Amitriptyline is a treatment for irritable bowel syndrome (IBS) that doctors may use when other drugs or interventions have not helped. Research into its effectiveness in treating IBS symptoms is ongoing.

The Food and Drug Administration (FDA) has not approved amitriptyline for IBS. However, some experts believe it may be an effective option for some. It falls into a class of medications called tricyclic antidepressants. Typically, doctors prescribe amitriptyline to people with depression.

People who have irritable bowel syndrome with diarrhea (IBS-D) may also benefit from low dose amitriptyline. However, doctors usually recommend other medications first.

Keep reading to learn more about using amitriptyline for IBS.

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Amitriptyline has approval from the FDA for treating depression in adults.

While the FDA has not approved amitriptyline for IBS, there have been some studies that suggest it may be effective when other treatments have not helped. However, it is not a cure.

Due to potential side effects risks, doctors may suggest amitriptyline for moderate to severe IBS cases.

There is ongoing research looking into the effects of amitriptyline for IBS in a clinical trial called the ATLANTIS trial. The researchers have not published their results yet.

Learn more about tricyclic antidepressants.

Other nonapproved uses

Other non-FDA approved uses of amitriptyline include the treatment of:

  • anxiety
  • sialorrhea, a gastrointestinal condition that causes excessive drooling
  • chronic nerve pain, as some research suggests amitriptyline can act on nerve signaling and reduce feelings of pain or discomfort

This list is not exhaustive, and other nonapproved uses of amitriptyline exist.

Another factor that may influence how long it takes amitriptyline to work is dosing.

Doctors usually start at the lowest dose, slowly increasing it if the medication is effective and they can manage the side effects well. The starting dose is usually 10 milligrams.

Compared with other treatments for IBS, such as laxatives and antimotility drugs, amitriptyline may take weeks to months to start working. The time it takes for amitriptyline to work can also depend on other factors, including the severity and nature of the condition.

The primary symptom of IBS-D is frequent diarrhea.

Research from 2008 suggests that low dose amitriptyline can be beneficial in treating IBS-D. Tricyclic antidepressants supposedly have some of the following effects:

  • reduced transit time for food to travel through the digestive system
  • altered gut motility, which refers to how food moves around in the digestive tract
  • altered visceral sensitivity, which is how the intestines or organs of the digestive tract react to pain

However, more research is necessary to determine the actual effect of amitriptyline on IBS and IBS-D.

Some studies have been inconclusive because researchers used amitriptyline alongside other medications. This makes it more difficult to recognize how effective the drug may be.

IBS-D treatment

Before prescribing amitriptyline for IBS, doctors may suggest other drugs first.

The following table shows potential treatments for IBS-D:

Drug classDrug name
Antimotilityloperamide (Imodium)
Antibioticsrifaximin (Xifaxan)
Opioid receptor activatorseluxadoline (Vibrezi)
Selective serotonin receptor blockersalosetron (Lotronex)

Doctors may prescribe lower doses of amitriptyline for IBS compared with the dose for depression. Still, people can experience side effects when using amitriptyline.

Common side effects include:

It is important to note that this medication also has a boxed warning for the risk of suicidal thoughts and behaviors in people under 24 years old.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

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Groups more likely to have side effects

Some people may be more likely to have certain side effects.

A doctor may exercise extra caution before prescribing amitriptyline if a person has:

Many treatments for IBS are available, and people’s experiences with drugs that doctors commonly use can differ.

Specific treatments for IBS depend on the nature, type, and severity of the condition. For example, people who have IBS-D may benefit from antimotility drugs to manage diarrhea.

The American College of Gastroenterology recommends the antispasmodic drug dicyclomine (Bentyl) to improve IBS symptoms. Despite this recommendation, the evidence supporting the use of antispasmodics is weak.

Drug makers have also developed new treatments for IBS. However, their efficacy is modest, and drugs may be expensive. Regulators have taken several drugs off the market due to safety concerns.

Nondrug treatments for IBS may include:

What about IBS with constipation?

People with IBS with constipation (IBS-C) may benefit from certain laxatives.

However, not all laxatives are appropriate for people with IBD-C. The evidence supporting using polyethylene glycol laxative for treating constipation in people with IBS is unclear.

Other drugs to lessen symptoms of IBS-C include chloride channel activators such as lubiprostone (Amitiza) and guanylate cyclase-C receptor activators such as linaclotide (Linzess) and plecanatide (Trulance).

Amitriptyline is an antidepressant medication that doctors sometimes prescribe to treat symptoms of irritable bowel syndrome.

Research suggests that low dose amitriptyline may be beneficial in treating some cases of IBS, including IBS-D. However, more research is necessary to determine the actual effect of amitriptyline on IBS. A clinical trial is currently in progress to study this in more detail.