How To Use This Medicine

Amitriptyline comes as a tablet to take by mouth. It is usually taken one to four times a day. To help you remember to take amitriptyline, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take amitriptyline exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of amitriptyline and gradually increase your dose. It may take a few weeks or longer before you feel the full benefit of amitriptyline. Continue to take amitriptyline even if you feel well. Do not stop taking amitriptyline without talking to your doctor.

Stopping amitriptyline suddenly may cause withdrawal symptoms such as:

• upset stomach
• headache
• lack of energy

Your doctor will probably decrease your dose gradually.

Other Uses For This Medicine

Amitriptyline is also sometimes used to treat chronic pain, eating disorders, and certain skin problems. Talk to your doctor about the possible risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Special Precautions

Tell your doctor and pharmacist if you are allergic to amitriptyline or any other medications.

Tell your doctor if:

• You or anyone in your family has or has ever had depression, bipolar disorder (mood that changes from depressed to abnormally excited)
• You have mania (frenzied, abnormally excited mood)
• You or anyone in your family has thought about or attempted suicide
• You drink large amounts of alcohol
• You have recently had a heart attack
• You have or have ever had glaucoma
• You have an enlarged prostate
• You have difficulty urinating
• You have seizures
• You have an overactive thyroid gland (hyperthyroidism)
• You have diabetes
• You have liver, kidney, or heart disease
• You are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking amitriptyline, call your doctor immediately.
• If you are having surgery, including dental surgery, tell the doctor or dentist that you are taking amitriptyline.

Amitriptyline may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you. Remember that alcohol can add to the drowsiness caused by this medication.

You should know that your mental health may change in unexpected ways, especially at the beginning of your treatment and any time that your dose is increased or decreased. These changes may occur at any time if you have depression or another mental illness, whether or not you are taking amitriptyline or any other medication. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms:

• new or worsening depression
• thinking about harming or killing yourself or planning or trying to do so
• extreme worry
• agitation
• panic attacks
• difficulty falling asleep or staying asleep
• aggressive behavior
• irritability
• acting without thinking
• severe restlessness
• frenzied abnormal excitement

Avoid drinking alcohol or taking other medicines that cause drowsiness (eg, sedatives, tranquilizers) while taking Amitriptyline. Amitriptyline will add to the effects of alcohol and other depressants. Ask your pharmacist if you have questions about which medicines are depressants.

Alcoholic beverages, hot weather, exercise, and fever can increase dizziness. To prevent dizziness or fainting, sit up or stand slowly, especially in the morning. Also, sit or lie down at the first sign of dizziness or weakness.

Involuntary and uncontrollable movements may develop in patients taking Amitriptyline. Occurrence is highest among the elderly, especially women. The risk of developing these involuntary movements and the likelihood they will become permanent are increased with long-term use and with high doses. However, it is possible to develop these symptoms after short-term use at low doses.

Contact your health care provider at once if any of the following occur:

involuntary movements of the tongue, face, mouth, or jaw (eg, protrusion of tongue, puffing of cheeks, puckering of mouth, chewing movements), sometimes accompanied by involuntary movements of the arms and legs

Amitriptyline may cause sensitivity to sunlight. Avoid prolonged exposure to the sun and other ultraviolet light (eg, tanning beds). Use sunscreens and wear protective clothing until tolerance is determined.

Do not become overheated in hot weather or during exercise or other activities since heatstroke may occur.

Before you have any medical or dental treatments, emergency care, or surgery, tell the doctor or dentist that you are using Amitriptyline.

Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor when you are unable to seek treatment on your own.

Drug Interactions

Do not take amitriptyline if you are taking monoamine oxidase (MAO) inhibitors, including:

• phenelzine (Nardil®)
• tranylcypromine (Parnate®)
• or if you are taking cisapride (Propulsid®)
• or you have stopped taking them within the past 2 weeks.

Tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following:

• cimetidine (Tagamet®)
• diet pills
• disulfiram (Antabuse®)
• ethchlorvynol (Placidyl®)
• guanethidine (Ismelin®)
• ipratropium (Atrovent®)
• quinidine (Quinidex®)
• flecainide (Tambocor®)
• propafenone (Rythmol®)
• medications for anxiety
• medications asthma
• medications colds
• medications irritable bowel disease
• medications mental illness
• medications nausea
• medications Parkinson's disease
• medications seizures
• medications ulcers
• medications urinary problems
• other antidepressants
• phenobarbital (Bellatal®, Solfoton®)
• sedatives
• citalopram (Celexa®)
• fluoxetine (Prozac®, Sarafem®)
• fluvoxamine (Luvox®)
• paroxetine (Paxil®)
• sertraline (Zoloft®)
• sleeping pills
• thyroid medications
• tranquilizers

Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

There may be other drugs not listed that can affect amitriptyline. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

If You Forget A Dose

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Side Effects

Amitriptyline may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• upset stomach
• vomiting
• drowsiness
• weakness or tiredness
• excitement or anxiety
• difficulty falling asleep or staying asleep
• nightmares
• restlessness
• headaches
• dry mouth
• constipation
• difficulty urinating
• blurred vision
• pain, burning, or tingling in the hands or feet
• changes in sex drive or ability
• excessive sweating
• changes in appetite or weight
• confusion
• unsteadiness

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them call your doctor immediately:

• slow or difficult speech
• dizziness or faintness
• weakness or numbness of an arm or a leg
• crushing chest pain
• rapid, pounding, or irregular heartbeat
• severe skin rash or hives
• swelling of the face and tongue
• yellowing of the skin or eyes
• jaw, neck, and back muscle spasms
• shaking hands that you cannot control
• difficulty sitting still
• fainting
• unusual bleeding or bruising
• seizures
• seeing things or hearing voices that do not exist (hallucinating)

Amitriptyline may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (at http://www.fda.gov/MedWatch/report.htm) or by phone (1-800-332-1088).

Storage Conditions

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In Case of Emergency/Overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of Overdose

• irregular heartbeat
• seizures
• coma
• confusion
• problems concentrating
• seeing things that do not exist (hallucinating)
• agitation
• drowsiness
• rigid muscles
• vomiting
• fever
• cold body temperature