US Brand Name: Elavil

generic name: amitriptyline HCl

Other Forms: Intramuscular injection, oral solution.

Class: antidepressants Specifically Tricyclic Antidepressants (TCAs)

1.  Other brand names & branded generic names¹

• Adepril (Italy)
• Amilit (Italy)
• Amineurin (Germany)
• Amiplin (Taiwan)
• Amiprin (Japan)
• Amitrip (New Zealand)
• Amyline (Ireland)
• Anapsique (Mexico)
• Apo-Amitriptyline (Canada)
• Domical (United Kingdom)
• Elatrol (Israel)
• Elatrolet (Israel)
• Enafon (Korea)
• Endep (Australia; Canada; New Zealand; South Africa)
• Lantron (Japan)
• Laroxyl (Benin; Burkina Faso; Ethiopia; France; Gambia; Germany; Ghana; Guinea; Italy; Ivory Coast; Kenya; Kuwait; Liberia; Libya Lebanon; Malawi; Mali; Mauritania; Mauritius; Morocco; Niger; Nigeria; Oman; Qatar; Republic of Yemen; Saudi Arabia; Senegal; Seychelles; Sierra Leone; South Africa; Sudan; Syria; Tanzania; Tunisia; Uganda; United Arab Emirates; Zambia; Zimbabwe)
• Larozyl
• Miketorin (Japan)
• Noriline (South Africa)
• Novoprotect (Germany)
• Pinsaun (Taiwan)
• Redomex (Belgium)
• Sarotard (Korea)
• Saroten Retard (Malaysia)
• Saroten (Benin; Burkina Faso; Cyprus; Denmark; Ethiopia; Finland; Gambia; Germany; Ghana; Greece; Guinea; Iran; Ivory Coast; Kenya; Kuwait; Liberia; Libya Lebanon; Malawi; Mali; Mauritania; Mauritius; Morocco; Niger; Nigeria; Oman; Portugal; Qatar; Republic of Yemen; Saudi Arabia; Senegal; Seychelles; Sierra Leone; South Africa; Sudan; Sweden; Switzerland; Syria; Tanzania; Tunisia; Uganda; United Arab Emirates; Zambia; Zimbabwe)
• Sarotena (India)
• Sarotex (Netherlands; Norway)
• Syneudon (Germany)
• Teperin (Hungary; Iraq; Jordan)
• Trepiline (South Africa)
• Tridep (India)
• Tripta (Malaysia; Thailand)
• Triptizol (Italy)
• Trynol (Taiwan)
• Tryptal (Israel)
• Tryptanol (Argentina; Hong Kong; Japan; Malaysia; Mexico; New Zealand; South Africa; Thailand)
• Tryptizol (Austria; Belgium; Denmark; United Kingdom; Netherlands; Norway; Portugal; Spain; Sweden; Switzerland)
• Trytomer (India)
• Uxen (Argentina)
• Vanatrip

2.  FDA Approved Uses of Elavil (amitriptyline)

Depression. The odds favor relief for endogenous depression - i.e. being depressed for no good reason other than your brain hating you.

3.  Off-Label Uses of Elavil (amitriptyline)

• Dysthymia (constant, mild depression)
• Neuropathic and chronic pain
• Vulvodynia- depression caused and/or accompanied by vaginal pain². It didn’t work all that well, unlike Pamelor (nortripyline).
• Somatoform pain disorder (where they think it’s all in your head)
  • Although the data are mixed when it comes to phantom limb pain. In this study it didn’t do much good, but in this study both amitriptyline and Ultram (tramadol) worked just fine.
• Migraines
• Post traumatic stress disorder
• Panic/Anxiety disorders
• Insomnia
• Irritable Bowel Syndrome (IBS)

4.  Elavil’s (amitriptyline) pros and cons

4.1  Pros

It’s been since forever, so doctors are familiar with its uses and effects.

4.2  Cons

• It’s been since forever, so younger doctors are unlikely to prescribe it, assuming they’ve even heard of it.
• It’s reported to have the harshest anticholinergic side effects of the more popular TCAs - Tofranil (imipramine HCl) & Tofranil-PM (imipramine pamoate), Norpramin (desipramine HCl), Elavil (amitriptyline HCl), and Pamelor (nortriptyline HCl). Trust me, its anticholinergic side effects have nothing on Vivactil’s (protriptyline).

5.  Elavil’s (amitriptyline) Side Effects

5.1  Typical Side Effects

The usual for TCAs - headache, nausea, dry mouth, sweating, blurry vision, sleepiness or insomnia, constipation, and weight gain. Expect the dry mouth, sedation, and constipation to be permanent.

5.2  Not So Common Side Effects

• Urinary hesitancy (Guys over 40 can freak out with prostate cancer hypochondria.)
• Heart palpitations
• No libido and other sexual dysfunctions
• Nightmares - more so than other meds
• The urinary hesitancy is something that meds with a positive effect on norepinephrine tend to do. It can be permanent, or happen at random.

5.3  Freaky Rare Side Effects

• Black tongue (one of my father’s rollerderby buddies used to get that from drinking too much)
• Sleepwalking (somnambulism)
• Reversible brain death. That was after an overdose, but I couldn’t resist. It reads like something from a Reanimator script.

