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Antidepressant (tricyclic)

Amitriptyline: uses, side effects & precautions

Also known as Elavil, Endep, Tryptizol.

This information is for general guidance only and does not constitute medical advice. Always consult a qualified healthcare professional for personal medical concerns. In an emergency, call your local emergency number.

What it is used for

  • Depression
  • Nerve (neuropathic) pain
  • Migraine prevention
  • Long-term pain conditions
  • Some sleep difficulties linked to pain
  • Bedwetting in children (in some regions, specialist use)

How it works

Amitriptyline increases the levels of serotonin and noradrenaline in the brain by slowing their reuptake, and also blocks other receptors. At lower amounts it is often used to calm pain signals and aid sleep; at higher amounts it can treat depression.

How it is taken

Usually available as tablets and as an oral liquid. It is taken by mouth, often in the evening because it can cause drowsiness. Take it exactly as your doctor or pharmacist directs and follow the label; do not stop suddenly.

No doses here on purpose. The right strength and schedule depend on you — only a doctor or pharmacist should set them. Always follow your prescription and the label.

Common side effects

  • Drowsiness
  • Dry mouth
  • Constipation
  • Blurred vision
  • Weight gain
  • Dizziness, especially on standing
  • Difficulty passing urine
  • Headache
  • Feeling unsteady

Serious effects — get help

  • New or worsening suicidal thoughts, especially early on (seek urgent help)
  • Irregular or fast heartbeat, chest pain, fainting
  • Confusion or hallucinations, particularly in older adults
  • Seizures
  • Severe constipation or inability to pass urine
  • Eye pain with sudden vision changes (possible acute glaucoma)
  • Severe allergic reaction
  • Signs of overdose are dangerous - it is toxic in excess

If a reaction is severe — for example trouble breathing, swelling of the face or throat, or collapse — go to the nearest emergency room now or call your local emergency number. Do not wait for an online consultation.

Interactions to watch

  • MAOI antidepressants (must not be combined)
  • Other sedating medicines, sleeping tablets and strong painkillers
  • Medicines affecting heart rhythm
  • Other antidepressants and serotonin-raising medicines
  • Alcohol (increased drowsiness)
  • Some medicines for bladder, breathing or Parkinson's that add to drying effects

Who should take care

  • Can be dangerous in overdose, so quantities may be limited and storage matters
  • Use with caution with heart disease, glaucoma, an enlarged prostate, epilepsy or thyroid problems
  • Older adults are more sensitive to confusion, falls and dry-mouth-type effects
  • Tell your clinician if you are pregnant, planning pregnancy or breastfeeding
  • May affect driving until you know how it affects you; do not stop suddenly

Frequently asked questions

Why am I prescribed amitriptyline for pain or migraine if it's an antidepressant?
At lower amounts amitriptyline can quiet certain pain signals and help sleep, which is why it is widely used for nerve pain and migraine prevention even in people who are not depressed.
Why does it make me so sleepy?
Amitriptyline has a strong sedating effect, which is why it is often taken in the evening. Drowsiness may ease over time. Do not drive until you know how it affects you.
Is it safe in older adults?
It can be used but requires caution, as older adults are more prone to confusion, falls, constipation and heart effects. A clinician weighs the benefits and risks carefully.
Can I stop when my pain improves?
Do not stop suddenly. Stopping abruptly can cause withdrawal effects. Your clinician will advise on reducing it gradually.

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