Brand & Generic Names; Drug Classes
|US brand name: Elavil|
|Generic name: amitriptyline|
|Primary drug class: Antidepressants|
|Additional drug class(es): Tricyclic & Tetracyclic Antidepressants|
Approved & Off-Label Uses (Indications)
Elavil’s US FDA Approved Treatment(s)
Uses Approved Overseas but not in the US
- Enuresis (bedwetting) In children ages 7 - 11 - UK
- No age specified - Australia, Ireland, South Korea
- Other Depression Spectrum Disorders - South Africa, South Korea
- Secondary Depression - South Africa
Off-Label Uses of Elavil
- Dysthymia (constant, mild depression)
- Neuropathic and chronic pain
- Vulvodynia - depression caused and/or accompanied by vaginal pain1. It didn’t work all that well, unlike Pamelor (nortripyline).
- Somatoform pain disorder (where they think it’s all in your head)
- Post traumatic stress disorder (PTSD)
- Panic/Anxiety disorders
- Irritable Bowel Syndrome (IBS)
When & If Elavil Will Work
Elavil’s Usual Onset of Action (when it starts working)
TCAs generally take 7 to 28 days to be effective, although you’ll feel something - usually side effects - the next day.
Likelihood of Working
As far as amitriptyline’s approved use goes, the odds favor relief for endogenous (biologically caused) depression - i.e. being depressed for no good reason other than your brain hating you.
Taking and Discontinuing
How to Take Elavil
Initial dose for outpatients (you’re not crazy enough to be hospitalized) should be 50 mg at bedtime. You can increase it by 25 mg a night every week until you get to a maximum of 150 mg a night. You can also try it in a divided dose. Elavil (amitriptyline) is approved for dosages of 200 - 300 mg a day for hospitalized patients and used to be prescribed up to 400 mg a day for inpatients. Personally I wouldn’t trust it above 150 mg a day. Not that it’s particularly more dangerous than other TCAs (see comments), as long as you’re not taking a bunch of other drugs, including a potent CYP2D6 inhibitor, and aren’t a poor CYP2D6 metabolizer. If amitriptyline isn’t doing anything at all for you by the time you reach 100 mg 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.
How to Stop Taking Elavil (discontinuation / withdrawal)
Your doctor should be recommending that you reduce your dosage by 25–50 mg a day every five days if you need to discontinue it. While TCAs don’t have a discontinuation syndrome as such, they can trigger mania if discontinued too quickly, regardless of your being bipolar or not. Any antidepressant can do that, it’s just more likely to happen with a TCA than other antidepressants.