Amitriptyline: a drug used to treat pain and prevent migraines (2023)

1. About amitriptyline for pain and migraines

Amitriptyline is a medicine used to treat pain. You can have it:

  • for the treatment of nerve pain (neuralgia) andBack pain
  • help preventthe migraine attack

Amitriptyline is available by prescription. It comes in pill form and as a liquid that you drink.

Amitriptyline is also used to treat depression.

Read more about amitriptyline for depression.

2. Key data

  • It is best to take amitriptyline at night or before bed. This is because it can make you feel sleepy.
  • You may feel better after 1-2 weeks, but it may take 6 weeks for amitriptyline to work as a pain reliever.
  • Amitriptyline may cause additional side effects if you stop taking it suddenly. Talk to your doctor if you want to stop taking it.
  • Amitriptyline is also used to treat depression, but in lower doses it is very good for treating pain.

3. Who can and who can't take amitriptyline?

Most adults (over the age of 18) can take amitriptyline. Children as young as 2 years old can take it for some types of nerve pain.

Amitriptyline is not suitable for some people.Before you start taking amitriptyline, talk to your doctor if:

  • have ever had an allergic reaction to amitriptyline or other medicines
  • have a heart problem: amitriptyline can make some heart problems worse
  • have a rare blood disorder called porphyria
  • have liver or kidney problems
  • TerEpilepsy- Amitriptyline may worsen seizures or convulsions
  • have ever taken medication for depression; some rarely used antidepressants can affect the way amitriptyline works
  • are pregnant, trying to conceive, or breastfeeding
  • I mentioned an eye problem.Glaucoma- Amitriptyline can increase intraocular pressure
  • having thoughts of harming or ending your life
  • have type 1 or type 2 diabetes

if you haveDiabetesAmitriptyline can change your blood sugar levels. If you test your blood sugar levels regularly, you may need to do this more often during the first few weeks of treatment. Talk to your diabetes doctor if the reading is too high or too low.

4. How and when to take amitriptyline?

It is common to take amitriptyline once a day. It is best to take it before going to bed as it can make you sleepy. If you find that you are still sleepy in the morning, try early in the evening.

This medication does not usually cause stomach upset. You can take it with or without food.

Swallow the tablets whole with a glass of water. If you chew them, they taste bitter.

The liquid comes with a plastic syringe or scoop to help you measure the correct dose. If you don't have one, ask your pharmacist. Do not use a kitchen teaspoon as it will not make the correct amount.


Amitriptyline tablets come in 3 different strengths: 10 mg, 25 mg, or 50 mg.

The liquid is also available in 3 different strengths: it contains 10mg, 25mg or 50mg of amitriptyline in a 5ml scoop.

The usual starting dose for adults and older children (12 to 17 years) is 10 mg daily. Your doctor may increase this dose if you need better pain relief.

The starting dose for younger children depends on their weight and symptoms. The doctor will tell you how much to give.

The maximum dose of amitriptyline for the treatment of pain is 75 mg daily. Your doctor may prescribe a higher dose if you are taking it to prevent migraines.

What happens if I forget to take it?

If you forget to take amitriptyline, take it as soon as you remember, unless it is almost time for your next dose. In this case, skip the missed dose and take the next one as usual.

If amitriptyline normally makes you drowsy and you have to drive, cycle, or use tools or machines, skip the missed dose and take the next one as usual.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten dose.

If you tend to forget doses, setting an alarm to remind you can help. You can also ask your pharmacist for advice on how to remember to take your medication.

What happens if I take too much?

Urgent notice:Call 111 now for advice if:

  • Take more than your usual dose of amitriptyline

Gonna111.nhs.ukor call111

Taking too much amitriptyline can cause serious side effects, such as: B. a change in heartbeat, seizures, or seizures.

5. Side effects

Like all medicines, amitriptyline can cause side effects in some people, but many people have no side effects or only side effects.

Some of the more common side effects of amitriptyline gradually improve as your body adjusts to the medication.

frequent side effects

The doses of amitriptyline for pain are lower than the doses for depression. This means that common side effects are usually milder and go away within a few days.

Continue to take the medication, but talk to your doctor or pharmacist if these side effects bother you or do not go away:

  • called
  • dizziness
  • dry mouth
  • feel sleepy
  • Difficulty urinating
  • Headache

serious side effects

It's rare, but some people experience a serious side effect after taking amitriptyline.

