Medication Guide
Amitriptyline (Elavil) Side Effects and Uses
A plain-language guide to Amitriptyline, a Tricyclic antidepressant (TCA). Learn how it helps, what it treats, how to take it and which side effects to know about.
Quick answer. Amitriptyline (Elavil) is a Tricyclic antidepressant (TCA). Common amitriptyline side effects include sleepiness or morning grogginess, dry mouth, constipation and blurred vision. The rare but serious ones, and when to get help, are listed under amitriptyline side effects below. Never stop or change your dose on your own.
How Amitriptyline Can Help You
Amitriptyline (Elavil) is a tricyclic antidepressant, or TCA. It raises two brain chemicals tied to mood and pain. Newer medicines are now the usual first choice for depression.
Still, amitriptyline is very useful in low doses for long-term pain. This includes nerve pain, migraine prevention, fibromyalgia and tension headaches. At these low doses, it calms overactive pain pathways and can improve sleep.
For pain and sleep, benefits often show up within one to four weeks. For depression, higher doses are needed. Improvement follows the usual four to eight weeks. TCAs act on several other receptors too. So dry mouth and drowsiness are more common than with newer drugs. Your prescriber starts low and goes slowly.
Uses for Amitriptyline
- Major depressive disorder
- Nerve pain (off-label)
- Migraine prevention (off-label)
- Chronic tension headache (off-label)
- Fibromyalgia (off-label)
- Insomnia (off-label)
- Irritable bowel syndrome (off-label)
How to Take Amitriptyline
Your prescriber decides your dose. It is usually much lower for pain, sleep or headaches than for depression. It is usually taken in the evening because it makes you sleepy. You can take it with or without food.
Take it at the same time each night. Allow a full night of sleep to limit morning grogginess. If you miss a dose, skip it and do not double up. Do not stop it suddenly. That can cause nausea, headache and poor sleep. An overdose can be dangerous. Take it exactly as prescribed and store it safely.
Amitriptyline Side Effects
Common Side Effects
- Sleepiness or morning grogginess
- Dry mouth
- Constipation
- Blurred vision
- Weight gain
- Dizziness on standing
- Trouble starting to urinate
- More sweating
Serious: Get Medical Help Promptly
- New or worse suicidal thoughts, mostly in people under 25 (boxed warning)
- Heart rhythm changes, with a pounding heartbeat or fainting
- Dangerous in overdose, so take it exactly as prescribed and store it safely
- Severe confusion, mostly in older adults
- Angle-closure glaucoma, with sudden eye pain or vision changes
- Serotonin syndrome when combined with other serotonin drugs
Elavil Generic Name and Forms
The generic name for Elavil is amitriptyline. Labels list it as amitriptyline hydrochloride. Elavil is an older brand name. Today, it is almost always filled as a generic tablet. The tablets come in several strengths. Low ones are often used for pain and sleep. Higher ones are used for depression.
It is a tricyclic antidepressant. The name comes from its three-ring shape. It has been in use since the early 1960s. Its FDA approval is for depression. Its uses for nerve pain, migraine and sleep are off-label. Still, they are common and well studied.
How Does Elavil Work?
Amitriptyline keeps two brain chemicals active for longer. They are serotonin and norepinephrine. The liver turns part of it into nortriptyline. That is also an active tricyclic medicine. So when you take amitriptyline, you get the effects of both.
At high blood levels, tricyclics can slow the heart's electrical signals. This is the main reason an overdose is so dangerous. It is why prescribers watch the dose, other medicines and heart history closely. Your prescriber may limit how many tablets you get at once. Store it out of reach of children and others.
Before You Start Amitriptyline
Amitriptyline is not used during recovery from a recent heart attack. Tell your prescriber about heart rhythm problems, glaucoma and seizures. Also mention trouble urinating or an enlarged prostate. Also mention thyroid disease, diabetes, liver disease and any past bipolar disorder.
