Amitriptyline for Anxiety (A review)

What type of drug is amitriptyline?

Amitriptyline is a tricyclic antidepressant widely used to treat anxiety and depression but low doses are used to reduce pain of some rheumatic conditions.

Lower doses of amitriptyline relieve muscle pain, improve quality of sleep and reduce discomfort.

Lower doses of amitriptyline could not help in treating anxiety or depression. 

How does amitriptyline work?

It increases the level of serotonin (neurotransmitter) production in brain.

Serotonin balances mood, emotional state, improves sleep, and reduce pain.

Body’s reaction to pain changes when serotonin level increases.

Amitriptyline could be prescribed to children and adults. It induces sleep immediately but changes in mood or pain occur in six weeks.

Uses of Amitriptyline 

For example, a doctor may recommend amitriptyline for treatment of:

  • excessive saliva production
  • Sleep problems 
  • irritable bowel syndrome
  • chronic pain
  • interstitial cystitis, or bladder pain syndrome
  • migraine
  • shingles pain                                                          
  • anxiety
  • Post-traumatic stress disorder

Other than anxiety, amitriptyline is prescribed for long term pain in muscles and bones.

These include:

  • arthritis 
  • back pain, neck and spine
  • fibromyalgia 
  • migraines
  • damage to nerve endings in limbs (peripheral neuropathy) 

Amitriptyline is not prescribed if:

  • you are allergic to a medication in the past
  • you have heart problems
  • you are bipolar 
  • you have liver or kidney problems
  • you have epilepsy
  • you have glaucoma 
  • you are have suicidal thoughts

Structure of Amitriptyline

The structure of amitriptyline enables it to attach to alpha-adrenergic, histaminic, and muscarinic receptors in the brain.

This means that amitriptyline can cause more side effects than some other tri cyclic anti-depressants. 

Some examples of other drugs in the tri cyclic anti-depressants class include:

  • clomipramine
  • doxepin
  • imipramine
  • nortriptyline                                             
  • protriptyline
  • trimipramine

Six dosages of amitriptyline are available that is, 10 milligrams (mg), 25 mg, 50 mg, 75 mg, 100 mg, and 150 mg.

How is it taken? It’s usually taken as tablets or syrup once a day, about two hours before bedtime.

The usual dose for chronic pain is 5–50 mg daily, though higher doses may be prescribed. It may take several weeks before it starts to work. 

Amitriptyline Dosage

Amitriptyline comes in a tablet form. The recommended dose is 100-300 milligrams (mg) for most adults and 25 mg for elderly patients.

The initial dose is typically between 50-100 mg. It can be taken with or without food.  

Amitriptyline Overdose

If you suspect an overdose, you should contact a poison-control center or emergency room immediately.

Missed Dose of Amitriptyline

If you miss a dose of amitriptyline, take it as soon as you remember.

If you remember near time of next dose then you should skip the missed dose and continue on your regular medication schedule.

Caution: Do not double up on doses to make up for a missed one.

Why is amitriptyline prescribed?

For chronic pain such as rheumatology patients amitriptyline is prescribed.

Causes of chronic pain include arthritis, spinal problems, fibromyalgia, chronic headaches, and peripheral neuropathy (damage to nerve endings in the upper and lower limbs).

Chronic pain is associated with changes in the central nervous system (the spinal cord and brain) that lead to failure of adequate pain regulation.

Amitriptyline works by rebalancing the chemicals in the central nervous system.

Is there any reason I won’t be prescribed amitriptyline?

Amitriptyline shouldn’t be used if you’re recovering from a recent heart attack (myocardial infarction) or have a condition called heart block.

It also shouldn’t be used in people with uncontrolled bipolar disorder (extreme mood swings) or acute porphyria (an enzyme disorder causing severe nerve or skin symptoms) or certain forms of glaucoma (increased pressure within the eyeball).

When and how do I take amitriptyline?

Amitriptyline is available as tablets or syrup, taken daily. It has sedative effects and may make you drowsy; it’s usually taken an hour or two before bedtime.

