Amitriptyline

Amitriptyline is a tricyclic antidepressant (TCA) with analgesic, sedative, and anticholinergic properties. It is widely used for both psychiatric and non-psychiatric conditions.

• Class: Tricyclic antidepressant (TCA)
• ATC code: N06AA09

• Inhibits reuptake of serotonin (5-HT) and norepinephrine (NE) in the central nervous system.
• Blocks muscarinic, histaminergic (H1), and alpha-adrenergic receptors, contributing to its side effects.

• Major depressive disorder
• Neuropathic pain (e.g., diabetic neuropathy, postherpetic neuralgia)
• Chronic tension-type headache and migraine prophylaxis
• Fibromyalgia
• Irritable bowel syndrome (off-label)
• Tinnitus-related anxiety or depression (off-label)

• Starting: 10–25 mg at bedtime
• Titration: Increase gradually based on response
• Max: 150–300 mg/day (lower in elderly or for non-psychiatric uses)

• Common: Dry mouth, constipation, urinary retention, sedation, weight gain, dizziness
• Serious: Cardiac arrhythmias, QT prolongation, seizures, orthostatic hypotension
• Toxicity: Narrow therapeutic index; risk of fatal overdose due to cardiac toxicity

• Recent myocardial infarction
• Arrhythmias
• Concurrent MAO inhibitor therapy
• Angle-closure glaucoma

• ECG in patients >40 years or with cardiac history
• Monitor for anticholinergic toxicity
• Assess for suicidal ideation, especially early in treatment

• Effective at low doses (10–50 mg) for pain and sleep-related symptoms
• Sedative effect useful in patients with insomnia
• Use with caution in elderly due to anticholinergic burden

• Brand names: Elavil®, Tryptizol®, Saroten®
• Generic: Amitriptyline hydrochloride