AmitriptylineAmitriptyline hydrochloride

About Amitriptyline

The label calls amitriptyline an antidepressant with sedative effects whose mechanism in people is not known; it blocks the reuptake of norepinephrine and serotonin by nerve cells. Its labeled use is relief of the symptoms of depression, and endogenous depression is more likely to respond than other kinds. Outpatients usually take about 75 mg a day in divided doses, raised if needed to 150 mg, with increases preferably in the late afternoon or bedtime doses, or start at 50 to 100 mg at bedtime and add 25 or 50 mg at a time, up to 150 mg. Hospitalized patients may need 100 to 200 mg a day, occasionally 300 mg. Teenagers and older adults generally take lower doses. Maintenance is usually 50 to 100 mg a day, often as one bedtime dose, for three months or longer, and a full response can take up to 30 days. It is not recommended under 12.

The boxed warning says antidepressants increased suicidal thinking and behavior in children, adolescents and young adults in short-term studies, so everyone taking it is watched for worsening mood, especially early on and after dose changes. It must not be taken with an MAO inhibitor or within 14 days of one, with cisapride, or by anyone allergic to it; it is not recommended in the acute recovery phase after a heart attack and is not started in someone receiving linezolid or intravenous methylene blue. Particularly at high doses, tricyclics can cause heart rhythm problems and a fast heartbeat, and heart attacks and strokes have been reported, so people with heart disease are watched closely. Other warnings cover seizures, angle-closure glaucoma, trouble urinating, an overactive thyroid, serotonin syndrome, mania in people with bipolar disorder (who are screened first), low sodium, and drowsiness that impairs driving. Side effects include dry mouth, constipation, blurred vision, trouble urinating, drowsiness, tiredness, nausea, headache, sweating, and changes in appetite, weight and sex drive.

An overdose can be fatal, so the label asks prescribers to write for the smallest quantity consistent with good care. Stopping suddenly after long use can cause nausea, headache and a general feeling of being unwell, so it is stopped only on medical advice, and when possible several days before elective surgery. Blood sugar can rise or fall, older adults may be at greater risk of falls, and MedlinePlus says older adults should not usually take it, since other medicines for the condition are safer or more effective. Amitriptyline crosses the placenta, there are no adequate studies in pregnancy, and it passes into breast milk. Elavil’s approval was withdrawn in 2006; in 2017 the FDA found it had not been withdrawn for reasons of safety or effectiveness, so generic versions can still be approved.

Taking Amitriptyline

How to take it

By mouth as prescribed, in divided doses or once a day at bedtime, at about the same times each day. It may take a few weeks or longer to feel the full benefit. Wait to drive or use machinery until you know how it affects you, and do not stop it without talking to your prescriber.

If you miss a dose

Take the missed dose as soon as you remember, unless it is almost time for the next dose; then skip it and continue your regular schedule. Do not take a double dose.

Storage

At room temperature in the original, tightly closed container, away from excess heat and moisture (not in the bathroom), out of reach of children.

Interactions to know about

Never with an MAO inhibitor or within 14 days of one, and never with cisapride. Quinidine, cimetidine, SSRIs such as fluoxetine, sertraline and paroxetine, topiramate and valproate can raise its levels. With other anticholinergic drugs, overheating in hot weather and a stalled bowel can occur; epinephrine-type drugs, including epinephrine given with local anesthetics, need care; disulfiram has caused delirium; and alcohol and sedatives add to drowsiness.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Amitriptyline differs from pharmacy to pharmacy

Generic amitriptyline tablets come from many makers in six strengths. The same daily dose can be written as one tablet or several smaller ones, in divided doses or as one bedtime dose, so the tablet count, and with it the quote, depends on how the prescription is written.

Because the label advises prescribing the smallest quantity consistent with good care, some fills are small, and each carries the pharmacy’s dispensing fee whatever its size.

Ways to pay less for Amitriptyline without insurance

• Ask whether amitriptyline is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Ask for quotes on your daily dose as one tablet and as smaller ones; the prescription has to match the one you choose.
• Once your dose is settled, ask the prescriber whether a ninety-day supply is appropriate for you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Amitriptyline

1. 1.Should I take my whole dose at bedtime, and how long before I notice a difference?
2. 2.Is it safe with my heart condition, glaucoma or trouble urinating?
3. 3.Do any of my medicines, such as an SSRI, cimetidine, topiramate, valproate or a migraine medicine, interact with it?
4. 4.How should I stop it if I no longer need it?

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