Amitriptyline for pain and migraine

Amitriptyline is a medicine used for treating pain. You can take it:

• to treat nerve pain (neuralgia) and pain that lasts a long time
• to help prevent migraines

Amitriptyline is only available on prescription. It comes as tablets and as a liquid that you swallow.

Amitriptyline is also used to treat depression. The doses used to treat pain are lower than the doses for depression. Taking amitriptyline for pain will not have the same effect as taking it for depression.

Most adults aged 18 years old and over can take amitriptyline. Children aged 2 years old and over can take it for some types of nerve pain.

Amitriptyline is not suitable for some people. To make sure it's safe for you, tell your doctor if you:

• have ever had an allergic reaction to amitriptyline or any other medicine
• have a heart problem – amitriptyline can make some heart problems worse
• have liver or kidney problems
• have epilepsy – amitriptyline can increase seizures or fits
• have ever taken any medicines for depression – some antidepressants can affect the way amitriptyline works
• are pregnant, trying to get pregnant, or breastfeeding
• have an eye condition called glaucoma – amitriptyline can increase the pressure in your eye
• have thoughts about harming yourself or ending your life
• have type 1 or type 2 diabetes

Amitriptyline may affect your blood sugar levels. If you have diabetes and you usually test your blood sugar levels, you may have to do this more often for the first few weeks of treatment. Talk to your diabetes doctor if your blood sugar goes too high or low.

Amitriptyline comes in 3 different strengths. It comes as:

• tablets containing 10mg, 25mg or 50mg
• liquid containing 10mg, 25mg or 50mg in a 5ml spoonful

The usual starting dose for adults and children aged 12 to 17 years old is 10mg a day. Your doctor can increase this dose if you need better pain relief.

The starting dose for children aged 11 years old and under depends on their weight and symptoms. The doctor will tell you how much to give them.

The maximum dose of amitriptyline for treating pain is 75mg a day. Your doctor may give you a higher dose if you're taking it to prevent migraine.

You'll usually take amitriptyline once a day. It's best to take it before you go to bed because it can make you sleepy. If you still feel drowsy in the morning you could try taking it earlier in the evening.

Amitriptyline does not usually upset your stomach. You can take it with or without food.

Swallow the tablets whole with a drink of water. If you chew them they taste bitter.

The liquid amitriptyline will come with a plastic syringe or spoon to help you measure out the right dose. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

Once you're feeling better, you'll probably continue to take amitriptyline for as long as it's working for you as a painkiller or to help prevent migraines.

Some people take it for many months and even for years but it should be reviewed regularly with your doctor.

If you forget a dose of amitriptyline, take it as soon as you remember, unless it's nearly time for your next dose. In this case, skip the missed dose and take your next dose at the usual time.

Never take 2 doses at the same time. Never have an extra dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

Taking too much amitriptyline can cause serious side effects such as a change in your heartbeat, seizures or fits.

• you take more than your prescribed dose of amitriptyline

Go to 111 online or call 111 . Call 111 if you're asking about a child under 5 years old.

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the amitriptyline packet or leaflet inside it, any remaining medicine, and any other medicines you take.

You may get extra side effects when you stop taking amitriptyline. This is more likely if you stop taking it suddenly.

You may get flu-like symptoms like feeling sick, muscle pain and feeling tired or restless.

To help prevent these side effects, your doctor will probably recommend reducing your dose gradually over several weeks, or longer if you've been taking amitriptyline for a long time.

Do not stop taking amitriptyline suddenly without talking to your doctor.

Doses of amitriptyline for pain are lower than the doses for depression. This means the common side effects tend to be milder and go away within a few days.

Some of the common side effects of amitriptyline gradually improve as your body gets used to the medicine.

These common side effects of amitriptyline happen in more than 1 in 100 people. There are things you can do to help cope with them:

Get more fibre into your diet such as fresh fruit, vegetables and cereals, and drink plenty of water. Try to exercise more regularly, for example, by going for a daily walk or run. If this does not help, talk to your pharmacist or doctor.

This is probably due to low blood pressure. Amitriptyline can reduce your blood pressure when you stand up.

Drink plenty of water or other non-alcoholic drinks. Do not stand up too quickly after you've been sitting or lying down. Do not drive, cycle or use tools or machines if you feel dizzy.

Chew sugar-free gum or suck sugar-free sweets.

Take amitriptyline in the evening. Do not drink too much alcohol. Do not drive, cycle or use tools or machinery if you feel sleepy or tired.

Relax when you try to pee. Do not try to force the flow of pee. If you cannot pee, try again a short time later.

Talk to your doctor urgently if you cannot pee at all.

Make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Try taking paracetamol or ibuprofen if you need pain relief.

Talk to your doctor if the headaches do not go away or are severe.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

It happens rarely, but some people have a serious side effect after taking amitriptyline.

Call a doctor or call 111 now if:

• you get a fast or irregular heartbeat
• the whites of your eyes turn yellow, or your skin turns yellow, although this may be less obvious on brown or black skin – these can be signs of a liver problem
• you have a headache, you feel confused or weak, or you get muscle cramps – these can be signs of a low sodium level in your blood
• you have eye pain, a change in your eyesight, or swelling or redness in or around your eye

• you have weakness on one side of your body, trouble speaking or thinking, loss of balance or blurred eyesight – these can be signs of a stroke
• you have a seizure or fit
• you get severe chest pain – this can be a sign of a heart attack

Do not drive yourself to A&E.

The person you speak to at 999 will give you advice about what to do.

• you have thoughts about harming yourself or ending your life

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to amitriptyline.

Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
• your throat feels tight or you're struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of amitriptyline. For a full list see the leaflet inside your medicine packet.

Amitriptyline can be taken during pregnancy and is not thought to be harmful to your baby.

Although amitriptyline is safe to use, paracetamol is usually the first choice of painkiller during pregnancy. However, amitriptyline may be recommended if other painkillers, like paracetamol or codeine, are not effective in treating your condition.

Speak to your doctor or specialist about taking amitriptyline during pregnancy. They can discuss with you the benefits and risks and help you to choose the best treatment for you and your baby.

If your doctor or health visitor says your baby is healthy, you can take amitriptyline while breastfeeding.

Although other medicines might be preferred for pain and migraine while you're breastfeeding, it's important you take the medicine that works for you. Talk to your doctor or pharmacist to help you decide.

Amitriptyline passes into breast milk in very small amounts and has only been linked with side effects in very few breastfed babies.

It's important not to share a bed with your baby while you're taking amitriptyline.

Talk to your health visitor, midwife, pharmacist or doctor as soon as possible if you have any concerns, including if your baby:

• is not feeding as well as usual or putting on weight as you would expect
• seems unusually sleepy
• seems restless or irritable
• is constipated
• is not peeing as much (not producing as many wet nappies)

There's no evidence that amitriptyline affects fertility in either men or women.

Tell your doctor if you're:

• trying to get pregnant
• pregnant
• breastfeeding

Many medicines and amitriptyline can affect each other and increase the chances of side effects.

Always check with your doctor or a pharmacist before starting any new medicine while you're taking amitriptyline.

Taking opioid-based medicines, like codeine, morphine or oxycodone, together with amitriptyline can increase your risk of becoming very drowsy and having breathing problems.

Tell your doctor if you've ever taken any medicines for depression. Some antidepressants can affect the way amitriptyline works and can cause very high blood pressure. This can happen even after you stop taking them.

Do not take St John's wort, a herbal remedy often taken for depression, while you're taking amitriptyline. It will increase your risk of side effects.

There's not enough information to say that other complementary medicines and herbal remedies are safe to take with amitriptyline. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.