Amitriptyline

Medication name

Amitriptyline ("Ammy-TRIP-ti-leen")
Brand name

Elavil ("el-A-vill")
Medication type

Tricyclic antidepressant

Tablets: 10mg, 25mg and 50mg strengths available

Liquids: available in three strengths – 10mg per 5ml, 25mg per 5ml and 50mg per 5ml

If you are 18 or over, your doctor can prescribe amitriptyline for you as a licensed medicine for depression.

If you are under 18, a specialist doctor may still consider this as a treatment option. However, other medicines are now usually considered first because they are better tolerated at the doses needed to treat depression.

Read our guide to depression

About amitriptyline

Amitriptyline is a tricyclic antidepressant used to treat depression. ‘Tricyclic’ describes the chemical structure of the medicine and not how it works.

Serotonin (also called '5HT') and noradrenaline are naturally occurring chemical messengers (or ‘neurotransmitters’) that have an important role in areas of the brain that control mood, thinking, feelings and emotions. Research suggests that depression is more likely to occur when the brain doesn’t have enough of these chemical messengers.

Tricyclic antidepressants like amitriptyline are thought to work by increasing levels of serotonin and noradrenaline in the brain. They could be called ‘serotonin and noradrenaline reuptake inhibitors’ because they work by blocking these chemical messengers from being taken back up into the brain cells. This means that more serotonin and noradrenaline are available to act on the target sites, which helps treat your symptoms.

Depression, and other conditions like anxiety disorders, are not just caused by low serotonin and noradrenaline levels, but a rise in serotonin and noradrenaline levels can improve symptoms and help you to feel better.

Amitriptyline and everyday life

You should start to see some positive effects from amitriptyline after one to two weeks.

Your doctor is likely to increase your dose over the course of a month to find the right level for you, starting with a lower dose and gradually increasing it should help you to tolerate the medication better.

If you do not feel much better after four weeks, you should go back to your doctor to review your treatment.

How people respond to treatment can vary. Sometimes improvement is slow and you may not feel any different to start with. This can be hard when your mood is low. And if you experience any side effects from your medication you may actually think you feel worse and not better. If you can, it is really important to give your medication a chance to work and continue to take it for at least three to four weeks.

Your parents, friends and your doctor may notice an improvement in you before you feel it yourself. Talking to other people, your pharmacist or your doctor can help if you need support.

If you think your medicine has not made any difference to how you feel after three to four weeks, you should go back to your doctor as a change in dose or medication might be needed.

It can take longer to work for some people than others, your doctor may recommend that you continue to take it for six to eight weeks before deciding whether to change to a different medication.

Amitriptyline can cause people to lose or gain weight.

Amitriptyline has been reported to reduce appetite, although appetite can also return if this was poor because you were feeling unwell.

It is not possible to predict how amitriptyline will affect each person before they start taking it, but weight gain is common. Talk to your doctor or pharmacist if you are concerned about changes to your weight while taking amitriptyline.

A very common side effect of amitriptyline is a dry mouth. Over a long time, this can increase your risk of developing tooth decay or gum disease. Make sure you brush your teeth well and have regular dental check-ups. Speak to your dentist, doctor or pharmacist about things you can do to help.

You may want to let your family and friends know you are taking amitriptyline so they can support you and help you look out for side effects.

For guidance on this, check out our page on getting support with your medication.

Amitriptyline is sometimes used to help people sleep better and may cause you to feel very sleepy, especially when you first start taking it. This may be a problem if you continue to feel sleepy during the day as well as at night.

If it makes you feel drowsy, try taking it just before you go to bed.

In some people, amitriptyline can cause strange dreams. Talk to your doctor if this happens for more than the first few nights.

If you have been taking amitriptyline for more than a month and you continue to feel very tired, sleepy or not able to function during the day, you should go back to your doctor and discuss what changes could be made to help. This may include switching to a different medication.

