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" What is it used for?  Depressive illness. Bedwetting (nocturnal enuresis) in children aged six years and over. Nerve pain (neuralgia) as a result of nerve damage, for example due to diabetes, stroke, injuries, chemotherapy, amputation (phantom limb limb) or shingles (postherpetic neuralgia). This is an unlicensed use. Preventing migraine. This is an unlicensed use.   How does it work? Amitriptyline is a type of medicine called a tricyclic antidepressant (TCA). This type of medicine acts on nerve cells in the brain.  In the brain there are numerous different chemical compounds called neurotransmitters. These act as chemical messengers between the nerve cells. Serotonin and noradrenaline are neurotransmitters and they have various functions that we know of.  When serotonin and noradrenaline are released from nerve cells in the brain they act to lighten mood. When they are reabsorbed into the nerve cells, they no longer have an effect on mood. It is thought that when depression occurs, there may be a decreased amount of serotonin and noradrenaline released from nerve cells in the brain.  Amitriptyline works by preventing serotonin and noradrenaline from being reabsorbed back into the nerve cells in the brain. This helps prolong the mood lightening effect of any released noradrenaline and serotonin. In this way, amitriptyline helps relieve depression.  Amitriptyline can have a sedating effect. This means it may be useful in treating depression in people who are also anxious and agitated, or who are suffering from disturbances in sleep.  It may take between two to four weeks for the benefits of this medicine to appear, so it is very important that you keep taking it, even if it doesn&amp;#039;t seem to make much difference at first. If you feel your depression has got worse, or if you have any distressing thoughts or feelings in these first few weeks, then you should talk to your doctor.  Amitriptyline is not prescribed for depression very often these days because there are other antidepressants that are usually preferred. Amitriptyline is more often prescribed to help prevent migraine or to help with certain types of nerve pain. It is not licensed for these uses, but has been shown to be effective. We don&amp;#039;t fully understand how the medicine works in these conditions, but you can ask your doctor for more information. Amitriptyline is also occasionally used for a completely different purpose - for the treatment of bedwetting in children. It works in this situation by blocking receptors called cholinergic or muscarinic receptors that are found on the surface of muscle cells in the wall of the bladder. This prevents a chemical called acetylcholine from acting on these receptors. Acetylcholine acting on these receptors normally causes the muscle in the bladder wall to contract, and the bladder to empty. By reducing this, amitriptyline helps the muscle in the bladder wall to relax. This reduces unstable, involuntary contractions of the bladder, and thereby increases the capacity of the bladder to hold urine. This in turn reduces the need to pass urine. When used for this purpose, amitriptyline should generally only be used for a maximum of three months, unless a full physical examination is given and the child is fully re-assessed.   How do I take it?  Amitriptyline comes as tablets and liquid. The dose of amitriptyline that your doctor has prescribed depends on what condition is being treated. It is important to follow the instructions given by your doctor, particularly if you have been prescribed the medicine for an unlicensed use. In these situations the information leaflet provided with the medicine won&amp;#039;t tell you how much to take. Your doctor&amp;#039;s instructions for how much to take and how often to take it should be printed on the dispensing label that your pharmacist has put on the packet of medicine. If you are unsure about anything you should ask your doctor or pharmacist. Amitriptyline is usually taken once a day at bedtime because it can make you sleepy. However, it may sometimes be taken in smaller doses two or three times a day. Amitriptyline can be taken either with or without food. You should try to take your amitriptyline at the same time(s) each day to avoid missing any doses. If you forget to take a dose take it as soon as you remember, unless it is nearly time for your next dose. In this case leave out the forgotten dose and just take the next dose as usual. Do not take a double dose to make up for a missed dose. You should keep taking this medicine regularly until your doctor tells you to stop. When treating depression, current recommendations are that antidepressants are continued for at least six months after recovery to help prevent the depression coming back after the medicine is stopped. You should not suddenly stop taking this medicine, as this can cause withdrawal symptoms such as nausea, vomiting, loss of appetite, headache, giddiness, chills, insomnia, restlessness or anxiety. Withdrawal symptoms are temporary and are not due to addiction or dependence on the medicine. They can usually be avoided by stopping the medicine gradually, usually over a period of weeks or months, depending on your individual situation. Follow the instructions given by your doctor when it is time to stop treatment with this medicine.    Warning!  