thoughtscape NP Psychiatry · Patient education
Amitriptyline
Elavil • tablets: 10–150 mg in six strengths
An older antidepressant also used for some pain conditions. The dose and safety plan depend on the reason for treatment.
Draft for review · Clinical content has not been revalidated for this website.
Your prescription sets the dose and timing. Do not move divided doses to bedtime or increase them yourself.
What it is used for
Treats depression in adults. Lower doses are also used off-label for nerve pain, headache prevention, fibromyalgia, or selected IBS symptoms.
A low pain dose may not treat depression. Feeling sleepy is not the same as improvement in mood.
How it works
It changes serotonin and norepinephrine signaling involved in mood and pain pathways.
Other actions contribute to dry mouth, constipation, sleepiness, dizziness, and cardiac risk—not just useful effects.
What to expect over time
EARLY DAYS
Sleepiness, dry mouth, or dizziness may appear before benefit. Report troublesome effects; do not simply push through them.
OVER SEVERAL WEEKS
Pain and mood responses vary. Keep follow-up appointments and agreed symptom targets; do not wait if mood worsens.
ONGOING REVIEW
Review benefit, function, side effects, and the amount of medicine kept at home. Make stopping a planned decision.
Taking your medication
Take exactly as prescribed, with or without food. Some regimens are taken at bedtime; others use divided doses. Do not combine them yourself.
Your clinician usually starts low and increases gradually. Pain doses are often lower than depression doses; tablet strength is not your daily dose.
Avoid alcohol. Do not drive until you know your response. Rise slowly, use sun protection and ask for a taper before stopping.
When to get help
Any suspected overdose: get emergency advice immediately, even without symptoms. Call Poison Help: 1-800-222-1222. Do not induce vomiting.
Get urgent care: fainting, irregular heartbeat, fever with confusion or muscle stiffness, severe belly pain, inability to urinate, or painful eye/vision changes.
Call 911: collapse, seizure, breathing trouble, inability to wake, or immediate self-harm danger. Report suicidal thoughts, worsening mood, or marked activation promptly.
Early side effects
Dry mouth, constipation, blurred vision, sleepiness, and dizziness on standing are common. Sugar-free gum, dental care, suitable fluids, fiber, and activity may help; persistent constipation needs treatment.
Other effects to discuss
Discuss weight, sexual effects, sweating, memory changes, or falls. Feeling too groggy or unlike yourself deserves review; do not change the dose on your own.
What to keep track of
Review mood, pulse, blood pressure, weight, bowel/bladder function, and falls. ECGs and blood tests depend on risk, symptoms, and interactions; a normal ECG does not eliminate future risk.
Before you start
Discuss heart disease or fainting, recent heart attack, bipolar disorder, seizures, glaucoma, urinary difficulty, severe constipation, liver disease, and overdose risk. Older adults may do better with an alternative. Tell your surgical or dental team before anesthesia. Discuss pregnancy and breastfeeding in advance; infant sedation and feeding problems need attention. Elavil is a former US brand. It is not FDA-approved for children.
Medicines & interactions
MAOIs and serotonin-raising drugs
MAOIs require a prescriber-directed washout, usually at least 14 days; timing depends on the medicines. Linezolid or IV methylene blue need coordinated care. Check tramadol, triptans, other antidepressants, and St. John's wort.
Medicines that raise levels or affect the heart
Fluoxetine, paroxetine, bupropion, and several other drugs can raise levels. Fluoxetine may require a longer gap before starting. Review heart-rhythm medicines, antibiotics, methadone, thyroid, and blood-pressure medicines.
Alcohol and OTC sleep/cold products
Avoid alcohol and check sedatives, diphenhydramine, other antihistamines, cold remedies, and supplements. Combinations can worsen sedation, confusion, constipation, urinary problems, or cardiac risk.
Everyday tips
Agree on the target: mood, pain, headaches, or bowel symptoms. Track function as well as symptom scores.
Keep the follow-up plan, especially after starting or changing a dose; monitor mood at every age, with added vigilance through age 24.
Tell your clinician about constipation or sexual effects early. Practical changes may help.
Discuss limited dispensing and secure storage if overdose risk is present. These reduce access; they cannot make an overdose safe.
Your questions, answered
What if I miss a dose?
Take it when remembered unless the next dose is near; then skip it. Never double. For a missed bedtime dose, ask if taking it late could impair you the next day. Check before restarting after several missed days.
Why a small supply or a heart tracing?
They are safety measures, not a judgment. Amitriptyline can affect heart conduction and is dangerous in overdose. ECGs are based on age, history, and other risks—not one universal age cutoff.
Can I stop once I feel better?
Do not stop abruptly. A personal taper over weeks or longer can reduce nausea, cramps, sweating, vivid dreams, and insomnia. It does not guarantee that withdrawal or symptoms will never return.
Will I need a blood level?
Sometimes, for interactions, unusual effects, or lack of benefit. Timing matters. A level within the reference range does not rule out toxicity or replace emergency overdose assessment.
Storage & safety
Keep the labeled container secured from children and pets, away from excess heat and moisture. Never share tablets. Ask your pharmacy about take-back disposal of unused medicine.
About this information
For general information only; not a substitute for individualized medical advice. This sheet does not cover every risk or interaction. Ask your prescriber or pharmacist before changing how you take this medication.
Sources
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.