Amitriptyline: Price, Dosage & Where to Buy

Amitriptyline is a tricyclic antidepressant used mainly for relieving symptoms of depression. It is available as a generic medicine in several oral tablet strengths and requires a prescription in the United Kingdom. Treatment is supervised because the medicine can affect mood, alertness, the heart and other body systems.

Amitriptyline is indicated for the relief of symptoms of depression. The label states that endogenous depression is more likely to be alleviated than other depressive states. Depression can affect mood, thinking, sleep, energy and daily functioning, and treatment decisions depend on an individual clinical assessment.

The medicine is not approved for treating bipolar depression, and the product is not recommended for patients under 12 years of age because of limited experience in this group. Anyone receiving treatment should be monitored for worsening depression, suicidal thoughts, unusual behaviour or other concerning changes, particularly early in treatment or after a dose change.

Amitriptyline is a tricyclic antidepressant. Medicines in this class increase the availability of certain chemical messengers, mainly noradrenaline and serotonin, between nerve cells in the brain. These messengers are involved in mood, attention, sleep and emotional responses.

Amitriptyline also affects other signalling systems, which can contribute to drowsiness, dry mouth, blurred vision, constipation, changes in heart rhythm and dizziness. A sedative effect may appear before improvement in depression. The full antidepressant effect can take time to develop, so treatment is monitored according to clinical response and tolerability rather than immediate changes alone.

The label lists oral tablets in 10 mg, 25 mg, 50 mg, 75 mg, 100 mg and 150 mg strengths, including coated and film-coated forms. The usual starting dose is 75 mg a day in divided doses for adult outpatients. The label lists an increase to a total of 150 mg per day when necessary.

The usual starting dose is 50 mg to 100 mg at bedtime as an alternative outpatient approach. The label lists 100 mg a day initially for hospitalised patients, with gradual increases to 200 mg a day and, for a small number, as much as 300 mg a day. The usual starting dose is lower for adolescent and elderly patients, with 10 mg 3 times a day and 20 mg at bedtime listed as potentially satisfactory.

The usual maintenance dosage is 50 mg to 100 mg per day; 40 mg per day is sufficient for some patients. Dosage is reduced to the lowest amount maintaining symptom relief, according to clinical response and tolerability.

A missed dose should not usually be replaced by taking extra medicine, because excessive amounts of amitriptyline can cause serious toxicity. The missed dose should be discussed with a pharmacist or prescriber, particularly if several doses have been missed or treatment is being stopped. Abrupt cessation after prolonged administration may produce nausea, headache and malaise, while gradual reduction has been associated with irritability, restlessness and dream or sleep disturbance.

Amitriptyline crosses the placenta. There are no adequate and well-controlled studies in pregnant women, and a few reports describe adverse events in infants whose mothers used amitriptyline during pregnancy, including central nervous system effects, limb deformities or developmental delay, although a causal relationship has not been established.

The label states that amitriptyline should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the fetus. Pregnancy and breastfeeding should be discussed with a doctor or pharmacist.

Store amitriptyline tablets in a well-closed container at 20° to 25°C. Protect them from light and use a tight, light-resistant container with a child-resistant closure to maintain quality.