Alcohol

It may be possible to drink some alcohol in moderation while taking amitriptyline. However, the two together might make you feel very sleepy and unsteady on your feet, especially when you first start taking the medication. It will also make you less alert when doing things that need focus, like driving.

During the first few weeks of treatment, it is recommended that you don’t drink alcohol until you know how the medicine affects you.

Drinking alcohol every day, or in large amounts, can make your symptoms worse and may mean you won’t get the maximum benefit from your medication.

Street drugs

Amitriptyline does not mix well with recreational drugs.

If you mix cannabis and amitriptyline, you could get a fast heartbeat.

Cannabis and other drugs may have their own side effects on your mental health, like anxiety or psychosis.

If you take heroin or methadone with amitriptyline, you may feel extremely sleepy.

You could get an irregular and dangerous heartbeat if you take amitriptyline with cocaine, amfetamines, ecstasy, MDA or 6-APB.

There are many other street drugs, but we don’t know what effect taking them with amitriptyline will have, so it’s best to be cautious. There is no regulation of street drugs or ‘legal highs’, so even if there are no known issues with the medication you take, the supply you receive might be mixed with other substances that could be dangerous.

Smoking

Cigarette smoke may affect the amount of amitriptyline in your body, although it is unlikely the dose of amitriptyline will need to be changed if you stop smoking or switch to using nicotine patches or vaping.

If you start or stop smoking while you are taking amitriptyline and you notice a deterioration in your mood or an increase in the side effects, contact your doctor to discuss this.

Get more advice on drugs and alcohol.

Amitriptyline may not mix well with some other medicines, including herbal remedies. It may affect how they work or could cause more side effects.

Do not take amitriptyline if you have taken a monoamine oxidase inhibitor antidepressant (MAOI) like moclobemide, phenelzine, isocarboxazid or tranylcypromine in the last 14 days.

Do not take amitriptyline if you are taking the herbal remedy St. John’s Wort. This does not mix well with amitriptyline, so please tell your doctor or pharmacist if you are trying this or would like to try it.

Before you start taking amitriptyline, tell your doctor if you are taking any other medications including things you have bought from a pharmacy or other shop for common illnesses like colds and flu or medications that you put on your skin.

Always tell the pharmacist that you are taking amitriptyline if you buy any medicines from a pharmacy.

Look at the leaflet inside your medicine box for more information about other medicines that can interact with amitriptyline. With some medicines your doctor may need to adjust the dose of your medicines if you take them together. Ask a doctor or pharmacist for more information if you have any questions.

Amitriptyline tablets may not be suitable for you if you have problems eating some sugars or dairy foods. If you are lactose intolerant, get advice from your local pharmacist.

There are several companies that manufacture this medicine and the non-active ingredients are likely to vary between products tablets and liquids.

Always let your pharmacist know if you have any food allergies or intolerances, and always check with them if you’re concerned about any of the ingredients in your medication.

If you need to avoid animal products such as gelatine, please note that this is often found in capsules but also in some tablet formulations. Ask your pharmacist if you have any questions about the ingredients. Find out more on the Vegan Society website.

Do not drive a car or ride a bike just after you start taking amitriptyline.

Taking amitriptyline may make you feel less alert than normal and/or give you blurred eyesight when you start taking it. This could affect you if you drive a car, ride a bike, or do anything else that needs a lot of focus. It might be best to stop doing these things for the first few days or weeks until you know how it affects you.

Most people drive as normal while taking amitriptyline, but if you are worried about this or have any concerns you would like to discuss, speak to your doctor or pharmacist.

Pregnancy

If you become pregnant while you are on amitriptyline, you should carry on taking it and make an appointment to see your doctor as soon as possible. They can discuss the benefits and risks of continuing amitriptyline and help you to make a decision that is best for you and your baby.

They may refer you to a specialist perinatal mental health team to support you with this decision.

You can find out more information about taking amitriptyline during pregnancy at Bumps (Best Use of Medicines in Pregnancy).

