Is Amitriptyline a High-Risk Medication?

December 21, 2022
Amitriptyline side effects
Is Amitriptyline a High-Risk Medication?

Amitriptyline is a generic name for Elavil (a medication that was discontinued in the US by the FDA). However, alternative generic versions of Elavil are still available in the market.

Amitriptyline is a prescription drug classified as a tricyclic antidepressant (TCA). It treats depression by balancing brain chemicals responsible for mood regulation: norepinephrine and dopamine. The process alleviates depression symptoms like tension, anxiety, and agitation while improving the mood of the patient. It is also used off-label for other conditions, including anxiety, insomnia, posttraumatic stress disorder, chronic pain, migraine prevention, and postherpetic neuralgia.

Even though the medicine has several benefits, Amitriptyline’s side effects may make it a high-risk medication. In this post, let’s learn more about possible risks as well as the ways to make the use of Amitriptyline safer.

Talk to your prescriber to know if the benefits of Amitriptyline outweigh the risks for you.

Amitriptyline Dosage

Amitriptyline is available in 10 mg, 25 mg, 50 mg, 75 mg, 100, and 150 mg oral tablets. The doctor may initially prescribe a low dosage and increase it gradually to reduce adverse reactions. Due to Elavil’s sleep effects, it usually is administered at bedtime.

The initial amitriptyline dose for depression is 25 mg per day which is increased to 50 to 100 mg maintenance dose per day given at bedtime. The dose is gradually reduced to the minimum required for symptom management.

It takes approximately four weeks to have the full effect from Elavil. A patient should only adjust Amitriptyline (Elavil) dosage or discontinue treatment with the doctor’s approval.

A Review of Side Effects

The side effects of Amitriptyline are common and usually mild. Severe reactions are rare.

Mild side effects may include the following:

  • Weight gain
  • Headaches
  • Dizziness or fainting
  • Dry mouth
  • Excessive sweating
  • Gastrointestinal upsets
  • Weight or appetite changes

Adverse effects from Elavil medication may include:

  • A coma
  • Temporary loss of consciousness
  • Abnormal heart rate
  • Black tongue and an unusual taste
  • Blurred vision
  • Conditions that affect the bone marrow
  • Convulsions or delusions
  • Heart problems
  • Intestinal obstruction (paralytic ileus)
  • Painful and difficult urination
  • Prolonged QT (disrupted electrical activity of the heart)
  • Reduced sex drive
  • Increased risk of stroke
  • Unusual bleeding and easy bruising

A person should urgent medical attention if he/she experiences any severe reaction.

Amitriptyline uses

Drug Interactions

There are several Amitriptyline interactions with some medications. Interactions with the following drugs can cause serious effects:

  • Asthma medication such as Bronchodilator
  • Allergy or cold medications like Benadryl
  • Antidepressants, or any other mental disorders drugs
  • Drugs used to treat irritable bowel syndrome, stomach conditions, or motion sickness
  • Narcotic pain medication
  • Medication to treat an overactive bladder
  • Parkinson’s disease medication
  • Insomnia medication
  • Herbal supplements and vitamins
  • Some prescription or over-the-counter medication

To prevent severe drug interaction, a patient should disclose to the doctor if he/she is or has been on any medication.

Contact your doctor if you experience any side effects to get your treatment plan adjusted.

Caution on Amitriptyline Use with MAOIs

It can be dangerous to take Elavil together with monoamine oxidase inhibitors (MAOIs). MAOIs belong to a different category of antidepressants. If Amitriptyline is used concurrently with MAOIs, it may cause severe serotonin syndrome leading to convulsions, extremely high fever, and sometimes even death. A patient should discontinue MAOIs for at least 14 days before commencing Amitriptyline dosage.

Some examples of MAOIs antidepressants include:

  • Isocarboxazid
  • Linezolid
  • Methylene blue injection
  • Moclobemide
  • Phenelzine
  • Selegiline
  • Tranylcypromine


Amitriptyline has several conditions a patient should be cautious about before taking it. The medication affects heart rhythm and may cause an irregular heartbeat.

Patients with the conditions below should consult a doctor before using Amitriptyline:

  • Schizophrenia since it may increase psychosis symptoms.
  • Bipolar as it can cause hypomania or mania.
  • Suicidal tendencies. Elavil may increase the risk of suicide.
  • Diabetes since it can cause high or low sugar levels.
  • If undergoing electroconvulsive therapy (ECT). It is essential to discontinue the Amitriptyline prescription several days before ECT.
  • Urinary retention
  • Alcohol addiction
  • An overactive thyroid gland
  • Enlarged prostate
  • Heart problems
  • Angle-closure glaucoma
Side effects of Amitriptyline


Amitriptyline is a prescription tricyclic antidepressant used to treat psychiatric disorders such as depression. It has many benefits, but because of serious interactions and contraindications, it is considered a high-risk medication that should be used cautiously. To avoid adverse effects, a patient should follow the doctor’s instructions. One should also seek professional help for dosage review, discontinuation, or in case of serious side effects. To know more about the most suitable medication for you, contact Mango Clinic today.


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