Elavil (now discontinued) was a brand name for a generic drug called amitriptyline hydrochloride, or simply amitriptyline.
Amitriptyline was also available under the brand name Endep, but the Food and Drug Administration (FDA) have discontinued these brands.
Amitriptyline is still available under its generic name. It belongs to the wider class of drugs called tricyclic antidepressants. Most of these drugs work by increasing the availability of dopamine and norepinephrine in the brain.
This article outlines the side effects and risks associated with amitriptyline.
The most commonly reported side effects of amitriptyline include:
Although less common, the following side effects may also occur:
- difficulty sleeping
- difficulty paying attention
- blurred vision
- acute angle glaucoma, an eye condition
- difficulty passing urine
- decreased sex drive
- postural hypotension
- abnormal heart rate
In some cases, amitriptyline may cause the following serious adverse reactions:
- prolonged QT, which is a problem with the electrical activity of the heart
- heart arrhythmias
- heart attack
- temporary loss of consciousness
- paralytic ileus, an intestinal obstruction
- conditions affecting the bone marrow
- allergic reaction
In addition to potentially causing side effects, amitriptyline may interact with other medications a person is taking. Such medications include:
Monoamine oxidase inhibitors
Tricyclic antidepressants can be fatal if a person takes them alongside monoamine oxidase inhibitors (MAOIs).
MAOIs are an older type of antidepressant medication. Although doctors have mostly phased out their use, some may still prescribe them when modern antidepressants are not effective.
Taking MAOIs with amitriptyline or other tricyclic antidepressants can cause dangerously high fever, severe convulsions, and even death.
Examples of MAOIs include:
People should be careful when switching from an MAOI to a tricyclic antidepressant. In such cases, experts recommend stopping the MAOI and waiting a minimum of 14 days before starting on a minimal dosage of tricyclic antidepressant.
A doctor may increase the amount gradually, if necessary.
Amitriptyline may also cause severe reactions when a person uses it in combination with other antidepressants, such as:
- phenobarbital (Bellatal, Solfoton)
- citalopram (Celexa)
- fluoxetine (Prozac, Sarafem)
- fluvoxamine (Luvox)
- paroxetine (Paxil)
- sertraline (Zoloft)
- other selective serotonin reuptake inhibitors (SSRIs)
Central nervous system depressants
Central nervous system (CNS) depressants are drugs that slow brain activity, relax the muscles, and have a calming effect on the body. Doctors sometimes prescribe them to help treat anxiety, acute stress, and sleep disorders.
Examples of CNS depressants include sedatives, tranquilizers, and hypnotics. Amitriptyline can enhance the effects of these drugs, so people should not take both at the same time.
Doctors may still prescribe the drug, but only in rare cases when it is necessary.
Taking amitriptyline alongside cisapride further increases the risk of heart arrhythmias and other serious cardiac events.
Other drug interactions
Amitriptyline also interacts with several other drugs, including:
- epinephrine, an emergency treatment for severe allergic reactions
- norepinephrine, a drug that controls dangerously low blood pressure
- ephedrine, a stimulant that treats low blood pressure during anesthesia
- dronedarone, a treatment for certain types of heart arrhythmia
- lithium, a drug that can help treat bipolar disorder
Due to safety concerns, drug manufacturers advise against the use of amitriptyline while taking these drugs.
A person should speak to their doctor about the other possible risks of taking amitriptyline. These include:
Suicidal thoughts and behaviour
The term “suicidality” refers to having suicidal thoughts and exhibiting suicidal behavior.
Taking antidepressants can increase the risk of suicidality in adolescents and young adults with major depressive disorder and other psychiatric conditions.
- If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Call 911 or the local emergency number.
- Stay with the person until professional help arrives.
- Remove any weapons, medications, or other potentially harmful objects.
- Listen to the person without judgment.
- If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-8255.
Worsening heart conditions
Amitriptyline is not suitable for people with a history of the following heart and circulatory problems:
- heart arrhythmias
- prolonged QT
- heart attack
- heart failure
Although there is no evidence to suggest that amitriptyline is addictive, the drug can cause temporary withdrawal symptoms.
These symptoms are more likely to affect people who stop taking the drug abruptly. However, they may also occur in people who reduce their dosage gradually.
Symptoms of amitriptyline withdrawal may include:
- a general feeling of being unwell
- disturbed sleep and dreams
Overdose of amitriptyline or other tricyclic antidepressants can be fatal. The following signs and symptoms indicate a serious overdose requiring urgent medical attention:
- irregular heartbeat
- weak pulse
- decreased heart rate
- decreased breathing rate
- low blood pressure
Other signs of overdose that require attention include:
- poor concentration
- difficulty controlling eye movement
- pupil dilation
- nervousness or anxiety
- muscle rigidity
People who have accidentally taken an extra dose of their medication should call a doctor for further instruction.
In other cases of overdose, people should call the emergency services. The signs and symptoms of amitriptyline overdose can develop rapidly.
Amitriptyline is a tricyclic antidepressant that doctors can prescribe to help treat depression and other psychiatric conditions. Although Elavil used to be available, the FDA called for the discontinuation of the brand.
Amitriptyline has a range of possible side effects, some of which can be very serious. It is important to note that not everyone experiences all or any side effects, and the benefits of the drug may outweigh the risks.
However, amitriptyline may not be suitable for certain people, particularly those with a history of heart or circulatory problems.
To avoid adverse drug interactions, people who are considering treatment with amitriptyline should tell a doctor about all of the other medicines they are taking or have recently taken.