Amitriptyline is best for pain and migraine

Amitriptyline contains Amitriptyline, a tricyclic antidepressant. It has anticholinergic and sedative properties. It prevents the reuptake, and hence the inactivation of neurotransmitters called noradrenaline and serotonin, that are present at the nerve terminals in our brain. Reuptake prevention of these monoamine neurotransmitters potentiate their action in the brain. This appears to be associated with the antidepressant activity and helps in regulating the mood. It also stops the transmission of pain signals from nerves to the brain thereby relieving neuropathic pain (pain from damaged nerves).

Amitriptyline is a medicine used for treating pain. You can take it:

• to treat nerve pain (neuralgia) and pain that lasts a long time
• to help prevent migraines

Amitriptyline is only available on prescription. It comes as tablets and as a liquid that you swallow.

Amitriptyline is also used to treat depression. The doses used to treat pain are lower than the doses for depression. Taking amitriptyline for pain will not have the same effect as taking it for depression.

Key facts

It’s best to take Amitriptyline in the evening or before you go to bed. This is because it can make you feel sleepy.

You may start to feel better after 1 or 2 weeks, but it can take 6 weeks for amitriptyline to work as a painkiller.

Amitriptyline can cause extra side effects if you stop taking it suddenly. Talk to your doctor if you want to stop taking it.

Do not drive, cycle or operate heavy machinery if amitriptyline makes you feel sleepy.

You can drink alcohol while taking amitriptyline but it may make you feel sleepy. It’s usually best to stop drinking alcohol until you see how the medicine affects you.

Who can and cannot take amitriptyline 

Most adults aged 18 years old and over can take amitriptyline. Children aged 2 years old and over can take it for some types of nerve pain.

Who may not be able to take amitriptyline for pain and migraine

Amitriptyline is not suitable for some people. To make sure it’s safe for you, tell your doctor if you:

• have ever had an allergic reaction to amitriptyline or any other medicine
• have a heart problem – amitriptyline can make some heart problems worse
• have liver or kidney problems
• have epilepsy – amitriptyline can increase seizures or fits
• have ever taken any medicines for depression – some antidepressants can affect the way amitriptyline works
• are pregnant, trying to get pregnant, or breastfeeding
• have an eye condition called glaucoma – amitriptyline can increase the pressure in your eye
• have thoughts about harming yourself or ending your life
• have type 1 or type 2 diabetes

Amitriptyline may affect your blood sugar levels. If you have diabetes and you usually test your blood sugar levels, you may have to do this more often for the first few weeks of treatment. Talk to your diabetes doctor if your blood sugar goes too high or low.

How and when to take amitriptyline

Always follow the instructions from a pharmacist or doctor or the leaflet in the medicine packet.

Dosage

Amitriptyline comes in 3 different strengths. It comes as:

• tablets containing 10mg, 25mg or 50mg
• liquid containing 10mg, 25mg or 50mg in a 5ml spoonful

The usual starting dose for adults and children aged 12 to 17 years old is 10mg a day. Your doctor can increase this dose if you need better pain relief.

The starting dose for children aged 11 years old and under depends on their weight and symptoms. The doctor will tell you how much to give them.

The maximum dose of amitriptyline for treating pain is 75mg a day. Your doctor may give you a higher dose if you’re taking it to prevent migraine.

How to take it

You’ll usually take amitriptyline once a day. It’s best to take it before you go to bed because it can make you sleepy. If you still feel drowsy in the morning you could try taking it earlier in the evening.

Amitriptyline does not usually upset your stomach. You can take it with or without food.

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

The liquid amitriptyline will come with a plastic syringe or spoon to help you measure out the right dose. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

How long to take it for

Once you’re feeling better, you’ll probably continue to take amitriptyline for as long as it’s working for you as a painkiller or to help prevent migraines.

Some people take it for many months and even for years but it should be reviewed regularly with your doctor.

If you forget to take it

If you forget a dose of amitriptyline, take it as soon as you remember, unless it’s nearly time for your next dose. In this case, skip the missed dose and take your next dose at the usual time.

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

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.