Amitriptyline: a medicine used to treat pain and prevent migraine - NHS

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Amitriptyline for pain and migraine

On this page

  1. About amitriptyline for pain and migraine
  2. Key facts
  3. Who can and cannot take amitriptyline
  4. How and when to take amitriptyline
  5. Side effects
  6. How to cope with side effects of amitriptyline
  7. Pregnancy and breastfeeding
  8. Cautions with other medicines
  9. Common questions about amitriptyline

1. About amitriptyline for pain and migraine

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

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

Amitriptyline is also used to treat depression.

2. Key facts

  • It's best to take your 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.
  • Amitriptyline is also used to treat depression, but at lower doses it's very good for treating pain.

3. Who can and cannot take amitriptyline

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

Amitriptyline is not suitable for some people. Check with your doctor before starting to take amitriptyline 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 a rare blood disorder called porphyria
  • have liver or kidney problems
  • have epilepsy – amitriptyline can increase seizures or fits
  • have ever taken any medicines for depression – some antidepressants used rarely can affect the way amitriptyline works
  • are pregnant, trying to become pregnant, or breastfeeding
  • have an eye problem 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

If you have diabetes, amitriptyline may change your blood sugar level. If 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 the reading goes too high or low.

4. How and when to take amitriptyline

It's usual to take amitriptyline once a day. It's best to take it before bedtime because it can make you feel sleepy. If you find that you are still feeling drowsy in the morning you could try taking it earlier in the evening.

This medicine 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 comes with a plastic syringe or spoon to help you measure out the right dose. If you don't have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give the right amount.

Dosage

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

The liquid also comes in 3 different strengths – containing 10mg, 25mg or 50mg of amitriptyline in a 5ml spoonful.

The usual starting dose for adults and older children (aged 12 to 17 years) is 10mg a day. This dose can be increased by your doctor 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 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.

What if I forget to take it?

If you forget to take your amitriptyline, take it as soon as you remember, unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next one as normal.

If amitriptyline usually makes you sleepy and you need to drive, cycle or use tools or machinery, skip the missed dose and then take the next dose as normal.

Never take 2 doses at the same time. Never take 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.

What if I take too much?

Urgent advice: Contact 111 for advice now if:

  • you take more than your usual dose of amitriptyline

Go to or call 111

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

5. Side effects

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

Some of the common side effects of amitriptyline gradually improve as your body gets used to the medicine.

Common side effects

Doses of amitriptyline for pain are lower than the doses for depression. This means the common side effects tend to be milder and go away within a few days.

Keep taking the medicine but talk to your doctor or pharmacist if these side effects bother you or do not go away:

  • constipation
  • dizziness
  • dry mouth
  • feeling sleepy
  • difficulty peeing
  • headache

Serious side effects

It happens rarely, but some people have a serious side effect after taking amitriptyline.

Call a doctor straight away if you have:

  • a fast or irregular heartbeat
  • yellow skin, or the whites of your eyes go yellow – these can be signs of a liver problem
  • a headache, feel confused or weak, or get muscle cramps – these can be signs of a low sodium level in your blood
  • thoughts about harming yourself or ending your life
  • eye pain, a change in your eyesight, swelling or redness in or around your eye

Immediate action required: Call 999 or go to A&E if:

  • you have weakness on one side of your body, trouble speaking or thinking, loss of balance or blurred eyesight – these can be signs of a stroke
  • you have had a seizure or fit
  • you get severe chest pain – this can be a sign of a heart attack

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to amitriptyline.

Immediate action required: Call 999 or go to A&E if:
  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of amitriptyline. For a full list see the leaflet inside your medicine packet.

Information:

If you have other possible side effects, you can report them using the Yellow Card safety scheme.

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6. How to cope with side effects of amitriptyline

What to do about:

  • constipation – eat more high-fibre foods such as fresh fruit and vegetables and cereals. Try to drink several glasses of water or other non-alcoholic drinks every day. If you can, it may also help to do some exercise.
  • dizziness – this is probably due to low blood pressure. Drink plenty of water or other non-alcoholic drinks. Do not stand up too quickly after you have been sitting or lying down.
  • dry mouth – try sugar-free gum or sugar-free sweets.
  • feeling sleepy or tired – take amitriptyline in the evening and cut down on the amount of alcohol you drink. Do not drive, cycle or use tools or machinery if you're feeling this way.
  • difficulty peeing – relax when you try to pee. Do not try to force the flow of urine. If you still cannot go, try again later. Talk to your doctor urgently if you cannot pee at all.
  • headaches – make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Try taking paracetamol or ibuprofen if you need pain relief. Talk to your doctor if the headaches last longer than a week or are severe.

7. Pregnancy and breastfeeding

Amitriptyline and pregnancy

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

Talk to your doctor as there may be other painkillers you can take instead of amitriptyline. Paracetamol is usually the first choice of painkiller if you're pregnant or breastfeeding.

