What to Know About Elavil (Amitriptyline)

Elavil is a medication used primarily for the treatment of depression. It is what’s known as a tricyclic antidepressant. It can also be used off-label to treat some symptoms of mood disorders, eating disorders, nerve pain, and anxiety.

In 2000, Elavil was discontinued by the Food and Drug Administration (FDA). The reasons why the brand name form of the drug was discontinued remain unclear.

It’s thought that Elavil was discontinued because of the risk it posed of developing a heart condition while using the medicine. However, in 2017 the FDA put out a notice stating that the reason for discontinuing the drug was unrelated to its safety or effectiveness.

This article breaks down the uses and side effects of Elavil. It also covers how to cope with these side effects, common dosages, and any potential risks of taking the drug.

Uses for Elavil

Amitriptyline has been found to be effective in treating depression. It is FDA-approved in the treatment of depression, but it is also sometimes prescribed off-label to treat other mental health conditions including bulimia, insomnia, post-traumatic stress disorder PTSD), and anxiety.

When taken for depression and other mood problems, people usually begin experiencing some improvements in mood within one to two weeks of taking Elavil. It usually takes several weeks to experience the full effects.

Side Effects of Elavil 

Even in its generic form, the side effects you might experience when using Elavil can be split broadly into two categories: mild or severe.

In other words, there are common side effects that typically go away with time and are usually nothing to worry about. On the other hand, there are more severe side effects that might require you to speak to your doctor about possibly lowering your dose or discontinuing the medication. 

Common Side Effects 

Although Elavil was discontinued, the generic form of the drug is still available and prescribed by doctors. It’s safe to take, and most people who use the medication will only experience a few mild side effects.

The most common side effects of Elavil include: 

• Drowsiness 
• Weight gain 
• Dizziness 
• Weight fluctuation 
• Blurred vision 
• Constipation 
• Headaches
• Dry mouth 
• Lightheadedness 
• Difficulty urinating

Severe Side Effects

Experiencing severe side effects while using amitriptyline is uncommon. However, there have been reports of the following side effects sometimes occurring while using this medication:

• Changes in your vision 
• Seizures 
• Being unable to urinate 
• Bruising or bleeding 
• Severe stomach pain
• Muscle spasms 
• Difficulty having sex 
• Developing a mask-like face 
• Hallucinations 
• Tremors 
• Fainting
• Difficulty speaking 
• Numbness in the arms or legs

If your doctor intends to have you discontinue Elavil, they will most likely gradually reduce your dose to wean you off of the medication.

Neuroleptic Malignant Syndrome

In sporadic cases, Elavil can cause a condition called neuroleptic malignant syndrome (NMS). NMS is a reaction to antipsychotic drugs that causes muscle stiffness, fever, or an altered mental state.

Symptoms of NMS include:

• Irregular heartbeat
• Muscle stiffness
• Excessive sweating
• Severe confusion
  

While there are very few reports of people developing an allergic reaction to Elavil or amitriptyline, it is possible. Symptoms of an allergic reaction to a medication typically include a swollen face, tongue, or throat, itching, dizziness, or trouble breathing. 

Coping With the Side Effects of Elavil 

While the more common side effects of this medication are not deadly, they can be bothersome. While using this medication, there are some safe ways to cope with the common side effects. For instance, if you are constantly constipated, you should increase your fiber intake and drink a lot of water.

People who experience dry mouth could also increase their water intake or chew on some ice chips for relief. 

If you experience headaches while taking amitriptyline, it’s safe to take over-the-counter pain medications like acetaminophen (e.g., Tylenol). But, if the headaches persist or increase in severity, you should speak to your doctor about them. 

Elavil has sedative effects and could cause you to become a little dizzy or drowsy. So, it’s advisable to take this medication in the evening and avoid driving or operating any heavy machinery after taking this medication.

Elavil Dosages

The dosage your doctor prescribes can vary depending on your needs, what it is treating, and the strength of the medication.

