Amitriptyline (Elavil®) or other Tricyclic Antidepressants

Amitriptyline is a tricyclic antidepressant medication and many physicians use it in low-dose in patients with amplified pain such as fibromyalgia. They speculate that it can help restore a more normal sleep pattern. However, studies specifically looking at whether or not it changes sleep (α-δ non-rapid eye movement sleep) show that it does not. An open label study of 175 adults with fibromyalgia showed that amitriptyline was equally effective as routine physical therapy over 6 months. In multicenter placebo-controlled trial of amitriptyline in 90 children with irritable bowel syndrome there was no difference between it and the placebo. A recent Cochrane systematic review of these medications in patients with fibromyalgia were disappointed that they found no supportive, unbiased evidence to substantiate its use. They conclude it will satisfactorily relieve pain in only a minority of patients.

Before starting amitriptyline, it is important that a cardiologist review an EKG on all patients to make sure there are no underlying heart problems. If these are present amitriptyline and tricyclic antidepressants can lead to serious heart problems.

Young people (up to age 24 years) taking amitriptyline are at an increased risk of suicide in the first few months and need to be monitored closely.

Other common side effects include:

  • upset stomach
  • drowsiness
  • dizziness
  • weakness
  • insomnia
  • weight gain
  • headaches
  • blurred vision
  • photosensitivity
  • dry mouth
  1. Carette S, Oakson G, Guimont C, Steriade M. Sleep electroencephalography and the clinical response to amitriptyline in patients with fibromyalgia. Arthritis & Rheumatism 1995;38:1211-7.
  2.  Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain and fibromyalgia in adults. Cochrane Database of Systematic Reviews 2012;12:CD008242.
  3. Joshi MN, Joshi R, Jain AP. Effect of amitriptyline vs. physiotherapy in management of fibromyalgia syndrome: What predicts a clinical benefit? Journal of Postgraduate Medicine 2009;55:185-9.
  4. Goldenberg D, Mayskiy M, Mossey C, Ruthazer R, Schmid C. A randomized, double-blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia. Arthritis & Rheumatism 1996;39:1852-9.
  5. Saps M, Youssef N, Miranda A, et al. Multicenter, randomized, placebo-controlled trial of amitriptyline in children with functional gastrointestinal disorders. Gastroenterology 2009;137:1261-9.
  6. Patra KP, Sankararaman S, Jackson R, Hussain SZ. Significance of screening electrocardiogram before the initiation of amitriptyline therapy in children with functional abdominal pain. Clinical Pediatrics 2012;51:848-51.

Comments are closed.