Amitriptyline

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.

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.