Tricyclic Antidepressant (TCA) Pregnancy: Not recommended during pregnancy unless clearly necessary and only after careful risk/benefit consideration; neonatal withdrawal symptoms can occur with chronic use or use in the final weeks of pregnancy

Amitriptyline

Brand names: Tryptizol, Elavil

Amitriptyline is a tricyclic antidepressant now used mainly at lower doses for neuropathic pain and as a migraine preventer, and at higher doses for depression where newer agents are unsuitable.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Major depressive disorder (adults): initially 25 mg twice daily (50 mg daily)

Route: Oral

Frequency: Twice daily

Max: Up to 150 mg daily divided into two doses

SPC main dose. Depression: initiate at a low level and increase gradually; if necessary increase by 25 mg every other day up to 150 mg daily divided into two doses; maintenance is the lowest effective dose; antidepressant effect usually sets in after 2–4 weeks; continue usually up to 6 months after recovery to prevent relapse. Elderly (>65 yr) / cardiovascular disease: initially 10 mg–25 mg daily, may increase up to 100 mg–150 mg in two divided doses; doses above 100 mg with caution. Neuropathic pain / chronic tension-type headache prophylaxis / migraine prophylaxis (adults): 25 mg–75 mg daily in the evening; initial dose 10 mg–25 mg in the evening, increased by 10 mg–25 mg every 3–7 days as tolerated, once daily or divided into two doses; a single dose above 75 mg is not recommended; doses above 100 mg with caution; analgesic effect normally seen after 2–4 weeks.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Recent myocardial infarction
Any degree of heart block or disorders of cardiac rhythm and coronary artery insufficiency
Concomitant treatment with MAOIs (monoamine oxidase inhibitors)
Severe liver disease
Children under 6 years of age

Side effects

Orthostatic hypotension (very common)
Palpitations, tachycardia (very common)
Somnolence, tremor, dizziness, headache, drowsiness, dysarthria (very common)
Dry mouth, constipation, nausea (very common)
Hyperhidrosis (very common)

Interactions

MAOIs — concomitant use contraindicated; may cause serotonin syndrome (14-day washout for irreversible non-selective MAOIs, 1 day for moclobemide)
Anaesthetics — may increase risk of arrhythmias and hypotension during tri/tetracyclic antidepressant therapy
QT-prolonging drugs — caution; cases of QT prolongation and arrhythmia reported

Clinical monograph

How it works

It inhibits the reuptake of serotonin and noradrenaline and blocks histaminergic, cholinergic and alpha-adrenergic receptors, which underlies both its analgesic and antidepressant effects and its sedative and anticholinergic adverse effects.

Prescribing in practice

It is dangerous and frequently fatal in overdose owing to cardiotoxicity and seizures, so quantities supplied should be limited in patients at risk of self-harm.
Anticholinergic effects such as dry mouth, constipation, urinary retention and blurred vision are common, and caution is needed in the elderly, in cardiac disease and where there is a risk of arrhythmia.
It causes sedation and is usually taken at night, and dose is increased gradually to balance benefit against tolerability.

Monitoring

Monitor mood, suicidal ideation particularly early in treatment, and cardiovascular and anticholinergic adverse effects, with caution in cardiac disease.

Counselling the patient

For pain or migraine the effective dose is lower than for depression, and benefit may take some weeks.
Drowsiness, dry mouth and constipation are common, especially at first; taking it at night can help.
Do not stop suddenly, and seek urgent help if mood worsens or thoughts of self-harm emerge.

Evidence & guidelines

NICE recommends amitriptyline as a first-line option for neuropathic pain, and it is well established as a tricyclic antidepressant.

Reference: NICE NG59 (Neuropathic Pain); NICE CG150 (Headaches); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways