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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Almost all of the material on this site is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, and 2012 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I’m usually cool with it.

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¹ While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

² Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had the forerunner to QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]