Use doses as prescribed by your physician. You will be prescribed with low doses (e.g. 5 –10 m g) initially then dose increase to 20 mg.

In case of severe sleep issues high dose of 50 mg or 75 mg is prescribed. 

How long does amitriptyline take to work?

Amitriptyline shows immediate effect on sleep but it takes two to six weeks to reduce muscle pain or mood issues. 

What are the possible risks or side-effects?

The most common side-effect is a dry mouth, but you may also feel drowsy or spaced out in the morning or during the day.

Side-effects may be reduced by following your doctor’s instructions regarding time and dose of medicine.

Some other side-effects include:

• difficulty passing urine

• constipation

• dizziness 

• blurred vision

• some weight gain or weight loss. 

Things you need to know before taking Amitriptyline for sleep

What is a typical dosage when prescribed for sleep?

Amitriptyline for sleep is prescribed at different doses.

The dose depends on factors like age, other medicines taken by patient, severity of problem, and drug cost. 

For adults, the dose is typically between 50 and 100 milligrams at bedtime. Adolescents and older adults may take lower dosages.

If you have certain known gene variations such as changes to the CYP2D6 and CYP2C19Trusted Source genes, you might need dose adjustments to lower the chance of side effects with amitriptyline.

Starting at a low dose helps the doctor see how you are reacting to the medicine before making changes.

When to seek emergency care

Call 911 right away if you experience any of these symptoms while taking amitriptyline, as they may indicate a life-threatening medical emergency:

  • rapid or irregular heart rate
  • chest pain and shortness of breath
  • slurred speech or weakness in one side of body

Are there interactions with other drugs?

Amitriptyline can interact with several medications.

So inform your doctor if you are taking any other medicines or dietary supplements

The most common medications that interact with amitriptyline include:

  • monoamine oxidase inhibitors (MAOIs) like selegiline (Eldepryl): can cause seizures or death
  • quinidine: can cause heart problems
  • opioid medicines like codeine: can increase drowsiness and raise the risk for serotonin syndrome, which can cause increased blood pressure and elevated heart rate 
  • epinephrine and norepinephrine: can increase blood pressure, headaches, and chest pain
  • topiramate: can cause high levels of amitriptyline in your body, increasing your risk of side effects

Warnings while taking amitriptyline for sleep

Until your body gets used to the medicine, be careful with any activities that require you to be alert like driving or operating machinery.

Avoid alcohol or other medicines that can make you drowsy with amitriptyline because it can increase the effect of the drug.

You should not suddenly stop taking amitriptyline. Gradually stop taking this medicine with suggestion from your physician. 

What are the benefits of taking amitriptyline for sleep?

A few advantages of amitriptyline include:

  • Less expensive. Amitriptyline is an older medicine available as a generic, so it’s inexpensive compared to some newer sleep aids.
  • Not habit forming. Amitriptyline is not addictive or habit forming like other medicines used for insomnia like diazepam (Valium) 

Amitriptyline can be helpful if insomnia is results from another condition you may have, such as pain, depression or anxiety.

You should discuss all your symptoms with your doctor to find the best treatment option for you.


Are there any side-effects of amitriptyline?

The most common side-effect is a dry mouth, feeling drowsy upon waking and confused in morning.

Talk to your doctor if side effects are more.

You should not reduce dose of drug without consulting your doctor.

Will it affect vaccinations?

No. You can have vaccinations while on amitriptyline.

Can I drink alcohol while on amitriptyline?

You should avoid alcohol as amitriptyline increases the effects of alcohol and may make you drowsy.

This is especially important if you’re driving or using machinery.

Are there side effects from taking amitriptyline for sleep?

Yes. There could be some side effects to amitriptyline.

Inform your doctor if you have any allergic reaction to medicine is past. Common side effects of amitriptyline are: 

– dry mouth

– headache

– weight gain or loss

– constipation 

– trouble urinating

– low blood pressure 

– drowsiness 

– blurred vision

– tremor

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