TCA — Interstitial Cystitis / Chronic Pelvic Pain 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

In urology, low-dose amitriptyline, a tricyclic antidepressant, is used off-label as an oral agent for bladder pain syndrome, chronic pelvic pain and to reduce nocturnal symptoms through its anticholinergic and analgesic effects.

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: Neuropathic pain (adults): 25 mg–75 mg daily in the evening

Route: Oral

Frequency: Once daily in the evening, or divided into two doses

Max: A single dose above 75 mg is not recommended; doses above 100 mg should be used with caution

SPC neuropathic-pain dose (also covers chronic tension-type headache prophylaxis and migraine prophylaxis). Individually titrate to the dose that provides adequate analgesia with tolerable adverse reactions; use the lowest effective dose for the shortest duration. Initial dose 10 mg–25 mg in the evening; increase by 10 mg–25 mg every 3–7 days as tolerated; analgesic effect normally seen after 2–4 weeks; treatment is symptomatic and may be needed for several years with regular reassessment. Elderly (>65 yr) / cardiovascular disease: start 10 mg–25 mg in the evening; doses above 75 mg with caution.

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)
Micturition disorders (common); urinary retention (uncommon)

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 noradrenaline and serotonin and has marked antimuscarinic, antihistaminic and sodium-channel-blocking actions; the anticholinergic and central pain-modulating effects underlie its urological use.

Prescribing in practice

Its antimuscarinic action can precipitate acute urinary retention and worsen bladder-emptying problems, and it is hazardous in cardiac disease, arrhythmias and recent myocardial infarction owing to QT prolongation and conduction effects.
It is dangerous and contraindicated with or soon after MAOIs and adds to the effects of other sedating and serotonergic drugs.
Use lower doses and titrate cautiously in the elderly, who are prone to confusion, falls, constipation and postural hypotension.

Monitoring

Monitor for anticholinergic effects including urinary retention, for mood and suicidal ideation early in treatment, and consider cardiac status in those at risk.

Counselling the patient

It is used here for pain and bladder symptoms, not as an antidepressant, and works gradually.
It commonly causes drowsiness, dry mouth, constipation, and blurred vision, so take it in the evening and avoid driving if affected.
Do not stop it suddenly after regular use.

Evidence & guidelines

Low-dose amitriptyline for bladder pain and chronic pelvic pain is supported by chronic-pain evidence and UK urology practice, with its pharmacology detailed in the SPC.

Reference: EAU IC/BPS Guidelines 2024; ESSIC Guidelines; Sant et al. (2003) IC/BPS amitriptyline RCT; 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

Pathways