What is amitriptyline

Active ingredient: amitriptyline

Drug class: tricyclic antidepressant (TCA)

Common strengths in the US: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg tablets. Some pharmacies may primarily stock 25 mg and 50 mg.

Amitriptyline is most often prescribed to help manage depression. Clinicians also use it for several other conditions when appropriate. If you are new to the medicine, jump to How to take it and Warnings.

Approved and common uses

Main indication: treatment of depression in adults.

Other clinician-directed uses: Your prescriber may recommend amitriptyline for certain conditions based on clinical judgment. Examples include sleep maintenance insomnia, neuropathic pain, migraine prevention, functional GI pain, or post-concussive headache. These uses are off-label and depend on individual assessment.

If you do not notice improvement after a few weeks, or if symptoms worsen, speak with your clinician promptly. For safety topics, see Side effects and Interactions.

How to take amitriptyline

Always follow the exact directions on your prescription label. The following are general points, not dosing advice:

  • Take with or without food; many people take it in the evening because it can be sedating.
  • Avoid grapefruit or grapefruit juice while using amitriptyline. For details, see Interactions.
  • Symptom improvement may take 2 to 4 weeks, with some benefits seen earlier. Continue exactly as prescribed unless your prescriber tells you to stop.
  • Do not double up if a dose is missed. See Missed dose.
  • Do not stop suddenly without medical guidance; tapering may be needed to reduce withdrawal-like symptoms.

How it works

Amitriptyline is a tricyclic antidepressant. While the full picture is complex, it increases the activity of certain brain chemicals that regulate mood, especially serotonin and norepinephrine, and blocks specific receptors that can influence pain and sleep. These combined effects can help relieve depression and some types of chronic pain.

Missed dose

If you take amitriptyline regularly and miss a dose, take it when remembered unless it is close to the time for your next dose. Skip the missed dose rather than taking two together.

Storage and handling

Store at 68 to 77 F (20 to 25 C). Brief excursions between 59 and 86 F (15 to 30 C) are acceptable. Protect from moisture, heat, and light. Keep away from pets and children. Do not store in a bathroom.

Important warnings and precautions

Do not use amitriptyline if any of the following apply to you unless your clinician has specifically cleared it:

  • You are taking a monoamine oxidase inhibitor (MAOI) or have taken one in the past 14 days.
  • You are allergic to amitriptyline or any tablet ingredient.
  • You are recovering from a recent heart attack.
  • You are taking medicines known to cause serious heart rhythm problems when combined with certain TCAs. See Interactions.

Tell your clinician before starting if any of the below apply:

  • Pregnancy, trying to conceive, or breastfeeding.
  • Use of any prescription, OTC, herbal, or supplement products.
  • History of mental health conditions such as bipolar disorder, mania, or prior suicidal thoughts or attempts.
  • Regular alcohol intake (for example 3 or more drinks per day) or alcohol use disorder.
  • Glaucoma, heart disease or rhythm problems, chest pain, thyroid problems, liver disease, enlarged prostate or urinary retention.
  • Seizure history, epilepsy, or porphyria.

Boxed warning: Antidepressants may increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults. Monitor closely during initiation and dose changes. Seek immediate medical help if concerning mood or behavior changes appear.

Drug and food interactions

Always provide your care team with a complete, up-to-date list of everything you take. Important interactions include:

  • MAOIs such as phenelzine or selegiline - do not combine or use within 14 days due to risk of severe reactions.
  • Medications that can affect heart rhythm: certain macrolide antibiotics (for example erythromycin), ketolides (telithromycin), some antihistamines like diphenhydramine, cisapride, droperidol, mibefradil, pimozide, and some streptogramins - risk of dangerous arrhythmias may rise.
  • SSRIs such as fluoxetine, and other agents like terbinafine, fluconazole, valproic acid, cimetidine, phenothiazines, or bupropion - may increase amitriptyline levels and side effects including drowsiness, dry mouth, blurry vision, or urinary retention.
  • Thyroid medications (for example levothyroxine), stimulants (for example albuterol, pseudoephedrine), or carbamazepine - side effects could be amplified or blood levels altered.
  • Warfarin - bleeding risk may increase; monitoring is advised.
  • Clonidine, guanethidine, or guanfacine - their blood pressure lowering effects may be reduced.
  • Anticholinergics such as scopolamine - may intensify dry mouth, constipation, and urinary retention.

