💊 Amitriptyline (Amitriptyline Hydrochloride)
Amitriptyline hydrochloride is a prescription medicine used for the relief of symptoms of depression. It has a sedative effect, which may be noticed before the antidepressant effect. It should be taken only as directed by your doctor.
In Arabic: أميتريبتيلين
✅ What it is used for
- Relief of symptoms of depression
- Endogenous depression is more likely to be alleviated than other depressive states
🧪 Active ingredient
The active ingredient is amitriptyline hydrochloride, an antidepressant with sedative effects. It inhibits the reuptake of norepinephrine and serotonin in neurons, which is believed by some to underlie its antidepressant activity; its exact mechanism of action in humans is not known.
🌿 Benefits
- Relief of depression symptoms
- Sedative effect that may appear before the antidepressant effect
📝 How to use
- Taken by mouth.
- The dose and duration are set by your doctor or pharmacist; do not change them without consulting them.
- Treatment usually starts at a low dose and is increased gradually based on response and tolerance.
- A sedative effect may appear before the antidepressant effect, and an adequate therapeutic effect may take as long as 30 days to develop.
- Maintenance doses may be given once daily, preferably at bedtime.
- Maintenance therapy is usually continued for 3 months or longer to lessen the possibility of relapse.
- Do not stop suddenly after long-term use; your doctor may reduce the dose gradually.
💊 Dosage forms
- Film-coated tablets in strengths of 10, 25, 50, 75, 100 and 150 mg
⚠️ Common side effects
- Dry mouth
- Constipation
- Blurred vision
- Drowsiness and dizziness
- Headache
- Weakness and fatigue
- Weight gain or loss
- Palpitations and fast heart rate
- Urinary retention
- Increased sweating
- Nausea, vomiting, epigastric distress
- Insomnia, nightmares, anxiety
🚨 Serious — seek medical help
- Suicidal thoughts or behavior, especially in children, adolescents and young adults
- Myocardial infarction and stroke
- Arrhythmias and heart block
- Seizures and coma
- Hallucinations, delusions, confusion
- Bone marrow depression (agranulocytosis, leukopenia, thrombocytopenia)
- Hepatitis and jaundice
- Increased eye pressure
- Neuroleptic malignant syndrome-like or serotonin syndrome (very rare)
- Swelling of face and tongue, rash (allergic reactions)
- Hyponatremia
⛔ Do not use if
- Prior hypersensitivity to amitriptyline
- Concomitant use with monoamine oxidase inhibitors (MAOIs); at least 14 days must pass after stopping an MAOI before starting amitriptyline
- Concomitant use with cisapride due to risk of QT prolongation and arrhythmia
- The acute recovery phase following myocardial infarction
❗ Warnings & precautions
- Boxed warning: antidepressants may increase the risk of suicidal thinking and behavior in children, adolescents and young adults (up to age 24) in short-term studies. Patients of all ages should be monitored closely for clinical worsening, suicidality or unusual changes in behavior.
- Families and caregivers should stay in close contact with the prescriber.
- Not approved for use in pediatric patients.
- Elderly patients are particularly sensitive to anticholinergic effects and may be at increased risk of falls.
- Withdrawal symptoms (nausea, headache, malaise, irritability, restlessness, sleep disturbance) may occur with abrupt cessation after prolonged use; these are not indicative of addiction.
- Rare cases of mania or hypomania have been reported after stopping chronic therapy.
- Drug levels may be higher in people with reduced CYP2D6 activity (poor metabolizers).
🔄 Drug interactions
- MAOIs: contraindicated (risk of hyperpyretic crises, severe convulsions, deaths)
- Cisapride: contraindicated due to arrhythmia risk
- Topiramate: a large increase in amitriptyline concentration may occur
- CYP2D6 inhibitors such as quinidine, cimetidine, other antidepressants, phenothiazines, propafenone and flecainide may cause abrupt toxicity
- SSRIs (e.g., fluoxetine, sertraline, paroxetine): caution; sufficient time (at least 5 weeks may be necessary) must elapse after stopping fluoxetine before starting a TCA
- Alcohol and other drugs: multiple drug ingestion is common in overdose; tell your doctor about everything you take
🤰 Pregnancy
There are no adequate and well-controlled studies in pregnant women. Amitriptyline crosses the placenta, and there have been a few reports of CNS effects, limb deformities or developmental delay in infants of mothers who took it during pregnancy, although a causal relationship has not been established. It should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the fetus, as decided by the doctor.
🍼 Breastfeeding
Amitriptyline is excreted into breast milk. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the mother.
🧒 Children
Not approved for use in pediatric patients; safety and effectiveness have not been established, and it is not recommended for patients under 12 years of age. The drug carries a boxed warning about increased suicidality in children and adolescents, and potential risks must be balanced against clinical need.
