Amitriptyline (generic for Elavil®)

Amitriptyline is the generic equivalent of Elavil®, Amitril®, Amitid®, and Endep®.

By law, a generic drug must be the same as its brand name counterpart in terms of active ingredient, dosage, safety, effectiveness, strength, stability, and quality. A generic may, however, differ in its inactive ingredients (i.e. flavoring, fillers, and preservatives).

Amitriptyline (Elavil®) does come with serious warnings. These include:

• Increased risk of suicidal thoughts or actions in adolescents and young adults*

• Serotonin syndrome—a rare, but potentially life-threatening condition that occurs when there’s too much serotonin in the brain

• Manic episodes or hypomania in patients with bipolar disorder

• Increased risk of irregular heartbeat or heart attack in people with a history of heart disease

• Seizures

• Glaucoma

If any of the above concern you, speak with your doctor or pharmacist about your perceived risk and other treatment options that exist.

*This warning is a boxed warning. A boxed warning is the most serious type of medication warning assigned by the FDA.

Amitriptyline is a tricyclic antidepressant (TCA). It works by blocking the brain’s absorption of norepinephrine and serotonin, “feed good” chemicals in your brain. The end result? An increased level of norepinephrine and serotonin in your brain, which is thought to improve mood.

The most common side effects of amitriptyline include:

• Dry mouth

• Constipation

• Nausea/vomiting

• Blurred vision, lightheadedness

• Low or high blood pressure

• Allergic reaction (i.e. skin rash, swelling of the face and tongue, itching, trouble breathing)

• Drowsiness

• Altered sex drive

• Numbness or tingling in the hands and feet

• Weight gain or loss

• Withdrawal symptoms—abrupt discontinuation of treatment can cause nausea, headache, and general discomfort

• Changes in blood sugar levels

Side effects may improve over time as your body adjusts to the medicine.

This list doesn’t represent all possible side effects (or serious side effects) of amitriptyline. If you’re experiencing any ongoing, bothersome side effect(s), tell your healthcare provider right away.

If you’d like to learn more, speak with your doctor or pharmacist. The Food and Drug Administration (FDA) also has a helpful medication guide for amitriptyline here.

Amitriptyline is FDA approved for the treatment of:

• Major depressive disorder (MDD) or depression

Amitriptyline may be used off-label for:

• Migraine prevention

• Postherpetic neuralgia

• Nerve pain

• Eating disorders

• Fibromyalgia

Amitriptyline can interact with some prescription drugs and supplements. It’s always recommended to give both your doctor and pharmacy an updated list of everything you’re taking, so drug interactions can be identified.

Some medicines and supplements amitriptyline can interact with include:

• Topiramate

• Reserpine

• Cimetidine

• Opioids: tramadol

• SSRIs (selective serotonin reuptake inhibitors): citalopram, sertraline, fluoxetine, paroxetine

• Monoamine oxidase inhibitors (MAOIs): selegiline, phenelzine, linezolid, methylene blue, tranylcypromine, isocarboxazid

• SNRIs (serotonin and norepinephrine reuptake inhibitors): desvenlafaxine, venlafaxine, duloxetine, milnacipran

• Triptans: sumatriptan, eletriptan, naratriptan

• St. John’s Wort

• Amitriptyline

• Epinephrine

• Thyroid medications

This list doesn’t represent all the drugs that may not be safe to take with amitriptyline. If you’re unsure whether a certain drug or supplement can be taken with amitriptyline, speak with your doctor or pharmacist. The FDA also has a helpful medication guide for amitriptyline here.

If you accidentally miss your dose of amitriptyline, take the dose as soon as you remember. If it’s almost time for your next dose (within 2 hours), skip the missed dose and take your next dose at the usual time. Don't take 2 doses at the same time or extra doses.

Amitriptyline may be taken with or without food.

During pregnancy: The safety of amitriptyline use during pregnancy hasn’t been established and results from animal reproduction studies remain inconclusive.

While breastfeeding: Amitriptyline can pass into breastmilk and may cause side effects in your infant.

It’s important to treat mental health-related conditions when pregnant or nursing, as untreated depression, anxiety, or other mental illnesses can harm both you and baby. Always let your healthcare professional know if you’re pregnant or breastfeeding, so you can discuss the benefits and risks of starting or continuing amitriptyline.

It’s recommended to avoid or limit the use of alcohol when taking amitriptyline. Alcohol can intensify the side effects of amitriptyline, including dizziness and sleepiness.