Call a doctor right away if you:

  • a fast or irregular heartbeat
  • yellow skin or the whites of the eyes turn yellow – these could be signs of a liver problem
  • Headache, confusion or weakness, or muscle spasms: These could be signs of low sodium levels in your blood.
  • Thoughts about hurting yourself or ending your life
  • Eye pain, blurred vision, swelling or redness in or around the eye

Immediate Action Required:Call 999 or ask A&E if:

  • You have weakness on one side of your body, trouble speaking or thinking, loss of balance, or blurred vision; these could be signs of a stroke.
  • Had a seizure or seizure
  • You have severe chest pain; this could be a sign of a heart attack.

severe allergic reaction

In rare cases, a severe allergic reaction is possible (anaphylaxis) to amitriptyline.

Immediate Action Required:Call 999 or ask A&E now if:
  • You have a rash that may include itching, redness, swelling, blistering, or peeling skin.
  • you are out of breath
  • You feel tightness in your chest or throat
  • You have trouble breathing or speaking
  • Your mouth, face, lips, tongue, or throat begin to swell

You may have a severe allergic reaction and need hospital treatment right away.

These are not all of the side effects of amitriptyline. For a complete list, see the leaflet that comes with your medicine package.


You can report any suspected side effects through the yellow card security system.

See Yellow Card for more information.

6. How to deal with the side effects of amitriptyline

What to do against:

  • called- Eat more foods rich in fiber, such as fresh fruits and vegetables and muesli. Try to drink several glasses of water or other non-alcoholic beverages each day. If you can, moving can also help.
  • dizziness- probably duelow blood pressure. Drink plenty of water or other non-alcoholic beverages. Do not get up too quickly after sitting or lying down.
  • dry mouth– Try sugar-free gum or sugar-free candy.
  • feeling sleepy or tired- Take amitriptyline at night and reduce your alcohol intake. Do not drive, ride a bicycle, or use any tools or machines if you feel this way.
  • Difficulty urinating– Relax while you try to urinate. Do not try to force the flow of urine. If you still can't walk, try again later. Talk to your doctor urgently if you can't urinate.
  • Headache– Rest and drink plenty of fluids. Don't drink too much alcohol. Try taking paracetamol or ibuprofen if you need pain relief. Talk to your doctor if the headache lasts more than a week or is severe.

7. Pregnancy and lactation

Amitriptyline and pregnancy

Amitriptyline is generally not recommended during pregnancy. This is because it has been linked to a low risk of problems for your baby if you take it early or late in pregnancy.

Talk to your doctor, as you may be able to take other pain relievers instead of amitriptyline.ParacetamolIt is usually the pain reliever of choice if you are pregnant or breastfeeding.

Your doctor will only prescribe amitriptyline for your pain during pregnancy if the benefits of taking the medicine outweigh the risks.

amitriptyline and lactation

Amitriptyline is generally not recommended if you are breastfeeding.

Amitriptyline passes into breast milk. It has been linked to side effects such as drowsiness in breastfed babies.

Talk to your doctor if you want to breastfeed. There may be other medicines you can take instead of amitriptyline.

Non-urgent advice:Tell your doctor if you:

  • trying to get pregnant
  • pregnant
  • breast-feeding

For more information on how this medicine may affect you and your baby during pregnancy,Read this brochure on amitriptyline on the Better Use of Pregnancy Drugs (BUMPs) website..

You can also read more about itParacetamol during pregnancyneither side does the NHS.

8. Precautions with other medicines

Many drugs and amitriptyline can interact, increasing the chance of side effects.

Always consult your doctor or pharmacist before starting any new medication while taking amitriptyline.

Taking opioid-based medications, such asCodeine,morphineooxicodonataken with amitriptyline may increase your risk of excessive sleepiness and breathing problems.

Tell your doctor if you have ever taken medicine for depression. Some antidepressants can affect and cause the way amitriptyline works.high pressure. This can also happen after you stop taking it.

Amitriptyline mix with herbal remedies and dietary supplements

Do not take St. John's wort, a commonly used herbal remedyDepressionwhile you are being treated with amitriptyline. This increases the risk of side effects.

There is very little information on how to take amitriptyline with other herbal remedies and supplements. They are not tested like drugs.

Important:drug safety

Tell your doctor or pharmacist if you are taking any other medicines, including herbal medicines, vitamins, or dietary supplements.

9. Frequently asked questions about amitriptyline

How does amitriptyline work?

Amitriptyline belongs to a group of medicines called tricyclic antidepressants.

