II. Indications
- Migraine Headache Prophylaxis
- Fibromyalgia
- Chronic Pain (esp. neuropathic pain)
- Insomnia
- Major Depression (historical use, replaced by SSRI and SNRI Antidepressants)
- Panic Disorder with Agoraphobia
- Obsessive Compulsive Disorder
III. Precautions
- See Tricyclic Antidepressants
- See Tricyclic Antidepressant Overdose
- Serious cardiotoxicity in overdosage
IV. Mechanism
- See Tricyclic Antidepressant
- Amitriptyline primarily inhibits Serotonin reuptake
- Amitriptyline is demethylated to Nortriptyline, which primarily inhibits Norepinephrine reuptake
V. Pharmacokinetics
- Serum Half Life: 30 to 45 hours
- Therapeutic plasma level: 110 to 250
VI. Safety
- Pregnancy Category C
- Avoid in Lactation
VII. Dosing: Migraine Headache Prophylaxis, Fibromyalgia or Chronic Pain
- Start at 25 mg orally at bedtime for 3 days
- Next: 50 mg orally at bedtime for 3 days
- Therapeutic Target Dose: 75 mg orally at bedtime (range 50 to 100 mg/day)
VIII. Dosing: Insomnia
- Initial: 25 mg orally at bedtime
- Morning Hangover Effect: Taper to 10 mg orally at bedtime
IX. Dosing: Major Depression (listed for historical purposes only)
- Avoid for Major Depression given adverse effects
- SSRIs and other new Antidepressants are preferred
- Adults
- Start 50-100 mg orally at bedtime (or 25 mg orally three times daily)
- Titrate to 150 mg orally at bedtime (or in divided doses)
- Max Dose: 300 mg daily
- Elderly and Children over age 12 years
- Start 10 mg orally three times daily and 25 mg orally at bedtime
- Titrate dose as needed
- Max Dose: 200 mg daily
X. Adverse Effects
- See Tricyclic Antidepressants
- Tricyclic Antidepressant Overdose
- Amitriptyline is among the most Anticholinergic of the Tricyclic Antidepressants (including Sedative effects)
- Consider Nortriptyline as an alternative
- Significant adverse effects
- Sedation and morning grogginess
- Anticholinergic Symptoms
- Orthostatic Hypotension
- Cardiac Arrhythmia
- Weight gain
XI. Drug Interactions
XII. Resources
- Amitriptyline (DailyMed)
XIII. References
- (2023) Med Lett Drugs Ther 62(1592): 25-32
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 36-7
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
Images: Related links to external sites (from Bing)
Related Studies
| amitriptyline (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| AMITRIPTYLINE HCL 10 MG TAB | Generic | $0.04 each |
| AMITRIPTYLINE HCL 100 MG TAB | Generic | $0.15 each |
| AMITRIPTYLINE HCL 150 MG TAB | Generic | $0.17 each |
| AMITRIPTYLINE HCL 25 MG TAB | Generic | $0.05 each |
| AMITRIPTYLINE HCL 50 MG TAB | Generic | $0.09 each |
| AMITRIPTYLINE HCL 75 MG TAB | Generic | $0.13 each |
Ontology: Amitriptyline (C0002600)
| Definition (NCI_NCI-GLOSS) | A drug that is used to treat depression and may be given to treat anxiety, sleep disorders, and pain. It is also being studied in an oral or gel form in the treatment of nerve pain caused by chemotherapy. Amitriptyline is a type of tricyclic antidepressant. |
| Definition (NCI) | A derivative of dibenzocycloheptadiene and a tricyclic antidepressant. Amitriptyline inhibits the re-uptake of norepinephrine and serotonin by the presynaptic neuronal membrane in the central nervous system (CNS), thereby increasing the synaptic concentration of norepinephrine and serotonin. Due to constant stimulation to these receptors, amitriptyline may produce a downregulation of adrenergic and serotonin receptors, which may contribute to the antidepressant activity. |
| Definition (MSH) | Tricyclic antidepressant with anticholinergic and sedative properties. It appears to prevent the re-uptake of norepinephrine and serotonin at nerve terminals, thus potentiating the action of these neurotransmitters. Amitriptyline also appears to antagonize cholinergic and alpha-1 adrenergic responses to bioactive amines. |
| Definition (CSP) | tricyclic antidepressant with anticholinergic and sedative properties; it appears to prevent the re-uptake of norepinephrine and serotonin at nerve terminals, thus potentiating the action of these neurotransmitters; it also appears to antagonize cholinergic and alpha-1 adrenergic responses to bioactive amines. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D000639 |
| SnomedCT | 372726002, 40589005 |
| LNC | LP14983-8, MTHU004907 |
| English | Amitriptyline, amitriptyline, 1-Propanamine, 3-(10,11-dihydro-5H-dibenzo(a,d)cyclohepten-5-ylidene)-N,N-dimethyl-, Amitriptyline [Chemical/Ingredient], AMITRIPTYLINE, Amitriptyline (product), Amitriptyline (substance) |
| Swedish | Amitriptylin |
| Czech | amitriptylin |
| Finnish | Amitriptyliini |
| Russian | TRIPTIZOL, TEPERIN, AMITRIPTILIN, АМИТРИПТИЛИН, ТЕПЕРИН, ТРИПТИЗОЛ |
| Japanese | アミトリプチリン, 塩酸アミトリプチリン |
| Croatian | AMITRIPTILIN |
| Polish | Amitryptylina |
| Spanish | amitriptilina (producto), amitriptilina (sustancia), amitriptilina, Amitriptilina |
| French | Amitriptyline |
| German | Amitriptylin |
| Italian | Amitriptilina |
| Portuguese | Amitriptilina |
Ontology: Elavil (C0087119)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D000639 |
| English | Cahill May Roberts Brand of Amitriptyline Embonate, Cahill May Roberts Brand of Amitriptyline Hydrochloride, DDSA Brand of Amitriptyline Hydrochloride, Merck Sharp & Dohme Brand of Amitriptyline Embonate, Merck Sharp & Dohme Brand of Amitriptyline Hydrochloride, Tryptanol, Zeneca Brand of Amitriptyline Hydrochloride, Elavil, Tryptizol |