This medicine may cause drowsiness and could reduce your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won&amp;#039;t affect your performance.  You should avoid drinking alcohol while taking this medicine because it may increase the chance of side effects, particularly drowsiness and dizziness.  This medicine can occasionally cause your blood pressure to drop when you move from a lying down or sitting position to sitting or standing, especially when you first start taking the medicine or if you are taking a diuretic medicine such as furosemide. This may make you feel dizzy or unsteady. To avoid this try getting up slowly. If you do feel dizzy, sit or lie down until the symptoms pass.  Depression is associated with an increased risk of suicidal thoughts, self-harm, and suicide. You should be aware that this medicine may not start to make you feel better for at least two to four weeks. However, it is important that you keep taking it in order for it to work properly and for you to feel better. If you feel your depression has got worse, or if you have any distressing thoughts or feelings, particularly about suicide or harming yourself in these first few weeks, or indeed at any point during treatment or after stopping treatment, then it is very important to talk to your doctor.  Antidepressants may cause the amount of sodium in the blood to drop - a condition called hyponatraemia. This can cause symptoms such as drowsiness, confusion, muscle twitching or convulsions. Elderly people may be particularly susceptible to this effect. You should consult your doctor if you develop any of these symptoms while taking this medicine so that your blood sodium level can be checked if necessary. This medicine can cause a dry mouth, which may increase the risk of tooth decay with long-term use of the medicine. It is important to practice good oral hygiene and visit your dentist regularly for check-ups. During long-term treatment with this medicine your doctor may want to monitor your heart and liver function and take blood tests to monitor the levels of blood cells in your blood. You should let your doctor know if you experience symptoms such as a fever or sore throat while you are taking this medicine.  Changes in behaviour have been seen in children taking this medicine to treat bedwetting. For further information talk to your doctor or pharmacist.   Use with caution in  Children. Young adults. Elderly people. People with decreased liver function. Heart disease. People with an overactive thyroid gland (hyperthyroidism). People taking thyroid medication for an underactive thyroid gland (hypothyroidism). People with a tumour of the adrenal gland (phaeochromocytoma). Men with an enlarged prostate gland (prostatic hypertrophy). People with a history of difficulty passing urine (urinary retention). People with chronic constipation. People with a history of raised pressure in the eye or glaucoma. Diabetes. People with a history of epilepsy. People at risk of seizures (fits), eg due to alcohol/drug withdrawal, brain damage, other medicines. Psychotic illness, eg schizophrenia. Bipolar affective disorder (manic depression). People receiving electroconvulsive therapy (ECT). People with a history of suicidal behaviour or thoughts.    Not to be used in  Severe liver disease. People who have recently had a heart attack. People with a defect in the heart&amp;#039;s electrical message pathways resulting in decreased function of the heart (heart block). Irregular heartbeats (arrhythmias). Closed angle glaucoma. People in a manic phase of bipolar disorder (manic depression). People who have taken a monoamine oxidase inhibitor antidepressant (MAOI) in the last two weeks. Hereditary blood disorders called porphyrias. This medicine is not recommended for treating depression in children under 16 years of age, or for treating bedwetting in children under six years of age.  This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.   Pregnancy and breastfeeding Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.   This medicine should be used with caution during pregnancy and only if the benefits to the mother outweigh any risks to the developing baby. This is particularly important in the first and third trimester. The medicine may cause amitriptyline-type side effects or withdrawal symptoms in the newborn baby if used in late pregnancy. It is important to seek medical advice from your doctor if you get pregnant or plan to have a baby while taking this medicine, so that you can discuss the potential risks to the baby if you keep taking the medicine, compared with the risks of stopping treatment.  This medicine passes into breast milk. It should be used with caution in mothers who are breastfeeding, and only if the potential benefits outweigh any risks to the nursing infant. Seek medical advice from your doctor.    Label warnings  This medication may cause drowsiness. If affected do not drive or operate machinery. Avoid alcoholic drink.    Side effects Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.  Dry mouth. Drowsiness. Blurred vision. Constipation. Nausea. Difficulty passing urine. Drop in blood pressure when moving from a lying or sitting position to sitting or standing, causing dizziness and lightheadedness (postural hypotension). Sweating. Involuntary muscle movements such as tremors or twitching. Rashes. Confusion or delirium. Feeling weak or tired. Headache. Sexual problems such as reduced sex drive or erectile dysfunction. Enlargement of the breasts and production of breast milk. Changes in behaviour. Increased appetite and weight gain. Taste disturbances. Low blood pressure (hypotension). Disturbances in the normal numbers of blood cells in the blood. Abnormal heartbeats (arrhythmias or heart block). Faster than normal heartbeat (tachycardia). Convulsions (fits).  