👴 Older adults
Treatment is generally started at low doses with close observation. Elderly patients are particularly sensitive to anticholinergic effects (tachycardia, urinary retention, constipation, dry mouth, blurred vision, worsening of narrow-angle glaucoma, cognitive impairment, confusion, sedation, delirium) and may be at increased risk for falls.
🌡️ Storage
Store at 20° to 25°C (68° to 77°F) in a tight, light-resistant container.
⏰ Missed dose
The label does not give specific instructions for a missed dose. Ask your doctor or pharmacist, and do not double the dose without guidance.
🆘 Overdose
Deaths may occur from overdosage with this class of drugs. Signs of toxicity develop rapidly and include cardiac dysrhythmias, severe hypotension, convulsions and CNS depression including coma. Contact a poison control center or go to the nearest emergency department immediately for hospital monitoring.
💰 Price & brands in your area
🏛️ Official price in Palestine — Ministry of Health price list:
| Product | Company | Pack | Price |
|---|---|---|---|
| AMITRIPTYLINE TEVA 10 MG 28 TAB AMITRIPTYLINE | Teva | 28 TAB | 12 ₪ |
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Mechanism of action
A sedative tricyclic antidepressant (dibenzocycloheptadiene derivative) that inhibits the membrane pump mechanism responsible for uptake of norepinephrine and serotonin in adrenergic and serotonergic neurons; its mechanism in man is not known. It is not an MAO inhibitor and does not act primarily by CNS stimulation.
Labeled dosing
General adult dosing per the label; actual dosing is determined by the physician. Outpatients: 75 mg/day in divided doses, increased if necessary to 150 mg/day, or start with 50 to 100 mg at bedtime, increased by 25 or 50 mg to a total of 150 mg/day. Hospitalized patients: 100 mg/day initially, up to 200 mg/day, and a small number may need up to 300 mg/day. Adolescent and elderly patients: lower dosages (e.g., 10 mg three times daily with 20 mg at bedtime). Usual maintenance dose 50 to 100 mg/day (40 mg/day is sufficient in some); may be given as a single bedtime dose, reduced to the lowest amount that maintains relief, and continued 3 months or longer.
- Adequate antidepressant effect may take up to 30 days.
- Plasma levels correlate poorly with therapeutic effect; they may help identify toxicity, excessive levels or non-compliance, and dose adjustments should follow clinical response, not plasma levels.
- Plasma levels are generally higher in elderly patients for a given dose due to increased intestinal transit time and decreased hepatic metabolism.
- Higher doses should be avoided in adolescents and elderly patients who do not tolerate them.
- Overdose management involves ECG, cardiac monitoring, airway protection, gastric decontamination, at least six hours of observation, and consultation with a poison control center.
🎓 Key points for students
- Class: tricyclic antidepressant inhibiting norepinephrine and serotonin reuptake.
- Indication: symptoms of depression; endogenous depression more likely to respond.
- Contraindications: hypersensitivity, MAOIs (14-day washout), cisapride, acute recovery phase after MI.
- Boxed warning: increased suicidality in children, adolescents and young adults up to age 24.
- Anticholinergic effects: dry mouth, constipation, urinary retention, blurred vision, increased ocular pressure.
- CYP2D6 interactions: inhibitors (SSRIs, quinidine, cimetidine) raise TCA levels; about 7 to 10% of Caucasians are poor metabolizers.
- Toxicity: cardiac dysrhythmias, hypotension, seizures, CNS depression, and ECG changes (widened QRS, prolonged QT).
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What is amitriptyline used for?
It is used for the relief of symptoms of depression, and endogenous depression is more likely to be alleviated.
How long does it take to work?
A sedative effect may appear early, but an adequate antidepressant effect can take as long as 30 days.
Can I stop it suddenly?
Stopping suddenly after long-term use is not advised; nausea, headache, malaise, irritability and sleep disturbance may occur. Your doctor will reduce the dose gradually.
Is it suitable for children?
It is not approved for pediatric use and is not recommended under 12 years of age; it carries a boxed warning about increased suicidality in children and adolescents.
Can I take it during pregnancy or breastfeeding?
It should be used in pregnancy only if the benefit justifies the risk. It passes into breast milk, so your doctor will decide what is appropriate.
Which medicines must not be combined with amitriptyline?
MAOIs and cisapride are contraindicated, and caution is needed with SSRIs, topiramate and other drugs affecting CYP2D6.
⚕️ For education only — not a substitute for advice from your doctor or pharmacist. Do not start or stop any medicine without advice. Source: official FDA drug label via openFDA (2026-09), simplified. Updated: 2026-11-11.