What is amitriptyline?
Amitriptyline is an antidepressant drug licensed to treat moderate to severe depression. In multiple sclerosis, amitriptyline is often used in lower doses for the treatment of neuropathic or nerve pain, such as burning sensations, pins and needles or stabbing pains.
NICE guidelines on neuropathic pain recommend amitriptyline as a first-line treatment.
How do I take amitriptyline?
Amitriptyline is usually taken by mouth (orally) as tablets, but liquid forms are also available. As it can cause drowsiness, it is often suggested that you take it at night. Amitriptyline normally takes between two to four weeks to take effect, but can take as long as 6 weeks to take effect.
If you want to stop treatment, speak to your doctor about gradually reducing the dose you are taking. This reduces the risk of withdrawal symptoms such as headache, nausea, and an overall feeling of discomfort.
Who can take amitriptyline?
Amitriptyline can be taken by most adults, and also by children over the age of 2.
It may not be suitable for you if you have had an allergic reaction to amitriptyline or other medicines in the past, if you have porphyria, liver or kidney problems. If you have epilepsy, amitriptyline can increase seizures. If you have a heart problem, amitripyline may not be suitable as it can make some heart conditions worse. Amitripyline can increase the pressure in your eye, so it may not be suitable for you if you have glaucoma.
Amitriptyline is not always recommended if you are trying to become pregnant, during pregnancy or while breastfeeding. It has been linked to a small risk of problems for the unborn baby, and the drug also gets into breast milk and can cause side effects in a breastfeeding infant.
Amitriptyline can interfere with other medicines you are taking. Some antidepressants can interfere with amitriptyline to cause very high blood pressure even after you stop taking them. Make sure your doctor knows what other medicines and supplements you are taking.
You are advised by the NHS not to take St John's Wort, the herbal remedy for depression, while also taking amitriptyline, as it will increase your risk of side effects.
What side effects could I get with amitriptyline?
Amitriptyline boosts the sedative effects of alcohol and some other types of drug (eg antihistamines, tranquillisers, prescription pain medications, seizure medications, muscle relaxants, sleeping medications), possibly causing drowsiness. Be sure that your doctor knows what other medications you are taking.
Side effects of amitriptyline can include dry mouth, skin sensitivity, blurred vision, difficulty emptying the bladder and constipation.
As some of the side effects are similar to common symptoms of MS, talk to your doctor if you notice any of these happening while you are taking amitriptyline.
How does amitriptyline work?
Amitriptyline is one of a class of drugs called tricyclic antidepressants. It works by changing the way in which nerves in the central nervous system react to pain. The drug acts at the junctions between nerves, making pain messages less likely to be carried to the brain.
- London: NICE; 2013. Read the full guideline on the NICE website Neuropathic pain - pharmacological management: the pharmacological management of neuropathic pain in adults in non-specialist settings.
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Neuropathic or nerve pain is an invisible but debilitating symptom of multiple sclerosis. A pain consultant writes about how this can be managed.
Depression can be common in MS, either as a direct symptom or as a consequence of living with the condition. Find help to recognise and cope with depression here.