Teens and older adults are prescribed lower dosages, which are usually taken in 10 mg doses three times a day with a 20 mg dose taken at bedtime.

Dosages for the treatment of other health conditions can vary. For example, the dosage used to treat sleeping problems often ranges from between 10 and 50 mg per day. 

If you miss a dose of your medication, take it as soon as you remember. However, if it is close to the time for your next dose, simply skip your missed dose. Never take two doses at once to make up for missing a dose.

Warnings and Interactions 

Before prescribing amitriptyline, a doctor will take a thorough look into your medical history and find out if you are taking any other medications.

Let's take a look at some of the drugs that can interfere with Elavil and discuss who should not take Elavil.

Drugs That May Interfere With Elavil

Here are some drugs or substances that may negatively impact the efficacy of Elavil.

MAOIs

People who are already taking monoamine oxidase inhibitors (MAOIs) or have just recently stopped using MAOIs are typically not prescribed Elavil. This is because it can cause very high fevers, convulsions, and death in the most extreme cases. There’s some evidence to suggest that when Elavil is used with epinephrine, it could cause high blood pressure.

Alcohol

Like with most medications, you shouldn’t consume alcohol when using Elavil. Alcohol could heighten its sedative effects and cause the medicine to be ineffective in treating symptoms of depression.

Who Should Not Take Elavil

Here are some populations that Elavil is not recommended for.

People With Heart Problems

One of the more uncommon side effects of using Elavil is an irregular heartbeat. This is why people with heart problems might be discouraged from taking this medication. In severe cases, Elavil has been linked to a condition called QT prolongation, which could cause seizures, fainting, and in fatal cases, death. 

Younger People

Research has linked the use of antidepressants to an increased risk of suicidal thoughts and ideation, particularly in young people under the age of 25. If you or someone you know who’s on this medication notice any changes in mood or behavior, it’s crucial to speak to a doctor about it immediately.

Other Populations

In almost no scenario should Elavil ever be prescribed to the following people: 

• People with liver or kidney conditions 
• Pregnant people or people who are breastfeeding 
• People with epilepsy or any disease which causes seizures 
• People with glaucoma 
• People who have allergic reactions to tricyclic antidepressants 
• People with certain heart conditions like angina, for instance 
• People who are already taking another type of antidepressant 

Alternatives to Elavil

Today, tricyclic antidepressants like Elavil are typically not the first option for doctors when prescribing antidepressants to people living with depression.

Selective serotonin reuptake inhibitors (SSRIs) like Prozac, Celexa, and Cipramil, and serotonin-norepinephrine reuptake inhibitors (SNRIs) like Cymbalta, Effexor, and Fetzima are typically tried first. Research shows that they tend to have fewer side effects than tricyclic antidepressants.

Other Treatments for Depression

In addition to medication, doctors and mental health professionals may also recommend psychotherapy and lifestyle modifications for the treatment of depression. Some that may help include:

Psychotherapy

• Cognitive behavioral therapy (CBT): CBT is an approach that helps people identify and change the underlying negative thought patterns that contribute to the onset and maintenance of depression. Research has shown that CBT can be as effective as antidepressant medication in the treatment of depression. One study also found that online, telephone, group, and self-guided CBT can also be effective alternatives to individual, in-person treatment.
• Interpersonal therapy: This form of therapy focuses on helping people strengthen their relationships by improving communication and conflict-resolution skills. The idea behind this is that social relationships can play a role in alleviating depression symptoms.

Self-Help Strategies

• Lifestyle changes: Research suggests that lifestyle factors can play a part in causing depression. Strategies such as getting regular exercise, improving sleep, and following a balanced diet may help reduce symptoms of the condition.
• Social support: Feeling supported can play an important part in finding relief from depression symptoms. In addition to leaning on friends and family members, talking to a therapist, clergy member, or members of a depression support group can also be helpful.