Food and drink: avoid grapefruit and grapefruit juice because they can affect drug metabolism. Limit alcohol, which can add sedation and impair judgment.

Side effects - what to expect and when to seek help

Common effects, often mild and dose-related:

  • Drowsiness, dizziness, or fatigue
  • Dry mouth, constipation, or difficulty urinating
  • Blurred vision or headache
  • Nausea, reduced appetite, or diarrhea
  • Insomnia or changes in sexual desire or function
  • General weakness

Seek urgent medical care if you notice:

  • Allergic reactions such as hives, rash, swelling of lips or tongue, or trouble breathing
  • Chest pain, fainting, very fast or irregular heartbeat
  • Confusion, hallucinations, delusions, or severe agitation
  • Seizure, severe headache, one-sided weakness, slurred speech, or numbness
  • High fever, chills, or sore throat that does not resolve
  • Yellowing of the skin or eyes, dark urine, or severe abdominal symptoms
  • Uncontrolled muscle movements or tremors
  • New or worsening anxiety, panic, irritability, aggression, or suicidal thoughts
  • Unusual bleeding or bruising

If side effects interfere with daily life, contact your prescriber. A dose adjustment or a different medicine may help. To review interaction-related symptoms, return to Interactions.

Alternatives and similar medications

Depending on your diagnosis and medical history, your clinician may consider these options if amitriptyline is not suitable or not effective:

  • Other tricyclic antidepressants: nortriptyline, imipramine, desipramine - often similar in effect, with some differences in side-effect profile and tolerability.
  • SSRIs: sertraline, fluoxetine, escitalopram, paroxetine - commonly used first-line for depression and anxiety with generally fewer anticholinergic effects.
  • SNRIs: venlafaxine, duloxetine, desvenlafaxine - useful for depression and certain pain syndromes like diabetic neuropathy or fibromyalgia.
  • Atypical antidepressants: bupropion, mirtazapine, trazodone - chosen based on target symptoms such as low energy, insomnia, or sexual side effects.
  • Neuropathic pain agents: gabapentin, pregabalin, duloxetine - options when pain control is a primary goal.
  • Headache and migraine prevention: propranolol, topiramate, venlafaxine - alternatives when migraines are the main issue.

Always review benefits and risks with your prescriber before switching therapies. For pricing comparisons, see Prices in the USA.

Rough price comparison in the USA (USD)

Prices vary widely by pharmacy, insurance plan, and tablet strength. The following are typical cash price ranges for generics without insurance, as of recent US retail data:

  • Amitriptyline 25 mg or 50 mg - 30 tablets: about $3 to $15 at discount pharmacies, often $10 to $30 elsewhere.
  • Amitriptyline 10 mg or 75 mg - 30 tablets: commonly $5 to $25 depending on supply and location.
  • 90-day fills: multiply the 30-day cost by roughly 2.5 to 3.2, with additional discounts sometimes available.
  • Comparators: SSRIs like sertraline or fluoxetine often cost $4 to $15 for 30 tablets with discounts; SNRIs like duloxetine may run $8 to $40 for 30 capsules; gabapentin can range $5 to $25 for 30 to 60 capsules.

Brand-name Elavil is generally not marketed in the US today; generic amitriptyline is the norm. To verify the best local price, check reputable tools like your insurer directory or major pharmacy price finders.

More information and support

If you have questions about amitriptyline, talk with your prescriber or pharmacist. This medicine should be used only by the person for whom it was prescribed. If you experience severe or unexpected symptoms, seek medical care immediately.

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