Untreated depression or anxiety can also be harmful to you and your developing baby, so decisions about stopping or avoiding medication when you are pregnant need to be discussed carefully with your doctor. If you and your doctor agree that it is best for you to continue taking amitriptyline while pregnant, you should tell your midwife. If you are planning to get pregnant, it is recommended that you take folic acid while you are trying for a baby and during pregnancy. It is safe to take this together with amitriptyline.

Post-natal

Some newborn babies whose mothers take amitriptyline during pregnancy can get withdrawal symptoms at birth and soon after, like breathing problems or restlessness.

Tell your midwife if you are taking amitriptyline, so that they can help if the baby has any symptoms after birth.

Breastfeeding

Amitriptyline is passed to the baby in breastmilk in small amounts.

If your baby was born early, then breastfeeding while you are taking amitriptyline may not be recommended. Talk to your midwife and doctor about feeding options.

If you breastfeed while taking amitriptyline, seek urgent medical advice if your baby becomes restless, very sleepy, or develops feeding problems.

Sex

Amitriptyline can have side effects that affect your sex life. These include:

swollen testicles or problems getting an erection
loss of sex drive or not wanting to have sex

Some other uncommon or rare side effects include breast growth or milk flow from the breasts (regardless of gender). These may affect your confidence and therefore your desire to have sex. Talk to your doctor if you get these symptoms.

Untreated depression or anxiety can have a negative effect on your sex life, so if amitriptyline helps you to recover, positive effects can include improving your desire, experience and enjoyment of sex as your mood lifts and you become interested in life and relationships again.

Fertility

There is no evidence to suggest that amitriptyline will affect your fertility. Talk to your doctor about your amitriptyline if you are trying to get pregnant or planning a family.

Amitriptyline is not a banned substance in sport. However, it can produce a false positive result in some drug tests, including urine tests for LSD. Talk to your doctor about this if it is a problem for you.

Most people play sports as normal while taking amitriptyline, but if amitriptyline affects your concentration, eyesight or co-ordination, then you may want to wait to see if those effects go away before playing sports that need a lot of focus. If you have any concerns, discuss this with your doctor.

Amitriptyline may affect your concentration, give you blurred eyesight, and make you feel dizzy and tired.

Ideally it’s best not to take amitriptyline for the first time just before your exams.

It is not possible to predict how the medication will make you feel, and if you do get any side effects, these are more likely to occur when you first start taking amitriptyline.

You should talk to your doctor about any future exams if you are starting amitriptyline. You might decide together to delay starting it until you have done them.

If they are more than a month away, however, you might find that it is better to start amitriptyline to improve your sleep and your motivation and ability to study.

Most people take exams as normal while taking amitriptyline, but if you have any concerns, discuss this with your doctor.

Information and safety considerations

Your doctor will consider any other medical conditions or symptoms you have before recommending a medicine for you.

Your medicine will come with a ‘patient information leaflet’. It’s important that you read this information. Speak to your pharmacist if:

you’re not given a leaflet
you don’t understand the information
you need it in a different format or language
you’re concerned about something you’ve read

The information leaflet also includes a list of warnings and precautions to consider before you take the medicine. If you think that any of these apply to you and are concerned that your doctor is not already aware of them, check with your doctor or pharmacist before you start to take your medication (or as soon as possible if you are already taking it).

Uses, warnings, safety and side effects

Taking amitriptyline

Your doctor will advise you on how long it is best to keep taking your medication. This may vary depending on what you’re taking it for and how many times you’ve been unwell.

If you are prescribed amitriptyline for low mood or depression, it is recommended that you take it for at least six months after you feel well again. This means that most people take it for at least seven to nine months. Research has shown that stopping it sooner, or immediately after you start to feel better, increases the risk of your low mood returning.

If you have had low mood or depression more than once, or if there is a higher risk of you becoming unwell again, your doctor may advise you to continue amitriptyline for at least two years after you feel well again.

You will get the best from your medicine if you take it regularly every day, at the dose prescribed by your doctor.

You may have to take it more than once a day. Choose times that you can always remember. This could be mealtimes, or when you brush your teeth.