Older adults are often more prone to confusion, falls and constipation from tricyclics. So other options may be a better fit. Like all antidepressants, it has a boxed warning. It covers suicidal thoughts in young people. If you are thinking about harming yourself, call or text 988, or call 911. If someone may have taken too much, call 911 or Poison Control at 1-800-222-1222.
Interactions to Know About
It must never be combined with an MAOI antidepressant. Other drugs that raise serotonin add to the risk of serotonin syndrome. Drugs that affect the QT interval raise heart rhythm risk.
Some medicines slow the enzyme that breaks down amitriptyline. They include fluoxetine, paroxetine, bupropion and quinidine. They can raise its level sharply. Alcohol, sleep aids, opioids and other sedating drugs add to drowsiness. They can also slow breathing. Some allergy and bladder medicines can worsen dry mouth, constipation and confusion. Learn about medication management by telehealth in California.
Is Amitriptyline Right for You?
Only a full evaluation with a prescriber can tell you if Amitriptyline fits your symptoms, history and goals. Harpal Singh, PMHNP-BC offers psychiatric evaluations and ongoing medication management by telehealth anywhere in California.
SCHEDULE AN APPOINTMENT CALL (888) 457-8124
Related Medication Guides
Other guides in the same group, written the same simple way. Being in one group does not mean you can swap one medicine for another.
- Desvenlafaxine (Pristiq), SNRI antidepressant
- Doxepin (Silenor), Tricyclic antidepressant (TCA)
- Duloxetine (Cymbalta), SNRI antidepressant
- Escitalopram (Lexapro), SSRI antidepressant
- Fluoxetine (Prozac), SSRI antidepressant
- Fluvoxamine (Luvox), SSRI antidepressant
FAQ
Questions About Amitriptyline
What is the generic name for Elavil?
The generic name for Elavil is amitriptyline. The label may say amitriptyline hydrochloride. Today it is almost always filled as a generic. It is the same medicine no matter which name is on the label.
What is Elavil used for?
Elavil is FDA approved for depression. It is also widely used off-label at low doses. Common reasons are nerve pain, migraine, tension headaches, fibromyalgia and sleep. Your prescriber explains which purpose it serves in your plan.
Why was I prescribed an antidepressant for pain or migraines?
At low doses, amitriptyline strengthens the body's own pain control and calms overactive nerves. These effects are separate from its mood effect. Decades of research back this use. The doses are far below those used for depression.
Is low-dose amitriptyline different from a full antidepressant dose?
It is the same medicine. Low doses are often used for pain, headache prevention or sleep, while depression usually needs higher doses. Your prescriber decides the right amount, so do not raise it on your own.
Why do TCAs have more side effects than newer antidepressants?
Tricyclics also act on other body systems that newer drugs leave alone. This causes drowsiness, dry mouth, constipation and dizziness on standing. At low doses these are usually mild, but higher doses need closer follow-up.
Is amitriptyline safe for my heart?
TCAs can affect the heart's electrical signals, mostly at higher doses or in people with heart disease. Your prescriber may order an EKG before or during treatment. This is more likely at higher doses or if you have heart risk factors.
Will I be groggy in the morning?
Some people feel carryover sleepiness, mostly at first. Taking it earlier in the evening, getting a full night of sleep and giving your body a week or two to adjust often helps. If grogginess lasts, your prescriber can change the plan.
Can amitriptyline cause weight gain?
Yes, weight gain is a known side effect, often linked to a bigger appetite. Your prescriber may track your weight over time. Tell them if you notice a change, since there may be other options.
What should I avoid while taking amitriptyline?
Limit alcohol, since it adds to sleepiness. Be careful with other drugs that make you sleepy. Tell every provider, including dentists and surgeons, that you take a tricyclic. Never combine it with MAOIs, and keep it stored safely.
Is amitriptyline addictive?
Amitriptyline is not a controlled substance and does not cause cravings. The body does adjust to it, though, so stopping suddenly can cause nausea, headache and sleep trouble. Your prescriber can plan a slow taper when it is time to stop.