.
Can I drive?
• Amitriptyline may cause drowsiness. If this happens, do not drive.
What should I tell the doctor?
• If you are allergic to any drugs
• If you are taking any other medicines or herbal medicines
• If you are pregnant or breastfeeding, or if you are planning to
become pregnant in the future• If you have had a heart attack recently or have any heart problems
• If you have a history of epilepsy or fits
• If you have glaucoma
• If you have difficulty in passing water
• If you have thyroid disease
• If you have or have had a mental health problem
• If you are taking an antidepressant medicine, especially one called a
monoamine oxidase inhibitor (MAOI)
What if I forget or miss a dose?
• If you forget a dose then you can consider taking it when you
remember that night but this may result in sleepiness the following
day and affect your concentration, work or driving ability. The
alternative is to wait until the next dose is scheduled.
• If you only take one dose at bedtime and you miss the dose, do not
take the medicine in the morning. Wait until the next night and skip
the missed dose.
• Do not take two doses together.
What if I want to stop taking amitriptyline?
• If you stop taking amitriptyline suddenly, you might experience
withdrawal symptoms. Speak to your healthcare professional (doctor,
nurse, pharmacist) who will be able to supervise a gradual reduction.