As amitriptyline can make you sleepy, it might be best to take it at night time, 30 minutes before you go to bed.

When you have worked out what time of day is best for you, it is recommended that you take your medication at roughly the same time every day.

You can take it before or after food.

Swallow the tablets with a drink of water – if you chew them, they taste bitter.

If you forget to take a dose, then just take it as soon as possible.

If you forget to take it by the time your next dose is due, only take the next dose. Do not try and catch up by doubling your next dose.

If you forget to take your tablets for a few days, you may start getting withdrawal symptoms. Restarting your medication as prescribed should help improve these symptoms.

If you regularly forget to take it every day, your medicine may not work as well, and it could increase the risk of you becoming unwell again.

If you have been taking amitriptyline regularly for more than one to two months, it is recommended that they are stopped gradually, ideally over at least four weeks.

Discuss stopping your medication with your doctor. If you have important events coming up or are going through a period of life which is very demanding, like exams, starting a new job, or other roles you are responsible for, it might not be the best time to stop your medication. Planning and support are important to stopping your antidepressant medication successfully.

Antidepressants are not addictive, but if stopped suddenly they can cause discontinuation or withdrawal symptoms. These are caused by the receptors and levels of chemical transmitters in your brain readjusting after you reduce or stop your medication, and can also occur if you miss doses of medication.

Some of the symptoms you get may be similar to symptoms you had when you were unwell, so understandably, you might feel anxious or upset that your illness could be returning.

If you experience symptoms immediately or soon after stopping medication (days rather than weeks), this is usually a withdrawal symptom caused by your body adjusting to not having the medication anymore. If the symptoms start after a month or more after stopping your medicine, this might be a sign that you are becoming unwell again.

Withdrawal symptoms usually start within a few days of stopping (or sometimes reducing) your medication. A wide range of symptoms have been reported and are listed below. You may experience a few or a range. These include:

dizziness and/or feeling unsteady
headaches
numbness or tingling in hands or feet
sleep disturbances (vivid dreams, nightmares, not being able to sleep)
electric shock-like feelings in the head, spine, arms, legs or hands
feeling anxious, agitated or irritable and/or restless
confused or disorientated and reduced concentration
poor appetite, feeling or being sick or having diarrhoea (loose poo)
sweating or shaking
feeling emotional, low mood and tearful
flu-like symptoms/muscle aches and pains
tinnitus (ringing in your ears)
problems with your eyes, or fluttering/pounding heartbeat (these are not as often as the other symptoms listed above)

It is not possible to predict if you will experience withdrawal symptoms, or how bad they will be if you do experience them, but studies report about half of people may get them. The risk appears to be higher if:

you have been taking your medication for six to eight weeks and you stop taking it suddenly
you are a child or young person
you experienced an increase in anxiety symptoms when you started your medication
you have experienced withdrawal symptoms with another antidepressant before

If you do experience symptoms, they are usually mild and don’t last long (two to three weeks for most people), but for a few these could be severe enough to make you feel very unwell and last longer (two to three months or more). Arrange an appointment with your doctor to discuss your symptoms and seek advice if you are concerned or unable to tolerate them.

You can stop taking amitriptyline safely with your doctor’s help. Planning a gradual withdrawal together can help to minimise or prevent the withdrawal symptoms you experience.

Warnings and safety

If you have taken more than the dose prescribed by your doctor, contact NHS 111 immediately to ask for advice, or ask a family member or friend to do this for you. This is important even if you don’t feel any different.

NHS 111 can give you advice and direct you to the best place to get more help if you need it.

If you have taken too much medication on purpose, or if after taking this you quickly feel unwell, call 999 or get someone to take you to A&E straight away. This includes any of the following signs:

fast or uneven heartbeat
low blood pressure (feeling dizzy or faint)
your pupils (black centre part of your eye) going large
feeling sleepy
feeling agitated
being sick
having fits, or stiffness in your muscles
becoming unconscious

If you need to go to A&E, do not travel alone or drive yourself there. Get your parent, family member or friend to go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you and tell doctors how much you have taken.