Your doctor will only prescribe amitriptyline for your pain while you're pregnant if the benefits of taking the medicine outweigh the risks.

Amitriptyline and breastfeeding

Amitriptyline is not usually recommended if you're breastfeeding.

Amitriptyline gets into breast milk. It's been linked with side effects like sleepiness in breastfed babies.

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

Non-urgent advice: Tell your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

For more information about how this medicine can affect you and your baby during pregnancy, .

You can also read more about paracetamol in pregnancy on the NHS website.

8. Cautions with other medicines

Many medicines and amitriptyline can affect each other and increase the chances of side effects.

Always check with your doctor or a pharmacist before starting any new medicine while you are taking amitriptyline.

Taking opioid-based medicines, like codeine, morphine or oxycodone, together with amitriptyline can increase your risk of becoming very drowsy and having breathing problems.

Tell your doctor if you have ever taken any medicines for depression. Some antidepressants can affect the way amitriptyline works to cause very high blood pressure. This can happen even after you have stopped taking them.

Mixing amitriptyline with herbal remedies and supplements

Do not take St John's wort, a herbal remedy often taken for depression, while you are being treated with amitriptyline. It will increase your risk of side effects.

There’s very little information about taking amitriptyline with other herbal remedies and supplements. They are not tested in the same way as medicines.

Important

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

9. Common questions about amitriptyline

How does amitriptyline work?

Amitriptyline is from a group of medicines called tricyclic antidepressants.

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

This can also change the way that your nerves receive pain signals so pain goes away. This helps your symptoms if you are taking amitriptyline for pain relief or migraine.

When will I feel better?

You may find you are sleeping better straight away. But it usually takes 1 or 2 weeks for pain to begin to wear off.

It can take between 4 and 6 weeks before you feel the full benefits of amitriptyline as a painkiller.

Do not stop taking amitriptyline after 1 to 2 weeks just because you feel it's not helping your symptoms. Give it at least 6 weeks to work.

How will amitriptyline make me feel?

Many people sleep better while they're taking amitriptyline.

Although amitriptyline is an antidepressant, the doses are lower to help pain. Taking amitriptyline as a painkiller will not change your personality or make you feel any different.

How long will I take amitriptyline 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.

Is it safe to take amitriptyline for a long time?

Amitriptyline is safe to take for a long time. There do not seem to be any lasting harmful effects from taking it for many months or years.

Is amitriptyline addictive?

Amitriptyline is not addictive but you can get extra side effects if you stop taking it suddenly. You may have flu-like symptoms like feeling sick, muscle pain and feeling tired or restless.

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

What will happen when I stop taking amitriptyline?

You may get extra side effects when you stop taking amitriptyline, especially if you stop taking it suddenly.

These side effects are a physical reaction as the medicine leaves your system. You may get flu-like symptoms like feeling sick, muscle pain and feeling tired or restless.

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

Important

Do not stop taking amitriptyline suddenly, or without talking to your doctor.

Will I gain or lose weight?

Amitriptyline can change how hungry you feel. Some people feel more hungry when they're taking it – others feel less hungry. So your weight may change when you first start taking it.

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

Can I drive or ride a bike?

Some people feel sleepy while they're 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 migraine. Other treatments include:

Choosing a treatment that's most suitable for you depends on:

  • how long you've had the pain
  • your symptoms
  • what medicines have worked or not worked for you in the past
Can I drink alcohol with amitriptyline?

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 makes you feel.

Is there any food or drink I need to avoid?

Apart from avoiding drinking too much alcohol, you can eat and drink normally while taking amitriptyline.

Will it affect my contraception?

Amitriptyline does not affect any type of contraception including the combined pill and emergency contraception.

Will amitriptyline affect my sex life?

Some people have sex-related problems while taking amitriptyline. These can include:

  • men having problems with getting an erection and problems with ejaculating
  • women having some vaginal bleeding
  • both men and women having breast swelling

Sexual side effects are not common and should pass after the first couple of weeks. If they do not, and this is a problem for you, go back to your doctor to see if there's another medicine you can try.

If you're a woman and you get vaginal bleeding after the menopause, make an appointment to see your doctor as soon as possible.

Will amitriptyline affect my fertility?

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

Will recreational drugs affect amitriptyline?

Cannabis with amitriptyline can make you feel very sleepy, especially if you've just started taking amitriptyline. Cannabis with amitriptyline can also give you a fast heartbeat.

It is potentially dangerous to take amitriptyline with:

  • methadone
  • stimulants like MDMA (ecstasy) or cocaine
  • hallucinogens like LSD
  • novel psychoactive substances (previously called "legal highs") like mephedrone

Amitriptyline has not been properly tested with recreational drugs. Talk to your doctor if you think you might use recreational drugs while taking amitriptyline.

Useful resources

Page last reviewed: 16 September 2020
Next review due: 16 September 2023