Amitriptyline

What Is Amitriptyline?

Amitriptyline is a tricyclic antidepressant (TCA) that's been used for chronic pain since the 1960s. At lower doses than used for depression, it can be effective for neuropathic pain, fibromyalgia, headaches, and other chronic pain conditions. It's one of the most commonly prescribed medications for chronic pain.¹

Conditions It Treats²

Neuropathic pain
Fibromyalgia
Migraine prevention
Tension headache prevention
Chronic low back pain
Irritable bowel syndrome
Insomnia (related to pain)

How It Works

Increases serotonin and norepinephrine
Affects pain processing in the brain and spinal cord
Blocks sodium channels
Has sedating effects (helps sleep)
Pain relief independent of antidepressant effect

Dosing for Pain³

Usually start 10-25 mg at bedtime
Increase slowly every 1-2 weeks
Effective dose: 25-75 mg for most
Lower than depression doses
Takes 2-4 weeks to work

Common Side Effects

Drowsiness (often beneficial)
Dry mouth
Constipation
Weight gain
Blurred vision
Difficulty urinating
Morning grogginess

Managing Side Effects

Take at bedtime (drowsiness)
Stay hydrated (dry mouth)
Increase fiber (constipation)
Start low and go slow
Side effects often improve with time

Serious Considerations

Heart rhythm effects (avoid in heart disease)
Suicidal thoughts (young adults)
Overdose can be dangerous
Drug interactions
Don't stop suddenly—taper

Who Should Avoid

Recent heart attack
Certain heart rhythm problems
Glaucoma (narrow-angle)
Severe urinary retention
Taking MAO inhibitors

Effectiveness

One of most effective for nerve pain
Number needed to treat: 3-5
Many benefit at low doses
Also improves sleep

References

Moore RA, Derry S, Aldington D, et al. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015;7:CD008242.
Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162-173.
Jackson JL, Shimeall W, Sessums L, et al. Tricyclic antidepressants and headaches: systematic review and meta-analysis. BMJ. 2010;341:c5222.