Suicidal thoughts

Depression (and other mental illnesses) can sometimes cause you to have thoughts about hurting yourself or taking your own life. While uncommon, this could also be a side effect of your medicine. This can happen to anyone but is more likely to happen if you are under 25 years old.

If you have any thoughts like this, it is important you get urgent help. Contact your doctor immediately for advice and support. This could be your GP or specialist mental health team. If you are able, share how you are feeling with family member or friend as well so they can support you to get help.

If you discussed with your doctor what to do if you get these thoughts and created a safety plan, read this to remind you who to contact for support and what you can do to help you cope.

Read our guide to suicidal feelings

Serious side effects

Although rare, amitriptyline can cause serious side effects, including allergic reactions.

Stop taking amitriptyline and go to a hospital straight away if you get any of the following symptoms:

difficulty breathing
an allergic reaction or allergy (including symptoms such as swelling of your face, eyelids, lips, tongue or throat so that you cannot swallow or breathe, or really bad itching of the skin with raised lumps)
fast, uneven heartbeat and fainting (this could mean a life-threatening condition called Torsades de Pointes)
any combination of the following symptoms: high fever, agitation, confusion, trembling, sweating, diarrhoea (loose poo), fast heartbeat or weird movements of your muscles (this could be serotonin syndrome)
you start having seizures or fits for the first time

Get your parent, family member or friend to take you or go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you.

Contact your doctor immediately but don't stop taking amitriptyline, if you get any of the following symptoms:

your behaviour changes because you feel very happy or over-excited
you experience tiredness, confusion and muscle-twitching (you may have a low blood-level of sodium)
yellowing of the skin or whites of the eyes (these may be signs of hepatitis)
if fits that you have had in the past happen more often
sore throat, ulcers in your mouth or throat
unusual tiredness or weakness
unusual bleeding or unexplained bruises (this could indicate a serious effect on your blood, though this is very rare
a skin rash (which may be itchy)
sensitivity to the sun or sun lamps

If you are unable to contact your doctor, call NHS 111 for urgent advice.

Amitriptyline does not mix well with some anaesthetics used in surgery. Tell the doctor if you are going to have an operation. You may need to stop amitriptyline for a few days. You also need to tell the people who are going to do your operation before the day it takes place.

Side effects and your health

Side effects are more common when you first start taking amitriptyline. Many go away as you continue your medicine. If they don’t get better, or if you are worried by them and they are causing you distress, speak to your doctor or pharmacist about them.

Very common side effects (affecting more than one in ten people) include:

feeling sleepy
dry mouth
blocked nose
blurred vision
constipation (finding it difficult to poo)
nausea (feeling sick)
weight gain
excessive sweating
changes in heart rhythm - you may feel palpitations or a fast heartbeat
dizziness on standing
feeling more angry than usual

There are other side effects that you can get when taking this medicine. We have only included the most common ones here.

This list of side effects can look scary. You may not experience any of them, but it’s important to be aware of them so you know what to do if they do happen.

Unless your side effects are very severe or distressing, try to continue taking your medication until you can talk to your doctor. Your doctor can make changes to your medication to help if needed.

An uncommon but important side effect to be aware of includes thoughts of harming yourself or taking your own life. This may be a symptom of your illness, including depression, but may be a side effect of your medication. If you experience these thoughts, contact your doctor to seek immediate support to keep you safe.

Your doctor will make sure you are monitored carefully for these side effects, and you should decide with your doctor what to do if you experience these feelings while taking your medication. It’s a good idea to write these plans down and keep them somewhere safe.

If you are taking amitriptyline and have not talked about this with your doctor, go back to them and talk it through. You might also want to talk to your parents, family member or friend about it too.

There is no routine monitoring recommended before starting or while you are taking amitriptyline, although your doctor may recommend specific tests to help them make decisions about your medication. This may include an electrocardiogram (ECG) to check your heart, or a blood test.