Amitriptyline is a tricyclic antidepressant. It is used to treat a number of mental illnesses: major depressive disorder and anxiety disorders, and less commonly attention deficit hyperactivity disorder (ADHD) and bipolar disorder.

Some evidence suggests amitriptyline may be more effective than other antidepressants, including selective serotonin reuptake inhibitors (SSRIs). It is used in addition to other medications for pain: migraine prevention, also in cases of neuropathic pain disorders, fibromyalgia and nocturnal enuresis. 

Amitriptyline is a popular off-label treatment for irritable bowel syndrome (IBS), although it is most frequently reserved for severe cases of abdominal pain in patients with IBS because it needs to be taken regularly to work and has a generally poor tolerability profile, although a firm evidence base supports its efficacy in this indication. Amitriptyline can also be used as an anticholinergic drug in the treatment of early-stage Parkinson's disease if depression also needs to be treated. Amitriptyline is the most widely researched agent for prevention of frequent tension headaches.

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Dosage and administration

Orally, the initial dose is 25-50 mg before sleep. Then, within 5-6 days, the dose is individually increased to 150-200 mg. If there is no improvement during the second week, the daily dose is increased to 300 mg. If the signs of depression disappear, the dose is reduced to 50-100 mg and therapy is continued for at least 3 months.

In elderly patients with mild disorders, the dose is 30-100 mg, usually 1 time before sleep, after reaching the therapeutic effect, switch to the minimum effective dose - 25-50 mg.


Side effects

  • Common side effects, occurring in more than 1% of users, include dizziness, headache, and weight gain.
  • Side effects common to anticholinergics occur more often than with other TCAs such as imipramine.
  • Cognitive side effects include delirium and confusion, as well as mood disturbances such as anxiety and agitation.
  • Cardiovascular side effects may include orthostatic hypotension, sinus tachycardia, and QT-interval prolongation.
  • Sexual side effects include loss of libido and impotence, while sleep disturbances may include drowsiness, insomnia, and nightmares. 
  • Amitriptyline is said to have the most anticholinergic side effects and to be the most likely to produce delirium.



  • Hypersensitivity to TCAs or to any of its excipients
  • History of myocardial infarction
  • History of arrhythmias, particularly heart block to any degree
  • Congestive heart failure
  • Coronary artery insufficiency
  • Mania
  • Severe liver disease
  • Being under seven years of age
  • Breast feeding
  • Patients who are taking monoamine oxidase inhibitors (MAOIs) or have taken them within the last 14 days.