side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more

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> Elavil



Brand & Generic Names; Drug Classes

US brand name: Elavil
Generic name: amitriptyline

Drug Class(es)

Primary drug class: Antidepressants
Additional drug class(es): Tricyclic & Tetracyclic Antidepressants

Approved & Off-Label Uses (Indications)

Elavil’s US FDA Approved Treatment(s)

Depression.

Uses Approved Overseas but not in the US

N/A

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)
    • 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 (PTSD)
  • Panic/Anxiety disorders
  • Insomnia
  • 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.



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Elavil’s Pros and Cons

Pros

  • Amitriptyline has been on the market since forever, so doctors are familiar with its uses and effects.
  • Elavil has been around forever, so generic amitriptyline is cheaper than dirt on practically every insurance company and HMO formulary.

Cons

  • Elavil has been around since forever, so younger doctors are unlikely to prescribe it, assuming they’ve even heard of it.
  • Since you’re only going to get generic amitriptyline you may get your meds from a different manufacturer from month to month, which can make a difference. See the page on brand name and generic drug differences for more information.
  • Amitriptyline reported to have the harshest anticholinergic side effects of the more popular TCAs - Tofranil (imipramine HCl) & Tofranil-PM (imipramine pamoate), Norpramin (desipramine HCl), and Pamelor (nortriptyline HCl). If you look at the TCA binding profiles you can see its raw power at the muscarinic receptors and fairly high potency at the histamine receptors. Trust me, its anticholinergic side effects have nothing on Vivactil’s (protriptyline).

Interesting Stuff your Doctor Probably didn’t Tell You

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).

Best Known for

Being used at a nearly fatal dosage, along with Neurontin, on the TV show Fringe as a method to cross between universes. A cocktail of 2,000 mg of Elavil and 5,000 mg of Neurontin would probably send me to another universe.

Elavil’s Side Effects

Typical Side Effects

The usual for TCAs - headache, nausea, dry mouth, sweating, blurry vision, sleepiness or insomnia, constipation, and weight gain. Expect the sedation to hang around for awhile and the dry mouth and constipation to be permanent. The weight gain usually isn’t that bad.

Uncommon 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.

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. “Reversible brain death” reads like something from a Reanimator script.

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What You Really Need to be Careful About

Heart palpitations, arrhythmia, and similar cardiac weirdness.

Pregnancy Category

C-Use with caution

Pharmacology

Elavil’s Half-Life & How Long Until It Clears Your System

Plasma half-life: 24 hours. Expect it to clear out of your system in 5 days.

Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream2, so there’s nothing swimming around to attach itself to your brain and start doing stuff. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what3, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood.

Steady State

usually two to three days.

Steady state is the flipside of half-life. This is when you can expect to get over side effects caused by fluctuating amounts of a medication in your bloodstream. Often, but not always the same amount of time as the plasma clearance above.

How amitriptyline Works

the current best guess at any rate
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.

Active Ingredient

amitriptyline hydrochloride

The active ingredient is usually the same as the generic name, but more often than not it’s a chemical salt of the substance identified as the generic. E.g. Fluoxetine is the generic for Prozac, but the active ingredient is fluoxetine hydrochloride (or HCl). It usually doesn’t make much of a difference outside of the more esoteric aspects of a drug’s pharmacology, but not always.

Shelf Life

Tablets: 3 years

Noted Drug-Drug & Drug-Food Interactions

  • Alcohol. TCA + booze = dead.
  • Antabuse (disulfiram). Elavil (amitriptyline) + the drug that prevents alkies from drinking = delirious and potentially dead. Some people can’t win for losing.
Check for Other Drug-Drug & Drug-Food Interactions

Drugs.com’s drug-drug and drug-food interaction checker

It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on teh Faecesbooks.

Name, Address, Serial Number (Generic and Overseas Availability)

Available in the US as a generic? Yes||

Other Trade Names and Overseas Availability

See comments section below

Shapes & Sizes (How Supplied)

Tablets, intramuscular injection, oral solution

Comments, PI Sheet, Ratings, Reviews and More

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 300 mg 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 150 mg 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 most TCAs when at their high dosages
  • And I’m a poor metabolizer of CYP2D6 substrates

So decide for yourself about 150 mg 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!

Other brand names & branded generic names4

  • 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

Rate Elavil

Give your overall impression of Elavil on a scale of 0 to 5. Detailed ratings and reviews are available on the Elavil Ratings & Reviews Page.

Get all critical about Elavil

3 stars Rating 3.0 out of 5 from 39 criticisms.
Vote Distribution: 7 – 5 – 3 – 3 – 8 – 13


Rate this article

If you’re still feeling judgmental as well as just mental5, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.

Get all judgmental about the Elavil (amitriptyline) Synopsis

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Vote Distribution: 0 – 1 – 0 – 0 – 11 – 15



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Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, and Other Sites that may be of Interest

Elavil’s Full US Prescribing Information / PI Sheet

UK SPC

Discussion board

If you have any questions not answered here, please see the Crazymeds Elavil discussion board.


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Bibliography

Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Third edition by Stephen M. Stahl © 2008 Published by Cambridge University Press.

Primer of Drug Action 12th edition by Robert M. Julien Ph.D, Claire D. Advokat, Joseph Comaty © 2011 Published by Worth Publishers.

Clinical Handbook of Psychotropic Drugs 18th edition Adil S. Virani, K. Bezchlibnyk-Butler, J. Jeffries © 2009 Published by Hogrefe & Huber Publishers.

Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 An imprint of Elsevier.

PDR: Physicians’ Desk Reference 2010 Edition 56 Maria Deutsch & Anu Gupta, Drug Information Specialists, et al. © 2002. Published by Medical Economics Company.

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

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


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

2 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady state if they can't get, or won't provide a number for that.

3 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.

4 Warning: Footnote '#bg' referenced but not defined.

5 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!


If you have any questions not answered here, please see the Crazymeds Elavil discussion board. I welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why I write these damn things. I’m frustrated enough as it is. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds.


Last modified on Friday, 28 March, 2014 at 05:06:27 by SomeMedCriticPage Author: JerodPooreDate created Thursday, 31 January 2013 at 11:19:31

Elavil by JerodPoore is copyright © 2013 JerodPoore


Elavil, and all other drug names on this page and use throughout the site, are a trademark of someone else. Look on the the PI sheet or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing.




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All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
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Crazymeds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Safari or Chrome, although more than half of the visitors to this site use either Safari or Internet Explorer, so I’m doing my best to make things look nice for IE as well. I’m using Firefox and running Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
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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 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 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 Crazymeds. 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 a forerunner of 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]

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