The side effects listed above may not include all of the side effects reported by the medicine&amp;#039;s manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.   How can this medicine affect other medicines? It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.  Amitriptyline should not be taken in combination with a monoamine oxidase inhibitor antidepressant (MAOI), eg phenelzine, tranylcypromine, isocarboxazid, or moclobemide. Treatment with amitriptyline should not be started until at least two weeks after stopping an MAOI, and an MAOI should not be started until two weeks after stopping amitriptyline. Moclobemide should not be started until at least a week after stopping amitriptyline.  There may be an increased risk of drowsiness if other medicines that can cause drowsiness, such as the following, are taken in combination with amitriptyline:   baclofen (severe muscle weakness may also occur with this combination) benzodiazepines, eg diazepam, temazepam sedating antihistamines, eg chlorphenamine, promethazine sleeping tablets, eg zopiclone strong opioid painkillers, such as morphine, codeine, tramadol.   There may be an increased risk of side effects such as dry mouth, constipation, difficulty passing urine and blurred vision if amitriptyline is taken with other medicines that have anticholinergic effects, such as the following:   anticholinergics for urinary incontinence, eg tolterodine, oxybutynin anticholinergics for Parkinson&amp;#039;s disease, eg procyclidine, trihexyphenidyl some antihistamines, eg promethazine, chlorphenamine antispasmodics, eg hyoscine, atropine some antipsychotics, eg chlorpromazine, clozapine (some antipsychotics may also increase the blood level of amitriptyline) some antiarrhythmics, eg disopyramide, propafenone certain other antidepressants some antisickness medicines, eg meclozine, cyclizine.  If amitriptyline is taken with other medicines that enhance serotonin activity in the brain, there may be an increased risk of side effects such as agitation, tremor, shivering, increased heart rate and diarrhoea, known collectively as the &amp;#039;serotonin syndrome&amp;#039;. Other medicines that increase serotonin activity include the following:   linezolid lithium rasagiline selegiline SSRI antidepressants, eg fluoxetine, paroxetine, citalopram SNRI antidepressants, eg duloxetine, venlafaxine tramadol.  There may be an increased risk of side effects on the heart if amitriptyline is taken in combination with the following medicines; these medicines should preferably be avoided in people taking amitriptyline:   antiarrhythmic medicines to treat abnormal heart rhythms, eg amiodarone, procainamide, quinidine, disopyramide, sotalol, flecainide  the antihistamines astemizole, terfenadine or mizolastine arsenic trioxide atomoxetine the antimalarials halofantrine, chloroquine, quinine or Riamet certain antipsychotics, eg thioridazine, haloperidol, pimozide dronedarone droperidol  moxifloxacin pentamidine saquinavir telithromycin.   Amitriptyline may alter the anti-blood-clotting effect of anticoagulant medicines such as warfarin. Your blood clotting time (INR) should be regularly monitored if you are taking these two medicines together.  Amitriptyline may oppose the blood pressure lowering effects of clonidine and guanethidine. There may be a sudden and marked increase in blood pressure and heart rate if adrenaline, noradrenaline or phenylephrine are given by injection to people taking amitriptyline. These medicines should be avoided or used at much reduced doses in people taking amitriptyline. Amitriptyline may oppose the effect of histamine (used to treat leukaemia) and is not recommended for people having this treatment. Treatment with this medicine may oppose the anticonvulsant effects of medicines used to treat epilepsy. The following medicines may increase the blood level of amitriptyline and could increase the risk of its side effects:  bupropion calcium-channel blockers such as diltiazem or verapamil cimetidine fluconazole methylphenidate ritonavir SSRI antidepressants such as fluvoxamine, paroxetine and fluoxetine terbinafine.  The level of amitriptyline in the blood may be decreased by the following medicines, and these could make it less effective:  barbiturates such as phenobarbital carbamazepine phenytoin rifampicin the herbal remedy St John&amp;#039;s wort (Hypericum perforatum).  If you experience a dry mouth as a side effect of this medicine you may find that medicines that are designed to dissolve and be absorbed from under the tongue, eg sublingual glyceryl trinitrate (GTN) tablets for angina, become less effective. This is because the tablets do not dissolve properly in a dry mouth. To resolve this, drink a mouthful of water before taking sublingual tablets.    Other medicines containing the same active ingredient Amitriptyline is a generic medicine. There are currently no branded medicines available in the UK that contain amitriptyline as the active ingredient.  Last updated 08.05.2013 "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.netdoctor.co.uk/medicines/depression/a6193/amitriptyline/>