Amitriptyline

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Dec 14, 2022

Warnings

Amitriptyline Risks, Warnings, and Complications

Amitriptyline can cause serious problems in some people. Talk to your doctor or pharmacist about other treatments if you are at increased risk of complications from amitriptyline use.

WORSENING DEPRESSION AND SUICIDAL THOUGHTS: Amitriptyline can lead to worsening depression and suicidal thoughts in some people. The risk is greatest in people younger than 24 years of age and those with a history of other mental illnesses. The risk is also high during the first few weeks of treatment and after dose changes. Call your doctor right away if you notice any unusual behavior, mood changes, suicidal thoughts, or worsening depression symptoms. Members of your household should know when and how to seek medical care for you if you are not able to do so yourself.
NOT FOR BIPOLAR DEPRESSION: Bipolar disorder is a mental health condition characterized by alternating episodes of depression and mania. Amitriptyline is not used to treat depression related to bipolar disorder. Taking antidepressant drugs like amitriptyline can trigger a manic episode in people with bipolar disorder. Before starting amitriptyline, tell your healthcare provider if you have a personal or family history of bipolar disorder or risk factors for this condition. Call your doctor without delay if you or your family members notice any unusual behaviors while on amitriptyline, such as excessive excitability, unusual talkativeness, racing thoughts, or restlessness.
RISK OF HEART ATTACK AND STROKE: Amitriptyline can affect your heart rhythm and cause a fast, pounding, or irregular heartbeat. There are reports of people taking medications like amitriptyline and having a heart attack or stroke during treatment. The risk is higher in people taking high doses of amitriptyline and those with a history of heart disease. Before starting amitriptyline, tell your healthcare provider if you have any history of heart problems or a prior heart attack or stroke.
SEIZURES: Taking amitriptyline can increase the risk of seizures. The risk is greater in people with a history of seizures and those on high doses of amitriptyline. Before starting amitriptyline, tell your healthcare professional if you have had a seizure in the past.
GLAUCOMA: Amitriptyline can worsen or cause angle-closure glaucoma, an eye condition associated with increased eye pressure. You may need to get regular eye exams while on this medicine. Contact your doctor without delay if you notice any vision changes during treatment with this medicine.
RISK OF FALLS: Amitriptyline can cause side effects like tiredness, dizziness, loss of balance, and low blood pressure (orthostatic hypotension). These side effects can increase the risk of falls. Make sure you stand up slowly from a sitting or lying position. Call your doctor if you have severe dizziness or persistent dizziness after a couple of weeks of starting amitriptyline. The risk of falls is highest in older adults (age 65 years and above), those with low blood pressure, and people taking medications to lower blood pressure.
SEROTONIN SYNDROME: Taking amitriptyline with certain other medications that also increase serotonin levels in the central nervous system can lead to a potentially life-threatening condition called serotonin syndrome. Signs and symptoms of serotonin syndrome may include fever, shivering, diarrhea, muscle rigidity, seizures, and even death. Give your doctor a complete list of your medications before starting amitriptyline to prevent serious drug reactions like serotonin syndrome.
ANTIDEPRESSANT INDUCED LIVER INJURY: Certain antidepressant drugs, including amitriptyline, can lead to drug-induced liver injury. Tell your healthcare provider if you have a history of impaired liver function or liver disease. Call your doctor without delay if you develop signs and symptoms such as yellowing of the eyes or skin or severe stomach pain during chronic treatment with this medicine.
SERIOUS ALLERGIC REACTION: In a small number of people, amitriptyline can cause a serious allergic reaction. Call your doctor immediately or seek emergency medical care if you develop a severe skin rash, hives, or swelling of the face or throat while on this medication.

Precautions Before Starting Amitriptyline

Tell your healthcare provider if you have ever had an allergic reaction to amitriptyline, any of the active or inactive ingredients in amitriptyline tablets, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, supplements, and any herbal remedy. This can help avoid possible drug interactions.

Give your doctor a complete medical history. Amitriptyline may not be right for people with certain medical conditions such as a prior heart attack, glaucoma, enlarged prostate, seizures, hyperthyroidism (overactive thyroid gland), excessive alcohol intake, diabetes, schizophrenia, heart disease, liver disease, or kidney disease.

Elderly patients (age 65 years and above) should discuss the pros and cons of taking amitriptyline with their doctor. There may be a safer alternative drug available to treat your condition.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding. Amitriptyline can potentially cause problems in infants whose mothers take this medicine during pregnancy. Also, amitriptyline passes into breast milk and may be harmful to a breastfeeding infant.

Precautions During Use of Amitriptyline

Keep all your doctors’ appointments while taking amitriptyline. Your doctor may gradually increase your dose based on your response. They may also want to order certain tests during your treatment with this medicine.

Amitriptyline can make you drowsy and dizzy. Do not drive a car or operate machinery until you know how it affects you. Avoid drinking alcohol while on this medicine because alcohol can make these side effects worse.

You may experience lightheadedness, dizziness, or fainting if you get up too quickly from a sitting or lying position while on amitriptyline. This is called orthostatic hypotension. It can occur, especially when you first start amitriptyline or after a dose increase. To reduce your risk of falls, rise slowly and rest your feet on the ground for a few minutes before you stand up.

Tell your doctor if you become pregnant while on amitriptyline.

Be sure to tell your healthcare professional that you are on amitriptyline before any surgery, including dental procedures.

Amitriptyline Drug Interactions

Certain other drugs can affect how amitriptyline works. Possible interactions between amitriptyline and other medicines can increase the risk of severe adverse effects.

Tell your healthcare professional if you are taking monoamine oxidase inhibitors (MAOIs) like selegiline (Eldepryl, Emsam, Zelapar), isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate), or if you have taken monoamine oxidase inhibitors in the past 14 days. You should not take amitriptyline in this case.

Also, tell your healthcare provider or pharmacist if you have taken fluoxetine (Prozac, Sarafem) in the past five weeks. Your doctor may change the dose of your medication and/or monitor you carefully for side effects.

Tell your healthcare provider if you are taking a medication called cisapride (Propulsid) (this medicine is not available in the US).

The following medications can also have interactions with amitriptyline:

Antihistamines
Anticholinergic drugs
Diet pills
Medications used to treat alcohol dependence such as disulfiram (Antabuse)
Stomach acidity and peptic ulcer medicines like cimetidine (Tagamet)
Antihypertensive medications like guanethidine (Ismelin)
Asthma medications like ipratropium (Atrovent)
Medications used to treat irregular heartbeat, such as quinidine (Quinidex), propafenone (Rythmol), and flecainide (Tambocor)
Medications used to treat stomach problems, anxiety, the common cold, nausea, irritable bowel disease, other mental illnesses, Parkinson's disease, seizures, and urinary problems
Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac, Sarafem), citalopram (Celexa), fluvoxamine (Luvox), sertraline (Zoloft), and paroxetine (Paxil)
Other antidepressants
Sedatives, tranquilizers, sleeping pills
Psychotropic drugs
Thyroid medications
Anticonvulsants like phenobarbital (Bellatal, Solfoton)

The above list may not describe all possible interactions of amitriptyline. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, OTC (non-prescription) medications, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

Find the best discount on Amitriptyline »