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6.  Interesting Stuff Your Doctor Probably Won’t Tell You About Elavil (amitriptyline)

Pamelor (nortripyline) is an active intermediate metabolite of Elavil (amitriptyline). So just as Lexapro (escitalopram oxalate) tends to have fewer side effects than Celexa (citalopram hydrobromide), the same may apply to Pamelor (nortripyline).

7.  Elavil’s (amitriptyline) Dosage and How to Take Elavil (amitriptyline)

Initial dose for outpatients should be 50mg at bedtime. You can increase it by 25mg a night every week until you get to a maximum of 150mg a night. You can also try it in a divided dose. Personally I wouldn’t trust it above 100mg a day. Not that it’s particularly dangerous (see comments), as long as you’re not taking a bunch of other drugs, including a potent CYP2D6 inhibitor, and are a poor CYP2D6 metabolizer. It’s actually rated for 300mg a day for hospitalized patients and used to be prescribed up to 400mg a day for in-patients. If amitriptyline isn’t doing anything at all for you by the time you reach 100mg a day, try something else. If it’s sort of working for you, try Pamelor (nortriptyline HCl), or another TCA if you haven’t already.

8.  How Long Elavil (amitriptyline) Takes to Work

TCAs generally take 7 to 28 days to be effective, although you’ll feel something - usually side effects - the next day.

9.  How to Stop Taking Elavil (amitriptyline)

Your doctor should be recommending that you reduce your dosage by 25–50mg a day every five days if you need to discontinue it. TCAs often trigger mania if discontinued too quickly, regardless of your being bipolar or not.

10.  Elavil’s (amitriptyline) Half-Life & Average Time to Clear Out of Your System

It has a half-life of 24 hours. Expect it to clear out of your system or to be able to step down a dosage every 5 days.

11.  Days to Reach a Steady State

Usually two to three days.

12.  How Elavil (amitriptyline) Works

Elavil (amitriptyline) is a typical TCA in that it acts like a an antidepressant, anticonvulsant and antipsychotic in one pill. It does moderate-strong inhibition of norepinephrine reuptake, mild-to-moderate inhibition of serotonin reuptake, blocks sodium voltage channel (like many anticonvulsants do), and is a fairly strong antagonist of the serotonin 5-HT1A & 5-HT2A receptors and a moderate alpha-1 norepinephrine antagonist (like a lot of antipsychotics). It’s also a pretty strong antihistamine and anticholinergic - also like a lot of antipsychotics - which is why the anticholinergic side effects are so bad.

13.  Comments

Amitriptyline has a fairly high overdose rate, but it turns out that it’s not necessarily due to suicidal behavior. Apparently it can be used recreationally, especially as a way to both enhance the effects of some drugs of abuse and mask that use in urine tests. Pretty nifty huh? Well, that’s why there are so many bodies being wheeled out of the ERs and into the morgues.
Amitriptyline can be tricky enough by itself when using it for what it’s meant for. You don’t have to worry about a overdose, even if you’re taking the maximum dosage of 300mg a day, as long as you’re not taking another medication. If you are taking other meds, crazy or not, you talk to your pharmacist, you use the drug-drug interaction checker that’s all over this site, and everything is good.

I’m leery of it at dosages above 100mg a day mainly due to:

• The ratio of dosage-dependent side effects (which are all of the anticholinergic and antihistamine side effects) to effects
• Because Mouse and I have had problems with TCA when at their high dosages
• And I’m a poor metabolizer of CYP2D6 substrates

So decide for yourself about 150mg a day, or more. If the side effects are sucking and you’re not feeling any positive effect soon, I recommend talking to your doctor about moving on to something else.

And if you’re stupid enough to take varying amounts of amitriptyline on an inconsistent basis along with drugs of dubious origin for recreational purposes, well, it’s probably better that you were purged from the gene pool. So have a party!

14.  Discussion board

Crazy Meds’ Elavil discussion board

15.  Your Comments About and Experiences with Elavil

Tell us what you think about Elavil

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Enter your own Comments & Experiences with Elavil here.
You must be a registered member of the Crazy Meds Talk forum to post a comment on this page.

16.  Full US PI sheet, Global SPCs & PILs, check for drug-drug interactions

Elavil Full US Prescribing Information / PI Sheet

Check for drug-drug interactions

17.  Bibliography

Essential Psychopharmacology 3rd Edition Stephen M. Stahl, M.D., Ph. D. © 2008. Published by Cambridge University Press

Clinical Handbook of Psychotropic Drugs 18th edition Adil S. Virani, K. Bezchlibnyk-Butler, J. Jeffries

A Primer of Drug Action Robert M. Julien, M.D., Ph. D. © 2011. Twelfth Edition.

Physicians’ Desk Reference Edition 56 Maria Deutsch & Anu Gupta, Drug Information Specialists, et al. © 2002. Published by Medical Economics Company.

Instant Psychopharmacology 2nd Edition Ronald J. Diamond M.D. © 2002. Published by W.W. Norton

The Complete Guide to Psychiatric Drugs Edward Drummond, M.D. © 2000. Published by John Wiley & Sons, Inc.

Mosby’s 2007 Drug Guide David Nissen PharmD, Editor.© 2007. An imprint of Elsevier.

¹ The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions.

² That sure the hell would depress me to no end.

Date created 31 Dec 1969 - 17:00)} Page Creator: JerodPoore Last edited by:

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