They are thought to work by increasing a chemical called serotonin in the brain. It can improve your mood.

It can also change the way your nerves receive pain signals, making the pain go away. It helps with your symptoms if you take amitriptyline for pain relief or migraines.

When will I feel better?

You may find that you sleep better right away. But it usually takes 1-2 weeks for the pain to subside.

It may take 4 to 6 weeks before you feel the full benefits of amitriptyline as a pain reliever.

Do not stop taking amitriptyline after 1 to 2 weeks just because you feel it is not relieving your symptoms. Give it at least 6 weeks to take effect.

How do I feel with amitriptyline?

Many people sleep better while taking amitriptyline.

Although amitriptyline is an antidepressant, the doses are lower to reduce pain. Taking amitriptyline as a pain reliever will not change your personality or make you feel differently.

How long should I take amitriptyline?

Once you feel better, you will likely continue to take amitriptyline as long as it works as a pain reliever or to prevent migraines.

Some people take it for many months and even years.

Is it safe to take amitriptyline for a long time?

Amitriptyline is safe for long-term use. There do not appear to be any lasting negative effects from taking it for many months or years.

Is amitriptyline addictive?

Amitriptyline is not addictive, but you may experience additional side effects if you stop taking it suddenly. You may have flu-like symptoms such as nausea, muscle pain, and tiredness or restlessness.

To avoid this, your doctor will probably recommend gradually reducing your dose over several weeks, or longer if you have been taking amitriptyline for a long time.

What happens if I stop taking amitriptyline?

Additional side effects may occur when you stop taking amitriptyline, especially if you stop taking it suddenly.

These side effects are a physical reaction when the medicine leaves your body. You may have flu-like symptoms such as nausea, muscle pain, and tiredness or restlessness.

To avoid this, your doctor will probably recommend gradually reducing your dose over several weeks, or longer if you have been taking amitriptyline for a long time.


Do not stop taking amitriptyline suddenly or without consulting your doctor.

Will I gain or lose weight?

Amitriptyline can change the feeling of hunger. Some people feel more hungry when they take it, others feel less hungry. Therefore, your weight may change once you start taking it.

If you start to have weight problems while taking amitriptyline, talk to your doctor or pharmacist.

Can I drive a car or ride a bike?

Some people feel sleepy while taking amitriptyline. It is best to stop driving and cycling for the first few days of treatment until you know how this medicine makes you feel.

Are there other treatments for nerve pain or migraines?

Antidepressants like amitriptyline are just one of several ways to treat nerve pain or prevent migraines. Other treatments include:

  • painkillers likeParacetamol
  • Commonly Used MedicationsEpilepsyandpregabalin
  • Drugs commonly used for treatmenthigh pressureyou know propranolol
  • physical therapy

Choosing the most suitable treatment for you depends on:

  • how long have you been in pain
  • your symptoms
  • which medications have or have not worked for you in the past
Can I drink alcohol with amitriptyline?

You can drink alcohol while taking amitriptyline, but it may cause drowsiness. It's usually best to stop drinking alcohol until you see how the drug makes you feel.

Is there any food or drink that I should avoid?

In addition to avoiding drinking too much alcohol, you can eat and drink normally while taking amitriptyline.

Does this affect my birth control?

Amitriptyline does not affect any type of birth control, includingcombination pillmiemergency contraception.

Will amitriptyline affect my sex life?

Some people have sexual problems while taking amitriptyline. This may include:

  • Men who have trouble getting an erection and have trouble ejaculating
  • Women with some vaginal bleeding
  • Men and women with swollen breasts

Sexual side effects are not common and should pass after the first few weeks. If not, and this is a problem for you, contact your doctor to see if there is another medication you can try.

If you are a woman and you canvaginal bleeding after menopause, make an appointment with your doctor as soon as possible.

Will amitriptyline affect my fertility?

There is no clear evidence that amitriptyline affects male or female fertility.

Do recreational drugs affect amitriptyline?

Cannabis with amitriptyline can make you very sleepy, especially if this is your first time using amitriptyline. Cannabis with amitriptyline can also cause rapid heartbeat.

It is potentially dangerous to take amitriptyline with:

  • methadone
  • Stimulants such as MDMA (ecstasy) or cocaine
  • Hallucinogens like LSD
  • new psychoactive substances (formerly called "legal highs") such as mephedrone

Amitriptyline has not been adequately tested with recreational drugs. Talk to your doctor if you think you may be taking recreational drugs while taking amitriptyline.

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