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.
Amitriptyline has approval from the
While the FDA has not approved amitriptyline for IBS, there have been
Due to potential side effects risks, doctors
There is ongoing research looking into the effects of amitriptyline for IBS in a clinical trial called the
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.
- 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 class | Drug name |
| Antimotility | loperamide (Imodium) |
| Antibiotics | rifaximin (Xifaxan) |
| Opioid receptor activators | eluxadoline (Vibrezi) |
| Selective serotonin receptor blockers | alosetron (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.
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 it’s safe to do so.
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.
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:
- a history of heart issues, such as:
- arrhythmias
- heart attacks
- heart failure
- other related problems
- a seizure disorder, as the drug can increase the risk of seizures
- recently taken medications called
monoamine oxidase inhibitors , in which case a doctor may give amitriptyline at least 14 days later
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
Nondrug treatments for IBS may include:
- lifestyle changes
- psychological interventions
- complementary and alternative medications
- certain types of
long-chain fiber supplementation, for example, psyllium husk (Metamucil)
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.